Acupuncture with manual and electrical stimulation for labour pain : a longitudinal randomised controlled trial

Background: Acupuncture is commonly used to reduce pain during labour despite contradictory results. The aim of this study is to evaluate the effectiveness of acupuncture with manual stimulation and acupuncture with combined manual and electrical stimulation (electro-acupuncture) compared with standard care in reducing labour pain. Our hypothesis was that both acupuncture stimulation techniques were more effective than standard care, and that electro-acupuncture was most effective.  Methods: A longitudinal randomised controlled trial. The recruitment of participants took place at the admission to the labour ward between November 2008 and October 2011 at two Swedish hospitals. 303 nulliparous women with normal pregnancies were randomised to: 40 minutes of manual acupuncture (MA), electro-acupuncture (EA), or standard care without acupuncture (SC). Primary outcome: labour pain, assessed by Visual Analogue Scale (VAS). Secondary outcomes: relaxation, use of obstetric pain relief during labour and post-partum assessments of labour pain. The sample size calculation was based on the primary outcome and a difference of 15 mm on VAS was regarded as clinically relevant, this gave 101 in each group, including a total of 303 women.  Results: Mean estimated pain scores on VAS (SC: 69.0, MA: 66.4 and EA: 68.5), adjusted for: treatment, age, education, and time from baseline, with no interactions did not differ between the groups (SC vs MA: mean difference 2.6, 95% confidence interval [CI] -1.7-6.9 and SC vs EA: mean difference 0.6 [95% CI] -3.6-4.8). Fewer number of women in the EA group used epidural analgesia (46%) than women in the MA group (61%) and SC group (70%) (EA vs SC: odds ratio [OR] 0.35; [95% CI] 0.19-0.67).  Conclusions: Acupuncture does not reduce women's experience of labour pain, neither with manual stimulation nor with combined manual and electrical stimulation. However, fewer women in the EA group used epidural analgesia thus indicating that the effect of acupuncture with electrical stimulation may be underestimated. These findings were obtained in a context with free access to other forms of pain relief.

Comparison of treatment of incomplete abortion with misoprostol by physicians and midwives at district level in Uganda : a randomised controlled equivalence trial

BACKGROUND: Misoprostol is established for the treatment of incomplete abortion but has not been systematically assessed when provided by midwives at district level in a low-resource setting. We investigated the effectiveness and safety of midwives diagnosing and treating incomplete abortion with misoprostol, compared with physicians. METHODS: We did a multicentre randomised controlled equivalence trial at district level at six facilities in Uganda. Eligibility criteria were women with signs of incomplete abortion. We randomly allocated women with first-trimester incomplete abortion to clinical assessment and treatment with misoprostol either by a physician or a midwife. The randomisation (1:1) was done in blocks of 12 and was stratified for study site. Primary outcome was complete abortion not needing surgical intervention within 14-28 days after initial treatment. The study was not masked. Analysis of the primary outcome was done on the per-protocol population with a generalised linear-mixed effects model. The predefined equivalence range was -4% to 4%. The trial was registered at ClinicalTrials.gov, number NCT01844024. FINDINGS: From April 30, 2013, to July 21, 2014, 1108 women were assessed for eligibility. 1010 women were randomly assigned to each group (506 to midwife group and 504 to physician group). 955 women (472 in the midwife group and 483 in the physician group) were included in the per-protocol analysis. 452 (95·8%) of women in the midwife group had complete abortion and 467 (96·7%) in the physician group. The model-based risk difference for midwife versus physician group was -0·8% (95% CI -2·9 to 1·4), falling within the predefined equivalence range (-4% to 4%). The overall proportion of women with incomplete abortion was 3·8% (36/955), similarly distributed between the two groups (4·2% [20/472] in the midwife group, 3·3% [16/483] in the physician group). No serious adverse events were recorded. INTERPRETATION: Diagnosis and treatment of incomplete abortion with misoprostol by midwives is equally safe and effective as when provided by physicians, in a low-resource setting. Scaling up midwives' involvement in treatment of incomplete abortion with misoprostol at district level would increase access to safe post-abortion care. FUNDING: The Swedish Research Council, Karolinska Institutet, and Dalarna University.

