Balancing values and imperatives : a study of nursing service in an ICU

There has been significant attention from the managers and purchasers of health services regarding the economic advantages that result from changes to the patterns of health care delivery in the acute hospital setting. The impact of these changes, whilst often rendering advantage at the economic management level of health care, can have different consequences for the people who deliver and the people who receive health service. This paper reports on a study that was conducted with a group of nurses to investigate the practice milieu of a critical care unit in the context of changes to health service management. Interpretive methods were used to capture the perspective of the nurses and the way they interpret the multiple factors that influence their practice and their practice environment. The findings indicate that the nurses in the study setting interpret these factors according to the influences they have on the structure, the geography and the value of their work. Explication of these findings provides a research base to inform recommendations relating to improving the practice milieu of the critical care environment.

The potential for ethanol production from sugarcane in Australia

The Australian sugar industry processes approximately 35 million tonnes of sugarcane per year from 400 000 hectares of land. Sugar remains the principal revenue stream from sugarcane in Australia with less than 60 ML/y of fuel ethanol produced from final molasses at present. Modelling has been undertaken to estimate the potential ethanol production from the Australian sugar industry for integrated facilities producing both sugar and ethanol from the entire sugarcane resource. Although research aimed at developing commercial processes is ongoing, the use of a proportion of the bagasse and trash for ethanol production, in addition to juice and molasses fermentation, would allow significant increases in the scale of ethanol production from sugarcane in Australia, increasing total industry revenues while maintaining energy self sufficiency.

Getting the point : the role of gesture in managing intersubjectivity in a design activity

This paper illustrates the complexity of pointing as it is employed in a design workshop. Using the method of interaction analysis, we argue that pointing is not merely employed to index, locate, or fix reference to an object. It also constitutes a practice for reestablishing intersubjectivity and solving interactional trouble such as misunderstandings or disagreements by virtue of enlisting something as part of the participants’ shared experience. We use this analysis to discuss implications for how such practices might be supported with computer mediation, arguing for a “bricolage” approach to systems development that emphasizes the provision of resources for users to collaboratively negotiate the accomplishment of intersubjectivity ra- ther than systems that try to support pointing as a specific gestural action.

The complementary potential of multimedia and science demonstrations

Science is often considered as one of the cornerstones of human advancement. Despite its importance in our society, science as a subject in schools appears to be losing ground. Lack of relevance, the nature of the curriculum and the pedagogical approach to teaching are some of the reasons which researchers believe are causing a “swing” away from science. This paper will argue for the effectiveness of simple science demonstrations as a feasible pedagogical option with a high task value and which has the potential to reengage and reinvigorate student interest in the subject. This paper describes a case study (N = 25) in which the Integrative problem based learning model for science was implemented in a year nine science class. The study was conducted at a secondary school in Australia. Teacher demonstrations were situated in classroom activities in a “Why is it so?” problem/question format. Qualitative data gathered from students demonstrated a number of benefits of this approach. This paper then explores ways in which Web 2.0 technologies could be incorporated to enhance the value of science demonstrations

Adaptive radiotherapy for virally mediated head and neck cancer : predicting which patients may benefit most

