Near infrared spectroscopy for rapid determination of Mankin score components : a potential tool for quantitative characterization of articular cartilage at surgery

PURPOSE The purpose of this study was to demonstrate the potential of near infrared (NIR) spectroscopy for characterizing the health and degenerative state of articular cartilage based on the components of the Mankin score. METHODS Three models of osteoarthritic degeneration induced in laboratory rats by anterior cruciate ligament (ACL) transection, meniscectomy (MSX), and intra-articular injection of monoiodoacetate (1 mg) (MIA) were used in this study. Degeneration was induced in the right knee joint; each model group consisted of 12 rats (N = 36). After 8 weeks, the animals were euthanized and knee joints were collected. A custom-made diffuse reflectance NIR probe of 5-mm diameter was placed on the tibial and femoral surfaces, and spectral data were acquired from each specimen in the wave number range of 4,000 to 12,500 cm(-1). After spectral data acquisition, the specimens were fixed and safranin O staining (SOS) was performed to assess disease severity based on the Mankin scoring system. Using multivariate statistical analysis, with spectral preprocessing and wavelength selection technique, the spectral data were then correlated to the structural integrity (SI), cellularity (CEL), and matrix staining (SOS) components of the Mankin score for all the samples tested. RESULTS ACL models showed mild cartilage degeneration, MSX models had moderate degeneration, and MIA models showed severe cartilage degenerative changes both morphologically and histologically. Our results reveal significant linear correlations between the NIR absorption spectra and SI (R(2) = 94.78%), CEL (R(2) = 88.03%), and SOS (R(2) = 96.39%) parameters of all samples in the models. In addition, clustering of the samples according to their level of degeneration, with respect to the Mankin components, was also observed. CONCLUSIONS NIR spectroscopic probing of articular cartilage can potentially provide critical information about the health of articular cartilage matrix in early and advanced stages of osteoarthritis (OA). CLINICAL RELEVANCE This rapid nondestructive method can facilitate clinical appraisal of articular cartilage integrity during arthroscopic surgery.

A critical realist perspective of Enterprise Architecture evolution : conditioning and outcomes

This paper investigates how Enterprise Architecture (EA) evolves due to emerging trends. It specifically explores how EA integrates the Service-oriented Architecture (SOA). Archer’s Morphogenetic theory is used as an analytical approach to distinguish the architectural conditions under which SOA is introduced, to study the relationships between these conditions and SOA introduction, and to reflect on EA evolution (elaborations) that then take place. The paper focuses on reasons for why EA evolution could take place, or not and what architectural changes could happen due to SOA integration. The research builds on sound theoretical foundations to discuss EA evolution in a field that often lacks a solid theoretical groundwork. Specifically, it proposes that critical realism, using the morphogenetic theory, can provide a useful theoretical foundation to study enterprise architecture (EA) evolution. The initial results of a literature review (a-priori model) were extended using explorative interviews. The findings of this study are threefold. First, there are five different levels of EA-SOA integration outcomes. Second, a mature EA, flexible and well-defined EA framework and comprehensive objectives of EA improve the integration outcomes. Third, the analytical separation using Archer’s theory is helpful in order to understand how these different integration outcomes are generated.

Navigating theory, negotiating difference and beating the system : a critical how-to of media assistance evaluation

The wave of democratisation across Europe, Africa, Asia and Latin America in the early 1990s triggered an increase in donor funding to media assistance initiatives, primarily within good governance policy frameworks. However, few media assistance projects have managed to effectively evaluate the impacts of their work. This thesis explores how the impacts of Australian media assistance on social change and governance can be most effectively evaluated and understood. The findings of this research suggest the importance of early investment in participatory planning of evaluation designs, which are then periodically revisited. These evaluation designs should be based on a theoretically sound link between models of change, evaluative questions and methods.

