Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

Visual perception of movement kinematics and the acquisition of "action prototypes"

Recognizing a class of movements as belonging to a "nominal" action category, such as walking, running, or throwing, is a fundamental human ability. Three experiments were undertaken to test the hypothesis that common ("prototypical") features of moving displays could be learned by observation. Participants viewed moving stick-figure displays resembling forearm flexion movements in the saggital plane. Four displays (presentation displays) were first presented in which one or more movement dimensions were combined with 2 respective cues: direction (up, down), speed (fast, slow), and extent (long, short). Eight test displays were then shown, and the observer indicated whether each test display was like or unlike those previously seen. The results showed that without corrective feedback, a single cue (e.g., up or down) could be correctly recognized, on average, with the proportion correct between .66 and .87. When two cues were manipulated (e.g., up and slow), recognition accuracy remained high, ranging between .72 and .89. Three-cue displays were also easily identified. These results provide the first empirical demonstration of action-prototype learning for categories of human action and show how apparently complex kinematic patterns can be categorized in terms of common features or cues. It was also shown that probability of correct recognition of kinematic properties was reduced when the set of 4 presentation displays were more variable with respect to their shared kinematic property, such as speed or amplitude. Finally, while not conclusive, the results (from 2 of the 3 experiments) did suggest that similarity (or "likeness") with respect to a common kinematic property (or properties) is more easily recognized than dissimilarity.

Lipid and fatty acid digestibility of three oil types in the Australian shortfin eel, Anguilla australis

The lipid and fatty acid digestibilities of three semi-purified, isonitrogenous (48.9–50.8% protein) and isocalorific (19.1–20.8 kJ g⁻¹) diets, in which the lipid source was either cod liver oil (CLO), linseed oil (LO) or sunflower oil (SFO), were estimated in the Australian shortfin eel (Anguilla australis) using chromic oxide as an external marker. Apparent percent protein and energy digestibilities of the diets were not significantly (P>0.05) affected by the lipid source, but the lipid digestibility was. The percent apparent lipid digestibility was lowest in the LO diet (90.2±0.6) and highest in the CLO diet (95.6±0.2).

Not all the fatty acids present in any one diet were recovered in the faecal samples. In diets with CLO, only three saturates (out of five), five monoenes and six (out of 11) PUFAs were detected in faecal samples. With all the diets, 20:0 and 22:0, and none of the n−6 HUFA were detected in the faecal samples. The digestibility of all the fatty acids, except 18:3n−3, was lowest in the diet with LO, and significantly so (P>0.05) from the other diets.

In shortfin eel, there was a trend for the digestibility of saturated fatty acids of diets with the animal oil as the lipid source to decrease with increasing chain length, and in diets with vegetable oil to increase initially and then decrease. A somewhat comparable trend was also evident in respect of monoenes.

When the digestibility of different categories of fatty acids is considered, the digestibility of saturates, monoenes, unsaturates, n−6, PUFA, HUFA and total fatty acid digestibilities of LO diet were the lowest, and differed significantly (P<0.05) from those of the CLO and SFO diets, except in the case of n−3 fatty acids.

The roles of static depth information and object-image relative motion in perception of heading

In a series of 6 experiments, two hypotheses were tested: that nominal heading perception is determined by the relative motion of images of objects positioned at different depths (R. F. Wang & J. E. Cutting 1999) and that static depth information contributes to this determination. By manipulating static depth information while holding retinal-image motion constant during  simulated self-movement, the authors found that static depth information played a role in determining perceived heading. Some support was also found for the involvement of R. F. Wang and J. E. Cutting’s (1999) categories of object-image relative motion in determining perceived heading. However, results suggested an unexpected functional dominance of information about heading relative to apparently near objects.

Intensive care nurses' perceptions of brain death

Research during the last 2 decades has revealed significant confusion or lack of acceptance and inconsistent application of the brain death concept within the medical and nursing professions. The aim of this naturalistic and descriptive study was to investigate the extent to which a sample of 40 Australian intensive care nurses regarded brain death as a meaningful conception of death. In contrast with the majority of the literature pertaining to health care professionals' perceptions of brain death which has focused upon clinical knowledge, the study elicited the expression of personal beliefs. The study utilised a structured interview method with nurses from seven metropolitan intensive care units (ICUs). Transcript analysis revealed five categories of perception constituting a spectrum ranging from complete acceptance to complete rejection, with almost half (48%, n=19) the sample regarding the brain dead patient as less than completely meaningfully dead.

Rather than supporting the literature's suggestion that non-acceptance of the medico-legally recognised brain death notion is, necessarily, evidence of professional ignorance, the findings suggest the participants holding these perceptions were generally well-informed about brain stem function and brain death diagnosis. The study affirms the importance of supportive workplace environments which facilitate the expression of dissonant perceptions and proposes that educators and managers must acknowledge these dissonances.

