Human papillomavirus prevalence, viral load and pre-cancerous lesions of the cervix in women initiating highly active antiretroviral therapy in South Africa : a cross-sectional study

Background Cervical cancer and infection with human immunodeficiency virus (HIV) are both important public health problems in South Africa (SA). The aim of this study was to determine the prevalence of cervical squamous intraepithelial lesions (SILs), high-risk human papillomavirus (HR-HPV), HPV viral load and HPV genotypes in HIV positive women initiating anti-retroviral (ARV) therapy. Methods A cross-sectional survey was conducted at an anti-retroviral (ARV) treatment clinic in Cape Town, SA in 2007. Cervical specimens were taken for cytological analysis and HPV testing. The Digene Hybrid Capture 2 (HC2) test was used to detect HR-HPV. Relative light units (RLU) were used as a measure of HPV viral load. HPV types were determined using the Roche Linear Array HPV Genotyping test. Crude associations with abnormal cytology were tested and multiple logistic regression was used to determine independent risk factors for abnormal cytology. Results The median age of the 109 participants was 31 years, the median CD4 count was 125/mm3, 66.3% had an abnormal Pap smear, the HR-HPV prevalence was 78.9% (Digene), the median HPV viral load was 181.1 RLU (HC2 positive samples only) and 78.4% had multiple genotypes. Among women with abnormal smears the most prevalent HR-HPV types were HPV types 16, 58 and 51, all with a prevalence of 28.5%. On univariate analysis HR-HPV, multiple HPV types and HPV viral load were significantly associated with the presence of low and high-grade SILs (LSIL/HSIL). The multivariate logistic regression showed that HPV viral load was associated with an increased odds of LSIL/HSIL, odds ratio of 10.7 (95% CI 2.0 – 57.7) for those that were HC2 positive and had a viral load of ≤ 181.1 RLU (the median HPV viral load), and 33.8 (95% CI 6.4 – 178.9) for those that were HC2 positive with a HPV viral load > 181.1 RLU. Conclusion Women initiating ARVs have a high prevalence of abnormal Pap smears and HR-HPV. Our results underscore the need for locally relevant, rigorous screening protocols for the increasing numbers of women accessing ARV therapy so that the benefits of ARVs are not partially offset by an excess risk in cervical cancer.

Increasing physical activity among women with young children: Results from the Proactive Mums Project

Context Evidence from the Australian Longitudinal Study of Women's Health suggests that mothers of young children have lower levels of physical activity (PA) than women of similar age without children. Objectives The aim of the ProActive Mums project was to determine the relative efficacy of two strategies designed to increase the proportion of mothers of young children who are meeting current PA guidelines, utilising child care centres (CCCs) as the setting for recruitment. Study Design The project used a randomised (after stratification to ensure even representation of CCCs from differing socio-economic areas) design incorporating repeated data collection from women in three groups, each consisting of 7 childcare centres (CCCs). Baseline surveys were completed by 554 mothers, with follow-up data collection immediately post-Intervention (8 weeks after baseline) and again 5 months later. Women from CCCs in Group 1 (control) received only the surveys throughout the duration of the project. Women from CCCs in Group 2 (information only) were given a print intervention, and women from CCCs in Group 3 were (in addition to being given the same print intervention as women from CCCs in Group 2) invited to to contribute to the development of, and participate in, strategies for the promotion of PA among mothers of young children. The two intervention strategies were extensively evaluated through a series of surveys and interviews. The Intervention The print intervention prescribed for women from CCCs in Group 2 and Group 3 consisted of an 8-page booklet containing motivational messages and information about physical activity. Women from CCCs in Group 3 were also invited to attend meetings at their CCC to identify strategies for increasing their PA. Contacts were made with key stakeholders in the community, including managers of sporting and recreation facilities, childcare service providers, and local councils. A wide range of strategies was developed during the intervention phase of the project, which specifically focused on the need to increase partner support and self-efficacy (or the confidence to be physically active). Results The mean age of participants was 33 (+ 4.8) years, and the mean number of children per family unit was 2.2 (± 0.9). At baseline, fewer than half the women were meeting current guidelines for adequate PA for health benefit, and there were no significant differences between groups in the proportion of women who were adequately active for health benefit. Women in Group 3 were significantly more likely to meet the guidelines at post-intervention follow-up than controls [OR = 1.71 (1.05-2.77)] after controlling for age and PA at baseline. There was no significant effect of the print intervention alone on meeting guidelines at post-intervention follow-up compared with controls, after controlling for age and PA at baseline [OR = 1.15 (0.70-1.89)]. Changes in Partner Support (PS) and Self Efficacy (SE) significantly predicted meeting current PA guidelines at post-intervention follow-up after controlling for baseline PA [∆ PS: OR = 2.29 (1.46-3.58); ∆ SE: OR = 1.86 (1.17- 2.94)]. The intervention effect in Group 3 was not maintained at long-term follow-up. Conclusions The findings indicate that a community participation approach that facilitates increased partner support and self-efficacy can be effective in increasing PA among mothers of young children. Changes in physical activity were found to be mediated by changes in partner support and self-efficacy for physical activity, suggesting that the intervention successfully targeted the individual characteristics it intended to, and that these variables do play an important role in increasing physical activity among women with young children. It is clear that further work needs to be done to explore methods of translating the short-term intervention effect shown in this study into long-term changes in PA behaviour. This study also provided insight into measurement issues in PA research and raised questions about self-report measures of PA and perceived constraints to being physically active. The results from post-study qualitative interviews suggest that many women at this life-stage experience time constraints which, when accompanied by a lack of partner support and financial constraints, make leisure-time PA virtually impossible for many women. Future strategies might focus on targeting this population immediately prior to this life-stage in an attempt to encourage habitual physical activity before women have children. Increasing PA in this population should also address the entire family unit, and consider the way leisure-time is negotiated among the adults within a household. Social change and increased awareness of the range of benefits of PA for women with children are additional strategies to be considered.