Critical factors for waste management in office building retrofit projects in Australia

Office building retrofit is a sector being highlighted in Australia because of the mature office building market characterised by a large proportion of ageing properties. The increasing number of office building retrofit projects strengthens the need for waste management. Retrofit projects possess unique characteristics in comparison to traditional demolition and new builds such as partial operation of buildings, constrained site spaces and limited access to as-build information. Waste management activities in retrofit projects can be influenced by issues that are different from traditional construction and demolition projects. However, previous research on building retrofit projects has not provided an understanding of the critical issues affecting waste management. This research identifies the critical factors which influence the management of waste in office building retrofit projects through a literature study and a questionnaire survey to industry practitioners. Statistical analysis on a range of potential waste issues reveals the critical factors, as agreed upon by survey respondents in consideration of their different professional responsibilities and work natures. The factors are grouped into five dimensions, comprising industry culture, organisational support and incentive, existing building information, design, and project delivery process. The discussions of the dimensions indicate that the waste management factors of office building retrofit projects are further intensified compared to those for general demolition and construction because retrofit projects involve existing buildings which are partially operating with constrained work space and limited building information. Recommendations for improving waste management in office building retrofit projects are generalised such as waste planning, auditing and assessment in the planning and designing stage, collaboration and coordination of various stakeholders and different specialists, optimised building surveying and BIM technologies for waste analysis, and new design strategies for waste prevention.

Transnational preservice teachers in local education programs : a critical realist approach to narratives

This study explores how preservice teachers with non-Australian educational backgrounds and prerequisite qualifications make their way into and through a local teacher education program. It is informed by Margaret Archer's sociology of reflexivity to understand the interplay between these people's personal resources and institutional constraints and enablements. Data were collected from seven participants through narrative interviews. A narrative analysis identified big and small stories. Findings show that these preservice teachers purposefully exercise their agency as they invest in a common project for a variety of transnational goals. The outcome of that project emerges from the interaction between structure and agency.

Nursing casualisation and communication : a critical ethnography

Aim The aim was to explore the relationship between nursing casualization and the culture of communication for nurses in a healthcare facility. Background Casualization, or non-standard work, is the use of temporary, contract, part-time and casual labour. An increase in casual labour has been part of a global shift in work organization aimed at creating a more flexible and cheaper workforce. It has been argued that flexibility of labour has enabled nurses to manage both non-work related needs and an increasingly complex work environment. Yet no research has explored casualization and how it impacts on the communication culture for nurses in a healthcare facility. Design Critical ethnography. Methods Methods included observation, field notes, formal interviews and focus groups. Data collection was undertaken over the 2 years 2008–2009. Results The concepts of knowing and belonging were perceived as important to nursing teamwork and yet the traditional time/task work model, designed for a full-time workforce, marginalized non-standard workers. The combination of medical dominance and traditional stereotyping of the nurse and work as full-time shaped the behaviours of nurses and situated casual workers on the periphery. The overall finding was that entrenched systemic structures and processes shaped the physical and cultural dimensions of a contemporary work environment and contributed to an ineffective communication culture. Conclusion Flexible work is an important feature of contemporary nursing. Traditional work models and nurse attitudes and practices have not progressed and are discordant with a contemporary approach to nursing labour management.

Critical reflection

Critical reflection is a necessary component of professionalism in early childhood education. Evidence of critical reflection within a service draws attention to the intellectual work of early childhood educators and highlights professional capacities beyond the care of young children.

Barbara's story : a thematic analysis of a relative's reflection of being in the intensive care unit

Aim The aim of this reflective account is to provide a view of the intensive care unit (ICU) relative’s experiences of supporting and being supported in the ICU. Background Understanding the relatives’ experiences of ICU is important especially because a recent work has identified the potential for this group to develop post-traumatic stress disorder, a condition that is normally equated with the ICU survivor. Design A thematic analysis was used in identifying emerging themes that would be significant in an ICU nursing context. Setting The incident took place in two 8-bedded ICUs (Private and National Health Service) in October. Results Two emergent themes were identified from the reflective story – fear of the technological environment and feeling hopeless and helpless. Conclusion The use of relative stories as an insight into the live experiences of ICU relatives may give a deeper understanding of their life-world. The loneliness, anguish and pain of the ICU relative extends beyond the walls of the ICU, and this is often negated as the focus of the ICU team is the patient. Relevance to clinical practice: Developing strategies to support relatives might include the use of relative diaries used concurrently with patient diaries to support this groups recovery or at the very least a gaining a sense of understanding for their ICU experience. Relative follow-up clinics designed specifically to meet their needs where support and advice can be given by the ICU team, in addition to making timely and appropriate referrals to counselling services and perhaps involving spiritual leaders where appropriate.

