Should law have a role in end-of-life care?

What do physicians think of law? Do they know the law? What role does it have in the provision of end-of-life care? Physicians in New South Wales, Victoria and Queensland are being asked about these issues in a study by the Queensland University of Technology entitled ‘Withholding and withdrawing life-sustaining treatment from adults who lack capacity: The role of law in medical practice’. This research aims to examine the role that law plays in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity.

Low cost railway level crossings

The Cooperative Research Centre (CRC) for Rail Innovation is conducting a tranche of industry-led research projects looking into safer rail level crossings. This paper will provide an overview of the Affordable Level Crossings project, a project that is performing research in both engineering and human factors aspects of low-cost level crossing warning devices (LCLCWDs), and is facilitating a comparative trial of these devices over a period of 12 months in several jurisdictions. Low-cost level crossing warning devices (LCLCWDs) are characterised by the use of alternative technologies for high cost components including train detection and connectivity (e.g. radar, acoustic, magnetic induction train detection systems and wireless connectivity replacing traditional track circuits and wiring). These devices often make use of solar power where mains power is not available, and aim to make substantial savings in lifecycle costs. The project involves trialling low-cost level crossing warning devices in shadow-mode, where devices are installed without the road-user interface at a number of existing level crossing sites that are already equipped with conventional active warning systems. It may be possible that the deployment of lower-cost devices can provide a significantly larger safety benefit over the network than a deployment of expensive conventional devices, as the lower cost would allow more passive level crossing sites to be upgraded with the same capital investment. The project will investigate reliability and safety integrity issues of the low-cost devices, as well as evaluate lifecycle costs and investigate human factors issues related to warning reliability. This paper will focus on the requirements and safety issues of LCLCWDs, and will provide an overview of the Rail CRC projects.

Understanding the relationships between the calf muscle pump, ankle range of motion and healing for adults with venous leg ulcers: a review of the literature

Exercise offers the potential to improve circulation, wound healing outcomes, and functional and emotional wellbeing for adults experiencing venous leg ulceration. Individuals with chronic leg ulcers typically have multiple comorbidities such as arthritis, asthma, chronic obstructive airways disease, cardiac disease or neuromuscular disorders, which would also benefit from regular exercise. The aim of this review is to highlight the relationships between the calf muscle pump and venous return and range of ankle motion for adults with venous leg ulcers. The effect of exercise will also be considered in relation to the healing rates for adults experiencing venous leg ulceration. The findings suggest there is evidence that exercises which engage the calf muscle pump improve venous return. Ankle range of motion, which is crucial for complete activation of the calf muscle pump, can also be improved with simple, home-based exercise programs. However, observational studies still report that venous leg ulcer patients are less physically active than age-matched controls. Therefore, the behavioural reasons for not exercising must be considered. Only two studies, both underpowered, have assessed the effect of exercise on the healing rates of venous leg ulcers. In conclusion, exercise is feasible with this patient population. However, future studies with larger sample sizes are needed to provide stronger evidence to support the therapeutic benefit of exercise as an adjunct therapy in wound care.

Does the use of store-and-forward telehealth systems improve outcomes for clinicians managing diabetic foot ulcers? : A pilot study

Diabetic foot ulcers are one of the most hospitalised diabetes complications and contribute to many leg amputations. Trained diabetic foot teams and specialists managing diabetic foot ulcers have demonstrated reductions in amputations and hospitalisation by up to 90%. Few such teams exist in Australia. Thus, access is limited for all geographical populations and may somewhat explain the high rates of hospitalisation. Aim: This pilot study aims to analyse if local clinicians managing diabetic foot complications report improved access to diabetic foot specialists and outcomes with the introduction of a telehealth store-and-forward system. Method: A store-and-forward telehealth system was implemented in six different Queensland locations between August 2009 and February 2010. Sites were offered ad hoc and/or fortnightly telehealth access to a diabetic foot speciality service. A survey was sent six months following commencement of the trial to the 14 eligible clinicians involved in the trial to gauge clinical perception of the telehealth system. Results: Eight participants returned the surveys. The majority of responding clinicians reported that the telehealth system was easy to use (100%), improved their access to diabetic foot speciality services (75%), improved upskilling of local diabetes service staff (100%), and improved patient outcomes (100%). Conclusion: This pilot study suggests that clinicians found the use of a telehealth store-and-forward system very useful in improving access to speciality services, clinical skills and patient outcomes. This study supports the recommendation that telehealth systems should be made available for diabetic foot ulcer management.