The role of management consultation, support, and coping on nurses` health during the stress of restructuring

This study examined the impact of hospital restructuring moves on a sample of Australian nurses' health. The role of organizational support, assessed via levels of consultation with staff, social support, and nurses coping were examined as further contributors or mediators of the relationship between the impact of restructuring and nurses' health. Data from 201 hospital nurses indicated that the factors in the model explained 41% of the variance in nurses' health. “Top-down” communication style by management contributed negatively to nurses' health and increased their perceptions of the impact of restructuring. Support from peers, supervisors, and family together with seeing the demands of impact of restructuring as a challenge, contributed positively to nurses' health and reduced the level of avoidance strategies used. The implications of these findings are discussed.

Unpacking the issues : researching the shortage of school principals in two states in Australia

An investigation into the declining supply of principals in two states in Australia revealed that a mosaic of issues surrounds the overall trend towards fewer applications for vacant positions. Looking beyond systemic factors influencing this trend – factors such as the increasing workload of principals – this study discovered why some schools are more affected by a shortage of applicants than others. It was found that one of four categories of deterrents was generally involved with declining numbers of applications: location, the size of school, the presence of an incumbent, or difficulties arising from local educational politics. It was also found that smaller numbers of applicants for vacant positions do not necessarily indicate a decline in interest in school leadership: interest in the principalship remains relatively high but principal aspirants have become increasingly strategic in their applications. Whilst drawing attention, in this paper, to the research finding that numerical interpretations of principal supply have serious limitations, the authors are keen to acknowledge, briefly, the research data that refers to (a) social and generational changes (b) demographic information, (c) teacher resistance to the modern principalship and how these data explain declining numbers. They also include information about recent changes that go counter to the trend.

Troubling identities: teacher education students` constructions of class and ethnicity

Working with diverse student populations productively depends on teachers and teacher educators recognizing and valuing difference. Too often, in teacher education programs, when markers of identity such as gender, ethnicity, 'race', or social class are examined, the focus is on developing student teachers' understandings of how these discourses shape learner identities and rarely on how these also shape teachers' identities. This article reports on a research project that explored how student teachers understand ethnicity and socio-economic status. In a preliminary stage of the research, we asked eight Year 3 teacher education students who had attended mainly Anglo-Australian, middle class schools as students and as student teachers, to explore their own ethnic and classed identities. The complexities of identity are foregrounded in both the assumptions we made in selecting particular students for the project and in the ways they constructed their own identities around ethnicity and social class. In this article we draw on these findings to interrogate how categories of identity are fluid, shifting and ongoing processes of negotiation, troubling and complex. We also consider the implications for teacher education.

`A bit of a chameleon act`: a case study of one teacher`s understandings of diversity

While for political, economic and social justice reasons, there is now an emphasis on ensuring that all children achieve educationally, including those whose ethnicity, 'race' or socio-economic status are different from the dominant culture, multiple and often contradictory discourses operate concerning how teachers should work with diversity. Within post-structural theories, 'race', socio-economic status, gender and ethnicity are theorised as fluid, dynamic and interconnected categories of identity. In this article, working with post-structuralist concepts including notions of 'discourse', 'subjectivities', and 'investments', I briefly review a number of discourses around identities and difference that play out within education, particularly in Australia, but with reference to research in North America, and the United Kingdom as well. I then draw on research data to present a case study of one teacher's perspective on diversity. Using his childhood experiences of being both an 'insider' and 'outsider' in mainstream culture, I speculate on how his subjectivities shape and are shaped by his professional identity and relations with students. I discuss his understanding of diversity and of socially just pedagogies in light of current discourses and consider some implications for how teacher education might develop richer, more complex understandings of diversity.

The dimensions of self-service technologies and the relation to 'self'

This paper assesses the “behavioural” notion of “self” across the various dimensions of self-service technologies (SSTs). In the context of SSTs, it is acknowledged that the customer role is extended to include that of “service employee”. Therefore, the authors propose the need to explore this new role, from the customer’s perspective, across a diverse range of SSTs. This proposition is supported in that prior research has looked generally across a broad range of SSTs, as opposed to drawing comparisons across the different types of SSTs. In bringing together two classification schemes of SSTs, which does not appear to have been done previously, the authors draw on past research and industry examples to explore the customer experience across different categories of SSTs. It is proposed that the dimensions of SSTs, including level of customer participation as influenced by the purpose of the SST, location of the SST, and type of technology employed, will uniquely influence the notion of “self”, and thus the customer’s SST experience. These propositions have implications for both future research and practice. Future research is needed to study empirically the characteristics of specific SSTs, and compare the many different types of SSTs, and how their unique characteristics influence the customer’s production/consumption experience. When marketers gain a better understanding of the dimensions of individual SSTs, and their influence on the customer, more effective management and use of SSTs will result.

Concept learning of text documents

Concept learning of text documents can be viewed as the problem of acquiring the definition of a general category of documents. To definite the category of a text document, the Conjunctive of keywords is usually be used. These keywords should be fewer and comprehensible. A naïve method is enumerating all combinations of keywords to extract suitable ones. However, because of the enormous number of keyword combinations, it is impossible to extract the most relevant keywords to describe the categories of documents by enumerating all possible combinations of keywords. Many heuristic methods are proposed, such as GA-base, immune based algorithm. In this work, we introduce pruning power technique and propose a robust enumeration-based concept learning algorithm. Experimental results show that the rules produce by our approach has more comprehensible and simplicity than by other methods.

