A cohort study of Chlamydia trachomatis treatment failure in women : a study protocol

Background Chlamydia trachomatis is the most commonly diagnosed bacterial sexually transmitted infection in the developed world and diagnosis rates have increased dramatically over the last decade. Repeat infections of chlamydia are very common and may represent re-infection from an untreated partner or treatment failure. The aim of this cohort study is to estimate the proportion of women infected with chlamydia who experience treatment failure after treatment with 1 gram azithromycin. Methods/design This cohort study will follow women diagnosed with chlamydia for up to 56 days post treatment. Women will provide weekly genital specimens for further assay. The primary outcome is the proportion of women who are classified as having treatment failure 28, 42 or 56 days after recruitment. Comprehensive sexual behavior data collection and the detection of Y chromosome DNA and high discriminatory chlamydial genotyping will be used to differentiate between chlamydia re-infection and treatment failure. Azithromycin levels in high-vaginal specimens will be measured using a validated liquid chromatography – tandem mass spectrometry method to assess whether poor azithromycin absorption could be a cause of treatment failure. Chlamydia culture and minimal inhibitory concentrations will be performed to further characterize the chlamydia infections. Discussion Distinguishing between treatment failure and re-infection is important in order to refine treatment recommendations and focus infection control mechanisms. If a large proportion of repeat chlamydia infections are due to antibiotic treatment failure, then international recommendations on chlamydia treatment may need to be re-evaluated. If most are re-infections, then strategies to expedite partner treatment are necessary.

Clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory : A modified Delphi study

Aim To develop clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory. Background Numerous studies have reported that nurse-administered procedural sedation and analgesia is safe. However, the broad scope of existing guidelines for the administration and monitoring of patients who receive sedation during medical procedures without an anaesthetist presents means there is a lack of specific guidance regarding optimal nursing practices for the unique circumstances in which nurse-administered procedural sedation and analgesia is used in the cardiac catheterisation laboratory. Methods A sequential mixed methods design was utilised. Initial recommendations were produced from three studies conducted by the authors: an integrative review; a qualitative study; and a cross-sectional survey. The recommendations were revised in accordance with responses from a modified Delphi study. The first Delphi round was completed by nine senior cardiac catheterisation laboratory nurses. All but one of the draft recommendations met the pre-determined cut-off point for inclusion. There were a total of 59 responses to the second round. Consensus was reached on all recommendations. Implications for nursing The guidelines that were derived from the Delphi study offer twenty four recommendations within six domains of nursing practice: Pre-procedural assessment; Pre-procedural patient and family education; Pre-procedural patient comfort; Intra-procedural patient comfort; Intra-procedural patient assessment and monitoring; and Post-procedural patient assessment and monitoring. Conclusion These guidelines provide an important foundation towards the delivery of safe, consistent and evidence-based nursing care for the many patients who receive sedation in the cardiac catheterisation laboratory setting.

Virtual worlds in Australian and New Zealand higher education : remembering the past, understanding the present and imagining the future

3D virtual reality, including the current generation of multi-user virtual worlds, has had a long history of use in education and training, and it experienced a surge of renewed interest with the advent of Second Life in 2003. What followed shortly after were several years marked by considerable hype around the use of virtual worlds for teaching, learning and research in higher education. For the moment, uptake of the technology seems to have plateaued, with academics either maintaining the status quo and continuing to use virtual worlds as they have previously done or choosing to opt out altogether. This paper presents a brief review of the use of virtual worlds in the Australian and New Zealand higher education sector in the past and reports on its use in the sector at the present time, based on input from members of the Australian and New Zealand Virtual Worlds Working Group. It then adopts a forward-looking perspective amid the current climate of uncertainty, musing on future directions and offering suggestions for potential new applications in light of recent technological developments and innovations in the area.

Teaching sociology within teacher education : revisiting, realigning and re-embedding

This paper uses theoretical resources from the sociology of education to consider the teaching of sociology in teacher education programs in Australia. Once a disciplinary ‘pillar’ of teacher education, sociology’s contribution has become less explicit while more integrated, with consequences for disciplinary identity. Here we explore how sociology is taught in teacher education curricula on two fronts. Firstly we outline how sociology is embedded as one of a number of competing perspectives in foundational studies, and its pedagogic consequences. Then we consider the powerful contribution of sociology in literacy studies, amidst public debate about literacy performance. The analysis draws on Bernstein’s (2000) distinction between singular disciplinary curriculum design and practically-oriented regional curriculum design. We seek to trouble the commonsense binary between theory and practice that structures debates around professional education in higher education more broadly, and to dignify service sociology as a valuable, generative site for the discipline’s future.