Background: Recent clinical studies have demonstrated an emerging subgroup of head and neck cancers that are virally mediated. This disease appears to be a distinct clinical entity with patients presenting younger and with more advanced nodal disease, having lower tobacco and alcohol exposure and highly radiosensitive tumours. This means they are living longer, often with the debilitating functional side effects of treatment. The primary objective of this study was to determine how virally mediated nasopharyngeal and oropharyngeal cancers respond to radiation therapy treatment. The aim was to determine risk categories and corresponding adaptive treatment management strategies to proactively manage these patients. Method/Results: 121 patients with virally mediated, node positive nasopharyngeal or oropharyngeal cancer who received radiotherapy treatment with curative intent between 2005 and 2010 were studied. Relevant patient demographics including age, gender, diagnosis, TNM stage, pre-treatment nodal size and dose delivered was recorded. Each patient’s treatment plan was reviewed to determine if another computed tomography (re-CT) scan was performed and at what time point (dose/fraction) this occurred. The justification for this re-CT was determined using four categories: tumour and/or nodal regression, weight loss, both or other. Patients who underwent a re-CT were further investigated to determine whether a new plan was calculated. If a re-plan was performed, the dosimetric effect was quantified by comparing dose volume histograms of planning target volumes and critical structures from the actual treatment delivered and the original treatment plan. Preliminary results demonstrated that 25/121 (20.7%) patients required a re-CT and that these re-CTs were performed between fractions 20 to 25 of treatment. The justification for these re-CTs consisted of a combination of tumour and/or nodal regression and weight loss. 16/25 (13.2%) patients had a replan calculated. 9 (7.4%) of these replans were implemented clinically due to the resultant dosimetric effect calculated. The data collected from this assessment was statistically analysed to identify the major determining factors for patients to undergo a re-CT and/or replan. Specific factors identified included nodal size and timing of the required intervention (i.e. how when a plan is to be adapted). This data was used to generate specific risk profiles that will form the basis of a biologically guided adaptive treatment management strategy for virally mediated head and neck cancer. Conclusion: Preliminary data indicates that virally mediated head and neck cancers respond significantly during radiation treatment (tumour and/or nodal regression and weight loss). Implications of this response are the potential underdosing or overdosing of tumour and/or surrounding critical structures. This could lead to sub-optimal patient outcomes and compromised quality of life. Consequently, the development of adaptive treatment strategies that improve organ sparing for this patient group is important to ensure delivery of the prescribed dose to the tumour volume whilst minimizing the dose received to surrounding critical structures. This could reduce side effects and improve overall patient quality of life. The risk profiles and associated adaptive treatment approaches developed in this study will be tested prospectively in the clinical setting in Phase 2 of this investigation.

Is providing elective ventilation in the best interests of potential donors?

In this paper, we examine the lawfulness of a proposal to provide elective ventilation to incompetent patients who are potential organ donors. Under the current legal framework, this depends on whether the best interests test could be satisfied. It might be argued that, because the Mental Capacity Act 2005 (UK) (and the common law) makes it clear that the best interests test is not confined to the patient's clinical interests, but extends to include the individual's own values, wishes and beliefs, the proposal will be in the patient's best interests. We reject this claim. We argue that, as things currently stand, the proposal could not lawfully be justified as a blanket proposition by reference to the best interests test. Accordingly, a modification of the law would be necessary to render the proposal lawful. We conclude with a suggestion about how that could be achieved.

Integrated TEM, XRD and electron-microprobe investigation of mixed-layer chlorite smectite from the Point-Sal ophiolite, California

Five basalt samples from the Point Sal ophiolite, California, were examined using HRTEM and AEM in order to compare observations with interpretations of XRD patterns and microprobe analyses. XRD data from ethylene-glycol-saturated samples indicate the following percentages of chlorite in mixed-layer chlorite-smectite identified for each specimen: (i) L2036 almost-equal-to 50%, (ii) L2035 almost-equal-to 70 and 20%, (iii) 1A-13 almost-equal-to 70%, (iv) 1B-42 almost-equal-to 70%, and (v) 1B-55 = 100%. Detailed electron microprobe analyses show that 'chlorite' analyses with high Si, K, Na and Ca contents are the result of interlayering with smectite-like layers. The Fe/(Fe + Mg) ratios of mixed-layer phyllosilicates from Point Sal samples are influenced by the bulk rock composition, not by the percentage of chlorite nor the structure of the phyllosilicate. Measurements of lattice-fringe images indicate that both smectite and chlorite layers are present in the Point Sal samples in abundances similar to those predicted with XRD techniques and that regular alternation of chlorite and smectite occurs at the unit-cell scale. Both 10- and 14-angstrom layers were recorded with HRTEM and interpreted to be smectite and chlorite, respectively. Regular alternation of chlorite and smectite (24-angstrom periodicity) occurs in upper lava samples L2036 and 1A-13, and lower lava sample 1B-42 for as many as seven alternations per crystallite with local layer mistakes. Sample L2035 shows disordered alternation of chlorite and smectite, with juxtaposition of smectite-like layers, suggesting that randomly interlayered chlorite (< 0.5)-smectite exists. Images of lower lava sample 1B-55 show predominantly 14-angstrom layers. Units of 24 angstrom tend to cluster in what may otherwise appear to be disordered mixtures, suggesting the existence of a corrensite end-member having thermodynamic significance.