Biochemical profiling of proteins and metabolites in wound exudate from chronic wound environments

The lack of fundamental knowledge on the biological processes associated with wound healing represents a significant challenge. Understanding the biochemical changes that occur within a chronic wound could provide insights into the wound environment and enable more effective wound management. We report on the stability of wound fluid samples under various conditions and describe a high-throughput approach to investigate the altered biochemical state within wound samples collected from various types of chronic, ulcerated wounds. Furthermore, we discuss the viability of this approach in the early stages of wound sample protein and metabolite profiling and subsequent biomarker discovery. This approach will facilitate the detection of factors that may correlate with wound severity and/or could be used to monitor the response to a particular treatment.

Strategies for the prevention of cervical cancer by human papillomavirus vaccination

As cervical cancer is causally associated with 14 high-risk types of human papillomavirus (HPV), a successful HPV vaccine will have a major impact on this disease. Although some persistent HPV infections progress to cervical cancer, host immunity is generally able to clear most HPV infections. Both cell-mediated and antibody responses have been implicated in influencing the susceptibility, persistence or clearance of genital HPV infection. There have been two clinical trials that show that vaccines based on virus-like particles (VLPs) made from the major capsid protein, L1, are able to type specifically protect against cervical intra-epithelial neoplasia and infection. However, there is no evidence that even a mixed VLP vaccine will protect against types not included in the vaccine, and a major challenge that remains is how to engineer protection across a broader spectrum of viruses. Strategies for production of HPV vaccines using different vaccine vectors and different production systems are also reviewed. © 2005 Elsevier Ltd. All rights reserved.

An exploration of the professional competencies required in engineering asset management

Engineering asset management (EAM) is a rapidly growing and developing field. However, efforts to select and develop engineers in this area are complicated by our lack of understanding of the full range of competencies required to perform. This exploratory study sought to clarify and categorise the professional competencies required of individuals at different hierarchical levels within EAM. Data from 14 interviews and 61 on-line survey participants has informed the development of an initial Professional Competency Framework. The nine competency categories indicate that Engineers working in this field need to be able to collaborate and influence others, complete objectives within organizational guidelines and be able to manage themselves effectively. Limitations and potential uses in practice and research for this framework are discussed.

Curriculum design and higher order skills : challenging assumptions

This paper is based on an Australian Learning & Teaching Council (ALTC) funded evaluation in 13 universities across Australia and New Zealand of the use of Engineers Without Borders (EWB) projects in first-year engineering courses. All of the partner institutions have implemented this innovation differently and comparison of these implementations affords us the opportunity to assemble "a body of carefully gathered data that provides evidence of which approaches work for which students in which learning environments". This study used a mixed-methods data collection approach and a realist analysis. Data was collected by program logic analysis with course co-ordinators, observation of classes, focus groups with students, exit survey of students and interviews with staff as well as scrutiny of relevant course and curriculum documents. Course designers and co-ordinators gave us a range of reasons for using the projects, most of which alluded to their presumed capacity to deliver experience in and learning of higher order thinking skills in areas such as sustainability, ethics, teamwork and communication. For some students, however, the nature of the projects decreased their interest in issues such as ethical development, sustainability and how to work in teams. We also found that the projects provoked different responses from students depending on the nature of the courses in which they were embedded (general introduction, design, communication, or problem-solving courses) and their mode of delivery (lecture, workshop or online).

The 7pm Project

The Making Connections: Innovations in Learning and Teaching Forum, jointly hosted by the Division of Technology, Information and Learning Support (TILS) and the Learning and Teaching Unit (LTU), was held on 20 June. The forum provided a snapshot of innovative practice across QUT, as well as an overview of services supporting innovation. Past events have attracted sizeable audiences and informal feedback has been very positive and encouraging. The objective of the forum is to give an opportunity to academic teaching staff to share their innovative practice with their peers, and it is planned that more events will be held to allow for further sharing of ideas. The program for the June 2012 forum included the following presentations: Ms Lindy Osborne: The 7pm Project Dr Ana Pavasovic: A multifaceted approach to teaching a first year unit Mr Paul Willis: Out of our comfort zone: How can Collaborate engage students in inclusive teaching practices Dr Kelly Zuniga: Can you draw what I see? Recasting the ‘crit’ to engage a larger classroom audience Dr Peter Bell, Dr Mark Lauchs, Amy Henderson and Edward Robinson: Crime Club: Lightbulb moments Dr Deboarh Peach: Improving student engagement through the integration of blended delivery approaches in WIL. Lindy Osborne Biography: As an early career academic, Lindy Osborne draws upon professional experience as a registered architect to offer students pioneering curricula that are firmly grounded in real-world practice. Since commencing her academic career in 2008, she has purposefully reconceptualised the delivery of Architectural Design, Technology, Professional Practice and Research subjects, using innovative digital technology and empowering students to direct their own learning. Lindy is cognisant of the impact that the physical learning environment has on students, and seeks to actively modify it to support students by enabling powerful enactive learning. Using technology embedded flexible learning spaces and innovative simulated office practice pedagogy,students actively learn in an authentic environment, redressing the structural and cyclical factors that have resulted in a lack of workplace learning opportunities. Lindy’s creative integration of interdisciplinary opportunities, popular culture, social media and Web-2.0 technologies connects with students on their level, while they develop critical professional skills both inside and perhaps more importantly outside, the formal classroom environment.