Alarm setting for the critically ill patient : A descriptive pilot survey of nurses’ perceptions of current practice in an Australian Regional Critical Care Unit

Aim: The aim of this survey was to assess registered nurse’s perceptions of alarm setting and management in an Australian Regional Critical Care Unit. Background: The setting and management of alarms within the critical care environment is one of the key responsibilities of the nurse in this area. However, with up to 99% of alarms potentially being false-positives it is easy for the nurse to become desensitised or fatigued by incessant alarms; in some cases up to 400 per patient per day. Inadvertently ignoring, silencing or disabling alarms can have deleterious implications for the patient and nurse. Method: A total population sample of 48 nursing staff from a 13 bedded ICU/HDU/CCU within regional Australia were asked to participate. A 10 item open-ended and multiple choice questionnaire was distributed to determine their perceptions and attitudes of alarm setting and management within this clinical area. Results: Two key themes were identified from the open-ended questions: attitudes towards inappropriate alarm settings and annoyance at delayed responses to alarms. A significant number of respondents (93%) agreed that alarm fatigue can result in alarm desensitisation and the disabling of alarms, whilst 81% suggested the key factors are those associated with false-positive alarms and inappropriately set alarms.

Conceptualisation and enactment of critical literacy for senior high school EAL learners in Queensland, Australia : commitments, constraints and contradictions

This case study examined four teachers' understandings and teaching of Critical Literacy with senior English as an Additional Language (EAL) learners in two Queensland high schools. Despite continuous, rapid curriculum change in Australia and efforts to diminish Critical Literacy, the four teachers continued to feature it successfully in their teaching with often marginalised learners. They used critical literacy to provide access to and critique dominant language codes, and to draw on learners' diverse experiences. To a lesser extent, the teachers created opportunities for redesigning dominant texts. Implications are important for policy production and interpretation, school planning and teacher professional development.

A critical evaluation of written discharge advice for people with mild traumatic brain injury : what should we be looking for?

Objective: To formally evaluate the written discharge advice for people with mild traumatic brain injury (mTBI). Methods: Eleven publications met the inclusion criteria: (1) intended for adults; (2) ≤two A4 pages; (3) published in English; (4) freely accessible; and (5) currently used (or suitable for use) in Australian hospital emergency departments or similar settings. Two independent raters evaluated the content and style of each publication against established standards. The readability of the publication, the diagnostic term(s) contained in it and a modified Patient Literature Usefulness Index (mPLUI) were also evaluated. Results: The mean content score was 19.18 ± 8.53 (maximum = 31) and the mean style score was 6.8 ± 1.34 (maximum = 8). The mean Flesch-Kincaid reading ease score was 66.42 ± 4.3. The mean mPLUI score was 65.86 ± 14.97 (maximum = 100). Higher scores on these metrics indicate more desirable properties. Over 80% of the publications used mixed diagnostic terminology. One publication scored optimally on two of the four metrics and highly on the others. Discussion: The content, style, readability and usefulness of written mTBI discharge advice was highly variable. The provision of written information to patients with mTBI is advised, but this variability in materials highlights the need for evaluation before distribution. Areas are identified to guide the improvement of written mTBI discharge advice.

The role of human factors in led outdoor activity accidents: literature review and exploratory analysis

While the exact rate of incidence is unknown (due to the paucity of exposure data), it is acknowledged that safety compromising accidents and incidents occur in the led outdoor activity domain, and that they represent an important issue. Despite this, compared to other safety critical domains, very little is currently known about the key causal factors involved in such accidents and incidents. This report presents the findings derived from a review of the literature, the aim of which was to identify the Human Factors-related issues involved in accidents and incidents occurring in this area. In addition, to demonstrate the utility of systems-based, theoretically underpinned accident analysis methodologies for identifying the systemic and human contribution to accidents and incidents occurring in the led outdoor activity domain, three case-study accidents were analysed using two such approaches. In conclusion, the review identified a range of causal factors cited in the literature; however, it was noted that the majority of the research undertaken to date lacks theoretical underpinning and focuses mainly on instructor or activity leader causal factors, as opposed to the wider system failures involved. The accident analysis presented highlighted the utility of systems-based, theoretically underpinned accident analysis methodologies for analysing and learning from accidents and incidents in the led outdoor activity sector. In closing, the need for further research in the area is articulated, in particular focussing on the development of standardised and universally accepted accident and incident reporting systems and databases, the development of data driven, theoretically underpinned causal factor taxonomies, and the development and application of systems-based accident analysis methodologies.