Making a point of difference : the glocalised ecology of the International Baccalaureate Diploma in Australian schools

The International Baccalaureate Diploma is an independent, globally available curriculum currently enjoying rapid uptake in government systems as an alternative curriculum. This paper explores the logic of its consumption in three case study schools across different states of Australia, and the relational ‘points of difference’ it creates in each local context and its curricular market. The analysis uses a typology of goods to describe the nature and dynamics of the IBD’s glocalised ecology of in each site. The conclusion argues the success of the IBD as a curricular alternative risks eroding its appeal as a positional good.

Dr. Seuss and the "Great Balancing Act" : Exploring the Ethical Places You’ll Go Within Australian Sport, Exercise, and Performance Psychology

Stories by children’s writer Dr. Seuss have often been utilised as non-traditional narrative reflections regarding the issues of ethics and morality (Greenwood, 2000). Such case studies are viewed as effective teaching and learning tools due to the associated analytical and decision-making frameworks that are represented within the texts, and focus upon the exploration of universally general virtues and approaches to ethics (Hankes, 2012). Whilst Dr. Seuss did not create a story directly related to the sport, exercise or performance domains, many of his narratives possess psychological implications that are applicable in any situation that requires ethical consideration of the thinking and choices people make. The following exploration of the ‘ethical places you’ll go’ draws upon references to his work as a guide to navigating this interesting and sometimes challenging landscape for sport, exercise, and performance psychologists (SEPP).

Assisting a suicide : potential succession law consequences

The recent criminal law decisions where people have been convicted of aiding suicide raise important legal and ethical issues in relation to whether euthanasia should be legalised. These cases also raise issues of great significance for succession lawyers. Where, as in cases such as Nielsen and Justins, the person convicted of aiding a suicide is a principal beneficiary under the will of the deceased, various legal consequences, such as: forfeiture of the interest under the will; liability for breach of fiduciary obligation; and/or a finding of undue influence, may follow which may result in loss of such benefit.

Towards more systematic Twitter analysis : metrics for tweeting activities

Twitter is an important and influential social media platform, but much research into its uses remains centred around isolated cases – e.g. of events in political communication, crisis communication, or popular culture, often coordinated by shared hashtags (brief keywords, prefixed with the symbol ‘#’). In particular, a lack of standard metrics for comparing communicative patterns across cases prevents researchers from developing a more comprehensive perspective on the diverse, sometimes crucial roles which hashtags play in Twitter-based communication. We address this problem by outlining a catalogue of widely applicable, standardised metrics for analysing Twitter-based communication, with particular focus on hashtagged exchanges. We also point to potential uses for such metrics, presenting an indication of what broader comparisons of diverse cases can achieve.

Behavioral biometrics for persistent single sign-on

Driven by the rapid development of ubiquitous and pervasive computing, personalized services and applications are deployed to support our lives. Accordingly, the number of interfaces and devices (smartphone, tablet computer, etc.) provided to access and consume these services is growing continuously. To simplify the complexity of managing many accounts with different credentials, Single Sign-On (SSO) solutions have been introduced. However, a single password for many accounts represents a single-point-of-failure. Furthermore, once initiated SSO session is a high potential risk when the working station is left unlocked and unattended. In this paper, we present a conception of a Persistent Single Sign-On (PSSO) for ubiquitous home environments by involving the capabilities of Behavioral Biometrics to check the identity of the user continuously in an unobtrusive manner.

Eyes on 3D-Current 3D biomimetic disease concept models and potential applications in age-related macular degeneration

Three dimensional cellular models that mimic disease are being increasingly investigated and have opened an exciting new research area into understanding pathomechanisms. The advantage of 3D in vitro disease models is that they allow systematic and in-depth studies of physiological and pathophysiological processes with less costs and ethical concerns that have arisen with animal models. The purpose of the 3D approach is to allow crosstalk between cells and microenvironment, and with cues from the microenvironment, cells can assemble their niche similar to in vivo conditions. The use of 3D models for mimicking disease processes such as cancer, osteoarthritis etc., is only emerging and allows multidisciplinary teams consisting of tissue engineers, biologist biomaterial scientists and clinicians to work closely together. While in vitro systems require rigorous testing before they can be considered as replicates of the in vivo model, major steps have been made, suggesting that they will become powerful tools for studying physiological and pathophysiological processes. This paper aims to summarize some of the existing 3D models and proposes a novel 3D model of the eye structures that are involved in the most common cause of blindness in the Western World, namely age-related macular degeneration (AMD).