Distance teacher education : Experiences from Dalarna University, Sweden

In 2003 the first distance teacher education started at Dalarna University in a small scale compared with today when a large part of the teacher education is distributed as distance education. From this point of view it seems important to ask the question: How can you become a successful distance student? This paper is based on a case study. Data were collected from earlier research reports, study registers and a group interview. The most important parameters appeared to be motivation, situation in life, discipline and experiences from earlier studies and/or work experience and good relations to other students and the university teachers.

Differences in muscle activity during hand dexterity tasks between women with arthritis and a healthy reference group

Background. Impaired hand function is common in patients with arthritis and it affects performance of daily activities; thus, hand exercises are recommended. There is little information on the extent to which the disease affects activation of the flexor and extensor muscles during these hand-dexterity tasks. The purpose of this study was to compare muscle activation during such tasks in subjects with arthritis and in a healthy reference group. Methods. Muscle activation was measured in m. extensor digitorium communis (EDC) and in m. flexor carpi radialis (FCR) with surface electromyography (EMG) in women with rheumatoid arthritis (RA, n = 20), hand osteoarthritis (HOA, n = 16) and in a healthy reference group (n = 20) during the performance of four daily activity tasks and four hand exercises. Maximal voluntary isometric contraction (MVIC) was measured to enable intermuscular comparisons, and muscle activation is presented as %MVIC. Results. The arthritis group used a higher %MVIC than the reference group in both FCR and EDC when cutting with a pair of scissors, pulling up a zipper and—for the EDC—also when writing with a pen and using a key (p < 0.02). The exercise “rolling dough with flat hands” required the lowest %MVIC and may be less effective in improving muscle strength. Conclusions. Women with arthritis tend to use higher levels of muscle activation in daily tasks than healthy women, and wrist extensors and flexors appear to be equally affected. It is important that hand training programs reflect real-life situations and focus also on extensor strength.

Tensions and dilemmas in community development: new discourses, new Trojans?

This paper begins by noting the range of contradictions and dilemmas facing those involved in community development today. It then draws on research into the operating frameworks that set the stage for much current community development activity. It discusses four key operating frameworks and how each framework can affect community development practice. The final section deals with the ways in which the frameworks, and the discourses associated with them, come together.

Technical efficiency in Australian textile and clothing firms: evidence from the business longitudinal survey

This paper estimates technical efficiency of Australian textile and clothing firms based on the data obtained from the Business Longitudinal Survey (BLS) conducted by the Australian Bureau of Statistics (ABS). Using a Cobb Douglas stochastic production frontier the paper examines firm level technical efficiency in the time varying inefficiency effect model with technical inefficiency effects assumed as an independently distributed truncated normal variable. Estimates of the production frontier revealed significant but small elasticities of labour and capital for textile and clothing firms, respectively, and a negative (but insignificant) Hicks neutral technical change for both. Estimated coefficients of the explanatory variables for inefficiency effects indicated that technical efficiency varied significantly according to firms’ age, size, capital intensity, proportion of non-production to total workers and type of legal status. Predicted firm specific efficiency varied from 16 per cent to 95 per cent and mean efficiency ranged between 30 to 70 per cent. In view of these results policies have been suggested to improve technical efficiency of the firms as well as productivity growth of the sub sectors.

Adopting a computational approach to identifying and modelling future development initiatives within the urban context

In 2002 the State Government of Victoria, in partnership with the City of Greater Geelong and Deakin University, initiated and urban design framework to explore development opportunities of a series of redundant industrial sites adjacent to Geelong's central activities area (CAA). One of the objectives of the framework was to explore a range of initiatives based on the expansion of Deakin University Waterfront campus from 700 students to an expected cohort of 5000 students. Working with a set of predefined constructs for different types of city-based user groups, such as net floor space requirements and time/travel distances between facilities, the following paper presents a simple computational approach to assist in identifying, mapping, and spatially exploring different development scenarios.