Sources of productivity growth in Australian textile and clothing firms

This paper estimates the sources of productivity growth in Australian textile and clothing firms based on the Business Longitudinal Survey (BLS) from 1995 to 1998. Productivity growth estimates have been obtained for each sub-category of textile and clothing firms. Sources of growth in multifactor productivity (MFP) are examined with growth in technical efficiency and scale effects based on estimates of stochastic frontier production functions. Separate estimates of output growth have been compared with the productivity growth estimates for each of the product categories. MFP improved in all clothing firms and declined in textile firms over 1997–1998 by four-digit level of Australia New Zealand Standard Industrial classification Scheme (ANZSIC). MFP declined in most major categories of both textile and clothing firms in 1995–1997. Changes in technical efficiency mostly dominated scale effects in the overall direction of MFPG in both textile and clothing firms. The findings of the study provide evidence for policies for improving the firms' operative performance in the ongoing liberalised regime.

Where else have you been? The effects of diaspora consciousness and transcultural mixtures on ethnic identity

In social science research, the demographic categories of ethnicity are linked to what the census bureau considers as a person’s ethnic heritage. However, these categories are based on the societal assumption that members of a given category share the same characteristics and life experiences, even though the heterogeneity between members within a category may be as diverse as between categories. The paper examines the 15 interview subjects of a research study drawn from 10 minority migrant groups, where seven of them indicated significant transcultural experiences before migrating to Australia. It argues that their lived experiences and subjectivity vary from others who migrated directly from their native countries. The formers’ diaspora consciousness and transcultural mixtures may introduce an artifact to a research study’s design, affecting the validity of the data collected. The paper examines other situations where this anomaly can occur and proposes precautions
to minimize its negative effects.

Students perceptions of learning outcomes from group-based, problem-based teaching and learning activities

Objective: A study aimed at exploring the variation in perceptions of learning outcomes reported by undergraduate nursing students enrolled in a problem-based learning subject in a pre-registration Bachelor of Nursing course (BN).
Method: Students were asked to respond to four open-ended questions which focussed on their learning outcomes in the different teaching/learning modalities of the subject. Data were analysed in two phases using a modified phenomenographic analysis. In the first phase a set of categories of description were developed from the student responses to questions related to the learning modalities. In the second phase the individual responses were classified in terms of the categories. Finally, correlations between the learning modalities were identified. In this paper the approach to analysis, the process of category identification and the correlations between the learning modalities will be described and the implications for further research and teaching will be discussed.
Results: The findings indicated that there were two distinct groups of student responses. Inward focussed students who described outcomes in terms of their own learning and students whose focus was outward i.e. describing learning in terms of patient care and how learning relates to that care. Another important result shows the relationship between the learning modalities and outcomes. From the students' perspective, the most sophisticated outcomes of the lectures and laboratories were ideas and skills to be used and applied in clinical settings. Whereas, the group-based activities in which clinical problems were presented to the students in the form of Situation Improvement Packages (SIPS) focussed their attention on the clinical setting which constituted a preparation for the realities of clinical practice.
Conclusion: The findings from this study indicate that students perceive their learning in the group based teaching/learning modality (SIPS) as effective in focussing them on the reality of their role in the clinical practice environment while lectures and laboratories provided the skills and knowledge required for this setting.

Cost of stroke in Australia from a societal perspective: results from the north east Melbourne stroke incidence study (NEMESIS)

Background and Purpose—— Accurate information about resource use and costs of stroke is necessary for informed health service planning. The purpose of this study was to determine the patterns of resource use among stroke patients and to estimate the total costs (direct service use and indirect production losses) of stroke (excluding SAH) in Australia for 1997.

Methods—— An incidence-based cost-of-illness model was developed, incorporating data obtained from the North East Melbourne Stroke Incidence Study (NEMESIS). The costs of stroke during the first year after stroke and the present value of total lifetime costs of stroke were estimated.

Results—— The total first-year costs of all first-ever-in-a lifetime strokes (SAH excluded) that occurred in Australia during 1997 were estimated to be A$555 million (US$420 million), and the present value of lifetime costs was estimated to be A$1.3 billion (US$985 million). The average cost per case during the first 12 months and over a lifetime was A$18 956 (US$14 361) and A$44 428 (US$33 658), respectively. The most important categories of cost during the first year were acute hospitalization (A$154 million), inpatient rehabilitation (A$150 million), and nursing home care (A$63 million). The present value of lifetime indirect costs was estimated to be A$34 million.

Conclusions—— Similar to other studies, hospital and nursing home costs contributed most to the total cost of stroke (excluding SAH) in Australia. Inpatient rehabilitation accounts for {approx}27% of total first-year costs. Given the magnitude of these costs, investigation of the cost-effectiveness of rehabilitation services should become a priority in this community.