Nutritional support and functional capacity in chronic obstructive pulmonary disease: A systematic review and meta-analysis

Currently there is confusion about the value of using nutritional support to treat malnutrition and improve functional outcomes in chronic obstructive pulmonary disease (COPD). This systematic review and meta-analysis of randomised controlled trials (RCTs) aimed to clarify the effectiveness of nutritional support in improving functional outcomes in COPD. A systematic review identified 12 RCTs (n = 448) in stable COPD patients investigating the effects of nutritional support [dietary advice (1 RCT), oral nutritional supplements (ONS; 10 RCTs), enteral tube feeding (1 RCT)] versus control on functional outcomes. Meta-analysis of the changes induced by intervention found that whilst respiratory function (FEV(1,) lung capacity, blood gases) was unresponsive to nutritional support, both inspiratory and expiratory muscle strength (PI max +3.86 SE 1.89 cm H(2) O, P = 0.041; PE max +11.85 SE 5.54 cm H(2) O, P = 0.032) and handgrip strength (+1.35 SE 0.69 kg, P = 0.05) were significantly improved, and associated with weight gains of ≥ 2 kg. Nutritional support produced significant improvements in quality of life in some trials, although meta-analysis was not possible. It also led to improved exercise performance and enhancement of exercise rehabilitation programmes. This systematic review and meta-analysis demonstrates that nutritional support in COPD results in significant improvements in a number of clinically relevant functional outcomes, complementing a previous review showing improvements in nutritional intake and weight.

Compounding practices in Queensland : experiences and perceptions of pharmacists and pharmacy students

Background: Changes in the roles of the contemporary pharmacist has seen a decline in the number and variety of extemporaneously compounded dosage forms. Pharmacy curricula reflect this change with a reduction in the emphasis on extemporaneous compounding practice. Aim: To elicit information about extemporaneously compounded dosage forms and perceptions of compounding practice from pharmacists and pharmacy students. Method: Self-administered surveys were mailed to 1063 pharmacists and offered online to 896 pharmacy undergraduates across the 4 years of a Bachelor of Pharmacy program in Queensland. Results: 382 (36%) pharmacists and 455 (51%) students completed the survey. Most pharmacists (96%) reported compounding a product in the 12 months prior to the survey, particularly semi-solids (89%) and liquids (64%) for external use. Most pharmacies (> 96%) owned basic compounding equipment, such as a slab and spatula, mortar and pestle, and cylindrical/conical measures. Half of the pharmacies used mechanical rather than electronic balances. Students expressed greater confidence in their ability to use basic compounding equipment and to perform basic compounding tasks as they progressed through the 4-year degree course. Pharmacists’ views on students’ ability to compound basic products at the end of their degree were generally similar to the proportion of final-year students who reported they could confidently complete the task. Conclusion: Despite a decline in extemporaneously compounded products in community pharmacy, pharmacy graduates need to be competent in compounding techniques.

Pieces of a city : the art of making speculative cities, bodies, & texts

This practice-led doctorate involved the development of a collection – a bricolage – of interwoven fragments of literary texts and visual imagery explor-ing questions of speculative fiction, urban space and embodiment. As a sup-plement to the creative work, I also developed an exegesis, using a combina-tion of theoretical and contextual analysis combined with critical reflections on my creative process and outputs. An emphasis on issues of creative practice and a sustained investigation into an aesthetics of fragmentation and assem-blage is organised around the concept and methodology of bricolage, the eve-ryday art of ‘making do’. The exegesis also addresses my interest in the city and urban forms of subjectivity and embodiment through the use of a range of theorists, including Michel de Certeau and Elizabeth Grosz.