Undergraduate pre-registration nursing education in Australia: a longitudinal examination of enrolment and completion numbers with a focus on students from rural and remote campus locations

Introduction: There is much evidence to indicate a shortage of Registered Nurses (RNs) in Australia and to suggest that the shortage may be more pronounced in rural and remote locations. Attracting RNs to work in rural and remote areas may not be as simple as increasing the intake of students into university undergraduate pre-registration nursing courses. There is some evidence indicating that student nurses may be more likely to enter the nursing workforce in rural and remote locations if they have existing associations with rural and remote areas and/or their undergraduate education provides opportunities to undertake supported placements in rural and remote settings. Two important difficulties have been associated with measuring outcomes in relation to rural and remote pre-registration nursing students. One is defining what constitutes a rural or remote location and the other is suspect data on the number of nursing students enrolled in, and completing, nursing courses. The aims of this study were to provide a longitudinal profile of the number of domestic students studying and completing undergraduate pre-registration nursing courses in Australia, with a particular emphasis on identifying those at rural and remote university campuses, and to compare results across States and Territories.
Method: This study presents the combined findings from two investigative reports. Data on undergraduate pre-registration nursing student numbers were collected via electronic survey instruments completed by staff at all Australian educational institutions offering undergraduate pre-registration nursing education programs in 2001 and 2002. Australian domestic students were the focus of this study. Data included the total number of domestic students enrolled in undergraduate pre-registration nursing courses in 2001 and 2002, the number of domestic students who successfully completed courses in 1999, 2000 and 2001, and estimates for the number expected to complete in 2002. Surveys were sent to course coordinators or other staff nominated by heads of divisions of nursing at each institution.
Results: There was a 100% response rate. Twenty-four rural and remote campus locations were identified using an adjusted form of the Rural, Remote and Metropolitan Areas (RRMA) classification system. The Australian Capital Territory and the Northern Territory did not have any rural or remote campus locations. In contrast, undergraduate pre-registration nursing in Tasmania was offered at a rural campus only (for the first 2 years). From 2001 to 2002, there was an increase of just over 5% in the total number of domestic students enrolled in undergraduate pre-registration nursing courses in Australia (2002 total = 22 811 students). Rural and remote location students accounted for slightly more than 25% of these students in 2001, and almost 27% in 2002. The States Victoria, New South Wales and Queensland had the highest percentage of students enrolled at rural and remote campus locations, greater than the Australian average for both years. In contrast, South Australia and Western Australia had less than 11% of students enrolled at rural and remote campus locations for each year. Total undergraduate pre-registration course completions increased by approximately 16% across Australia between 1999 (n = 4868) and 2002 (n = 5667), although for 2002, the figure was projected. Of these total course completions, the percentage of students completing at rural and remote campus locations increased from almost 23% to nearly 28% during the same period. Of the States/Territories with both metropolitan and rural/remote campus locations, only Victoria and Queensland had more than 25% of their total student completions consisting of students enrolled at rural and remote campus locations for each year. In contrast, South Australia and Western Australia had approximately 6% of student completions consisting of students enrolled at rural and remote campus locations in 1999, increasing to approximately 12% projected for 2002.
Conclusion: In this study, the authors attempted to improve the accuracy of data collection in relation to the number of domestic undergraduate pre-registration nursing students in Australia, which is representative of the potentially new Australian domestic RN workforce. There was a trend towards an increasing number of students being enrolled in undergraduate pre-registration nursing courses, and also toward an increasing number of course completions. From the perspective of the rural and remote RN workforce, the percentage of students enrolled and completing courses at rural and remote campus locations was found to be increasing. However, there may be some areas of concern for education and workforce planners in States and Territories that are providing a smaller percentage of their undergraduate pre-registration nursing courses in rural and remote areas. Several study limitations are discussed and suggestions made for future research.

Individual and organisational factors influencing academics` decisions to pursue the scholarship and teaching of ICT

This paper focuses on Information and Communication Technology (ICT) academics' perceptions of factors that promote and inhibit their pursuit of scholarship in their teaching work. It identifies critical factors that influence academics' attitudes, orientations and behaviours in respect to the scholarship of teaching, and from these builds a framework for understanding the interaction between these factors. We have named this framework the Scholarship of Teaching Support Framework.

During 2001 and 2002 a national project investigated teaching and learning initiatives in the major discipline of lCT in Australia's universities. As part of this project a mini-conference program was devised to elicit academics' perceptions of the factors influencing their teaching work and their participation in scholarly activities around this work. In total 83 ICT teachers from 29 universities participated in the mini-conference program. Attendees included staff members from a range of academic levels.