Innovation in the road and bridge industry

This paper reviews innovation activity in a key service industry – road and bridge construction. Based on a large-scale Australian survey and descriptive statistics, the paper finds that there is little difference in innovation levels between different types of industry participants and that innovation is difficult to implement. The survey gathered responses from suppliers, consultants, contracts and clients and compared results across these four industry sectors. The absorptive capacity and relationship capacities of respondents were also investigated. One in five respondents had poor absorptive capacity. Suppliers were found to the most effective learners and were the best adopters of ideas from outside their organisations and consultants were the least effective. Australian construction organisations have relatively good relationship skills because relationship-based contracts are common compared to other countries. Indeed, the survey found that nearly 60% of respondents had experience with such contracts, with clients having more experience than the other three sectors. The results have implications for the measurement of innovation in project-based industries, and the relative roles of clients and suppliers in driving innovation in the construction industry. Further research will examine the extent to which particular governance mechanisms within relationship contracts lead to improved innovation and project performance.

Diffusion of extreme weather-proofing technology in the built environment

This study addresses the research question: ‘What are the diffusion determinants for extreme weather-proofing technology in the Australian built environment?’ In order to effectively identify diffusion determinants, a synthesis of literature in both technical and management fields was conducted from a system-wide perspective. Review results where then interpreted through an innovation system framework, drawn from innovation systems literature, in order to map the current state of extreme weather-proofing technology diffusion in the Australian built environment industry. Drivers and obstacles to optimal diffusion are presented. Results show the important role to be played by Australian governments in facilitating improved weather proofing technology diffusion. This applies to governments in their various roles, but particularly as regulators, clients/owners and investors in research & development and education. In the role as regulators, findings suggest Australian governments should be encouraging the application of innovative finance options and positive end-user incentives to promote the uptake of weather proofing technology. Additionally, in their role as clients/owners, diffusion can be improved by adjusting building and infrastructure specifications to encourage designers and constructors to incorporate extreme weather proofing technology in new and redeveloped built assets. Finally, results suggest greater investment is required in research and development and improved knowledge sharing across the construction supply chain to further mitigate risks associated with greater incidences of extreme weather events.

The effect of varied test instructions on neuropsychological performance following mild traumatic brain injury : an investigation of ‘diagnosis threat’

Diagnosis threat is a psychosocial factor that has been proposed to contribute to poor outcomes following mild traumatic brain injury (mTBI). This threat is thought to impair the cognitive test performance of individuals with mTBI because of negative injury stereotypes. University students (N= 45, 62.2% female) with a history of mTBI were randomly allocated to a diagnosis threat (DT, n=15), reduced threat (DT-reduced, n=15) or neutral (n=15) group. The reduced threat condition invoked a positive stereotype (i.e., that people with mTBI can perform well on cognitive tests). All participants were given neutral instructions before they completed baseline tests of: a) objective cognitive function across a number of domains; b) psychological symptoms; and, c) PCS symptoms, including self-reported cognitive and emotional difficulties. Participants then received either neutral, DT or DT-reduced instructions, before repeating the tests. Results were analyzed using separate mixed model ANOVAs; one for each dependent measure. The only significant result was for the 2 X 3 ANOVA on an objective test of attention/working memory, Digit Span, p<.05, such that the DT-reduced group performed better than the other groups, which were not different from each other. Although not consistent with predictions or earlier DT studies, the absence of group differences on most tests fits with several recent DT findings. The results of this study suggest that it is timely to reconsider the role of DT as a unique contributor to poor mTBI outcome.

How realistic are older drivers’ ratings of their driving ability?