Land use planning and the airport metropolis

Australian airports have emerged as important urban activity centres over the past decade as a result of privatisation. A range of reciprocal airport and regional impacts now pose considerable challenges for both airport operation and the surrounding urban and regional environment. The airport can no longer be managed solely as a specialised transport entity in isolation from the metropolis that it serves. In 2007 a multidisciplinary Australian Research Council Linkage Project (LP 0775225) was funded to investigate the changing role of airports in Australia. This thesis is but one component of this collaborative research effort. Here the issues surrounding the policy and practice of airport and regional land use planning are explored, analysed and detailed. This research, for the first time, assembles a distinct progression of the wider social, economic, technological and environmental roles of the airport within the Australian airport literature from 1914 – 2011. It recognises that while the list of airport and regional impacts has grown through time, treatment within practice and the literature has largely remained highly specialised and contained within disciplinary paradigms. The first publication of the thesis (Chapter 2) acknowledges that the changing role of airports demands the establishment of new models of airport planning and development. It argues that practice and research requires a better understanding of the reciprocal impacts of airports and their urban catchments. The second publication (Chapter 3) highlights that there is ad hoc examination and media attention of high profile airport and regional conflict, but little empirical analysis or understanding of the extent to which all privatised Australian airports are intending to develop. The conceptual and methodological significance of this research is the development of a national land use classification system for on-airport development. This paper establishes the extent of on-airport development in Australia, providing insight into the changing land use and economic roles of privatised airports. The third publication (Chapter 4) details new and significant interdependencies for airport and regional development in consideration of the progression of airports as activity centres. Here the model of an ‘airport metropolis’ is offered as an organising device and theoretical contribution for comprehending the complexity and planning of airport and regional development. It delivers a conceptual framework for both research and policy, which acknowledges the reciprocal impacts of economic development, land use, infrastructure and governance ‘interfaces’. In a timely and significant concurrence with this research the Australian Government announced and delivered a National Aviation Policy Review (2008 – 2009). As such the fourth publication (Chapter 5) focuses on the airport and urban planning aspects of the review. This paper also highlights the overall policy intention of facilitating broader airport and regional collaborative processes. This communicative turn in airport policy is significant in light of the communicative theoretical framework of the thesis. The fifth paper of the thesis (Chapter 6) examines three Australian case studies (Brisbane, Adelaide and Canberra) to detail the context of airport and regional land use planning and to apply the airport metropolis model as a framework for research. Through the use of Land Use Forums, over 120 airport and regional stakeholders are brought together to detail their perspectives and interactions with airport and regional land use planning. An inductive thematic analysis of the results identifies three significant themes which contribute to the fragmentation of airport and regional and land use planning: 1) inadequate coordination and disjointed decision-making; 2) current legislative and policy frameworks; and 3) competing stakeholder priorities and interests. Building on this new knowledge, Chapter 7 details the perceptions of airport and local, state and territory government stakeholders to land use relationships, processes and outcomes. A series of semi-structured interviews are undertaken in each of the case studies to inform this research. The potential implications for ongoing communicative practice are discussed in conclusion. The following thesis represents an incremental and cumulative research process which delivers new knowledge for the practical understanding and research interpretation of airport and regional land use planning practice and policy. It has developed and applied a robust conceptual framework which delivers significant direction for all stakeholders to better comprehend the relevance of airports in the urban character and design of our cities.

The water catchment : fast forward to the past

The Water Catchment: fast forward to the past comprises two parts: a creative piece and an exegesis. The methodology is Creative Practice as Research; a process of critical reflection, where I observe how researching the exegesis, in my case analysing how the social reality of an era in which an author writes affects their writing of the protagonist's journey, and how this in turn shapes how I write the hero's pathway in the creative piece. The genre in which the protagonist's journey is charted and represented is dystopian young adult fiction; hence my creative piece, The Water Catchment, is a novel manuscript for a dystopian young adult fantasy. It is a speculative novel set in a possible future and poses (and answers) the question: What might happen if water becomes the most powerful commodity on earth? There are two communities, called 'worlds' to create a barrier and difference where physical ones are not in evidence. A battle ensues over unfair conditions and access to water. In the end the protagonist, Caitlyn, takes over leadership heralding a new era of co-operation and water management between the two worlds. The exegesis examines how the hero's pathway, the journey towards knowledge and resolution, is best explored in young adult literature through dystopian narratives. I explore how the dystopian worlds of Ursula Le Guin's first and last books of The Earthsea Quartet are foundational, and lay this examination over an analysis of both the hero's pathway within and the social contexts outside of the novels. Dystopian narratives constitute a liberating space for the adolescent protagonist between the reliance on adults in childhood and the world of adults. In young adult literature such narratives provide fertile ground to explore those aspects informing an adolescent's future.