In discussions of aspects of the scholarship of teaching at the mini-conference participants referred to both attributes and responses of both university teachers and the university institutions. We have categorized these factors into those that relate to the individual academic (Individual domain) and those that relate to the tertiary institutional system (Organisational domain). Many contributions highlighted the interaction between these two domains.

Within the Individual domain, two key factors described by participants as affecting the pursuit of the scholarship of teaching were teachers' motivation towards, and their capabilities in, scholarly activities surrounding their teaching. Within the organizational domain two influential factors also emerged. These were the organizational support provided through allocation of resources and symbolic support reflected in an institution's systems, policies and processes.

Our findings indicate that both the Individual and Organizational domains contribute to university teachers' decisions to pursue (or not to pursue) the scholarship of teaching.

These two domains were seen by participants to interact within university environments to influence whether a particular environment is supportive or unsupportive in terms of the pursuit of the scholarship of teaching. Factors both from and within the individual and the organizational domains were seen to interact with each other forming a web of interrelated factors that appear to influence individuals' decisions to pursue, or not to pursue, the scholarship of teaching. From this complexity four theoretical extremes emerged providing the dimensions and components of the Scholarship of Teaching Support Framework.

We argue that responsive and innovative approaches to university teaching are best supported by academics undertaking scholarly activities around their teaching work, yet this article presents a picture of a university work environment where scholarly activities that focus on teaching and learning are seen as generally unsupported and unrewarded. This perception was identified as commonalities across a university system. Although some exceptions were noted, participants generally agreed that the organisational domain of Australian universities was largely unsupportive of the pursuit of the scholarship of teaching. Similarly, in general, university ICT teachers were not thought to have the backgrounds and capabilities necessary for pursuing the scholarship of teaching, such as familiarity with literature on teaching and learning and skills in educational evaluation. However, despite perceived inhibitors in universities' organisational culture and allocation of resources, and a perceived lack in individuals' skills, participants agreed that scholarly activities and innovation in university teaching and learning do take place, These are largely driven by the intrinsic motivation of individuals. It was recognised that further work is necessary to explore how motivation can be engendered and encouraged.

The Scholarship of Teaching Support Framework is a useful tool for examining how conducive a given university teaching context is to the scholarship of teaching and, therefore, can be used for review purposes within both research and policy contexts. Such tools will become increasingly important as policy changes begin to affect practices in how university teaching work is managed, supported and encouraged.

Australian hackers and ethics

The aim of the paper is to look at the way hackers act and ways in which society can protect itself. The paper will show the current views and attitudes of hackers in an Australian context. The paper will also include a case study to show how a hacking incident can develop and how technology can be used to protect against hacking.

The first 50 years of the annual endowed accounting research lecture series at the University of Melbourne

Carnegie and Edwards (2001) suggest that the formation of an organisational body is just one of the 'signals of movement' within the dynamic process of professionalisation of an occupation and they list the sponsoring of professorial posts and research activities at universities as further examples. While the literature on this process in Australia does refer to the sponsorship of chairs of accounting (Carnegie & Williams, 2001), little has been written identifying the range of other areas of sponsorship by the organised accounting bodies. This paper presents details of the first fifty years presentations of the Annual Accounting Research Lectures held at The University of Melbourne, Australia. They have been presented continuously since 1940, when they were inaugurated with sponsorship from the Commonwealth Institute of Accountants. The paper presents the first complete listing of details relating to the presenter (including name, gender, residency and occupational area), title of the paper, date of presentation (where known) and details of publication (where appropriate). The initial and subsequent motivation for the presentation of the series and the influence of the lectures in promoting research and fostering relations between the professional bodies and the university, during a period of great significance in the development of accounting education and the professionalisation of accounting in Australia, is also discussed.

Engaging communities in participation: Participation for what? For whom? By whom? And how?

This paper presents a theoretical frame and process that may be used to clarify purpose inherent in community engagement activities and strategies, and to evaluate progress against these criteria. Participation, empowerment and civic governance are themes of research and practice embraced by disciplines as diverse as health promotion, community psychology, community development and urban planning. Workshop participants were encouraged to reflect on their own practice in light of the theoretical models developed in these disciplines. In this way, the workshop helped promote understanding of the need – and opportunity – to develop interdisciplinary approaches to conceptualising, implementing and evaluating university-community engagement initiatives.