One strategy that can be used by older drivers to guard against age-related declines in driving capability is to regulate their driving. This strategy presumes that self-judgments of driving capability are realistic. We found no significant relationships between older drivers’ hazard perception skill ratings and performance on an objective and validated video-based hazard perception test, even when self-ratings of performance on specific scenarios in the test were used. Self-enhancement biases were found across all components of driving skill, including hazard perception. If older drivers’ judgments of their driving capability are unrealistic, then this may compromise the effectiveness of any self-restriction strategies to reduce crash risk.

Characteristics of on-road driving performance of persons with central vision loss who use bioptic telescopes

Purpose. To compare the on-road driving performance of visually impaired drivers using bioptic telescopes with age-matched controls. Methods. Participants included 23 persons (mean age = 33 ± 12 years) with visual acuity of 20/63 to 20/200 who were legally licensed to drive through a state bioptic driving program, and 23 visually normal age-matched controls (mean age = 33 ± 12 years). On-road driving was assessed in an instrumented dual-brake vehicle along 14.6 miles of city, suburban, and controlled-access highways. Two backseat evaluators independently rated driving performance using a standardized scoring system. Vehicle control was assessed through vehicle instrumentation and video recordings used to evaluate head movements, lane-keeping, pedestrian detection, and frequency of bioptic telescope use. Results. Ninety-six percent (22/23) of bioptic drivers and 100% (23/23) of controls were rated as safe to drive by the evaluators. There were no group differences for pedestrian detection, or ratings for scanning, speed, gap judgments, braking, indicator use, or obeying signs/signals. Bioptic drivers received worse ratings than controls for lane position and steering steadiness and had lower rates of correct sign and traffic signal recognition. Bioptic drivers made significantly more right head movements, drove more often over the right-hand lane marking, and exhibited more sudden braking than controls. Conclusions. Drivers with central vision loss who are licensed to drive through a bioptic driving program can display proficient on-road driving skills. This raises questions regarding the validity of denying such drivers a license without the opportunity to train with a bioptic telescope and undergo on-road evaluation.

The international regulation of persons displaced by climate change

It is certain that there will be changes in environmental conditions across the globe as a result of climate change. Such changes will require the building of biological, human and infrastructure resilience. In some instances, the building of such resilience will be insufficient to deal with extreme changes in environmental conditions and legal frameworks will be required to provide recognition and support for people relocating as a result of environmental change. International legal frameworks do not currently recognise or assist people displaced as a result of environmental factors. The objective of this chapter is to examine the areas of international law relevant to displacement arising from environmental factors, consider some of the proposed climate displacement instruments and suggest the most suitable international institution to host a program addressing climate displacement. In order to determine the most appropriate institution to address and regulate climate displacement, it is imperative to consider issues of governance. This paper seeks to examine this issue and determine whether it is preferable to place climate displacement programs into existing international legal frameworks, or whether it is necessary to regulate this area in an entirely new institution specifically designed to deal with the complex and cross-cutting issues surrounding the topic...

A model for research supervision of international students in engineering and information technology disciplines

A large proportion (over 12 per cent) of international and non-English speaking background (NESB) postgraduate research students enrol in engineering and information technology (IT) programs in Australian universities. They find themselves in an advanced research culture, and are technically and scientifically challenged early in their programs. This is in addition to cultural, social and religious isolation and linguistic barriers they have to contend with. The project team surveyed this cohort at QUT and UWA, on the hypothesis that they face challenges that are more discipline-specific. The results of the survey indicate that existing supervisory frameworks which are limited to linguistic contexts are not fully assisting these students and supervisors to achieve high quality research. The goal of this project is to extend these supervisory frameworks to a holistic model that will address the unique needs and supervisory issues these students face in engineering and IT disciplines. The model will be useable by all other Australian universities.

The supervision tango : perceptions of supervisors of international graduate students in Engineering and IT

This paper, which was part of a larger study, reports on a survey that explored the perceptions of 69 graduate supervisors regarding issues in supervision from three higher education institutions in Australia. Factors that contribute to student success in higher education research degrees are many and diverse, including a complex dance of student factors, supervisor factors, and their supervisory context factors, and those informed by cultural and language differences. Therefore, a complex system approach using Bayesian network modelling was used to explore how student and/or supervisor factors influence the success of culturally and linguistically diverse (CALD) graduate students in Engineering and IT. Findings suggest that key factors include the experience of supervisors in terms of experience with the Australian higher education system, personal cross-cultural experience.