Safety impacts of alcohol and other drugs in construction : development of an industry policy and cultural change management program

There is increasing concern about the impact of employees‟ alcohol and other drug (AOD) consumption on workplace safety and performance, particularly within the construction industry. While most Australian jurisdictions have identified this as a critical safety issue, information is limited regarding the prevalence of AODs in the workplace and there is limited evidential guidance regarding how to effectively and efficiently address such an issue. The current research aims to scientifically evaluate the use of AODs within the Australian construction industry in order to reduce the potential resulting safety and performance impacts and engender a cultural change in the workforce - to render it unacceptable to arrive at a construction workplace with impaired judgement from AODs. The study will adopt qualitative and quantitative methods to firstly evaluate the extent of general AOD use in the industry. Secondly, the development of an appropriate industry policy will adopt a non-punitive and rehabilitative approach developed in consultation with employers and employees across the infrastructure and building sectors, with the aim it be adopted nationally for adoption at the construction workplace. Finally, an industry specific cultural change management program and implementation plan will be developed through a nationally collaborative approach. Final results indicate that a proportion of those sampled in the construction sector may be at risk of hazardous alcohol consumption. A total of 286 respondents (58%) scored above the cut-off cumulative score for risky or hazardous alcohol. Other drug use was also identified as a major issue. Results support the need for evidence-based, preventative educational initiatives that are tailored to the industry. This paper will discuss the final survey and interview results.

The impact of a model of nurse education to improve knowledge and recognition of delirium in older persons by registered nurses

Introduction: Delirium is a serious issue associated with high morbidity and mortality in older hospitalised people. Early recognition enables diagnosis and treatment of underlying cause/s, which can lead to improved patient outcomes. However, research shows knowledge and accurate nurse recognition of delirium and is poor and lack of education appears to be a key issue related to this problem. Thus, the purpose of this randomised controlled trial (RCT) was to evaluate, in a sample of registered nurses, the usability and effectiveness of a web-based learning site, designed using constructivist learning principles, to improve acute care nurse knowledge and recognition of delirium. Prior to undertaking the RCT preliminary phases involving; validation of vignettes, video-taping five of the validated vignettes, website development and pilot testing were completed. Methods: The cluster RCT involved consenting registered nurse participants (N = 175) from twelve clinical areas within three acute health care facilities in Queensland, Australia. Data were collected through a variety of measures and instruments. Primary outcomes were improved ability of nurses to recognise delirium using written validated vignettes and improved knowledge of delirium using a delirium knowledge questionnaire. The secondary outcomes were aimed at determining nurse satisfaction and usability of the website. Primary outcome measures were taken at baseline (T1), directly after the intervention (T2) and two months later (T3). The secondary outcomes were measured at T2 by participants in the intervention group. Following baseline data collection remaining participants were assigned to either the intervention (n=75) or control (n=72) group. Participants in the intervention group were given access to the learning intervention while the control group continued to work in their clinical area and at that time, did not receive access to the learning intervention. Data from the primary outcome measures were examined in mixed model analyses. Results: Overall, the effect of the online learning intervention over time comparing the intervention group and the control group were positive. The intervention groups‘ scores were higher and the change over time results were statistically significant [T3 and T1 (t=3.78 p=<0.001) and T2 and T1 baseline (t=5.83 p=<0.001)]. Statistically significant improvements were also seen for delirium recognition when comparing T2 and T1 results (t=2.58 p=0.012) between the control and intervention group but not for changes in delirium recognition scores between the two groups from T3 and T1 (t=1.80 p=0.074). The majority of the participants rated the website highly on the visual, functional and content elements. Additionally, nearly 80% of the participants liked the overall website features and there were self-reported improvements in delirium knowledge and recognition by the registered nurses in the intervention group. Discussion: Findings from this study support the concept that online learning is an effective and satisfying method of information delivery. Embedded within a constructivist learning environment the site produced a high level of satisfaction and usability for the registered nurse end-users. Additionally, the results showed that the website significantly improved delirium knowledge & recognition scores and the improvement in delirium knowledge was retained at a two month follow-up. Given the strong effect of the intervention the online delirium intervention should be utilised as a way of providing information to registered nurses. It is envisaged that this knowledge would lead to improved recognition of delirium as well as improvement in patient outcomes however; translation of this knowledge attainment into clinical practice was outside the scope of this study. A critical next step is demonstrating the effect of the intervention in changing clinical behaviour, and improving patient health outcomes.

Akin Collection : curation of a collaboration between Indigenous artists and fashion designers to create a retail-ready luxury fashion label

The Akin collection is the outcome of a project to lead, guide and curate a luxury, retail-ready fashion collection from a collaboration between five emerging fashion designers and five established Indigenous artists. Research background There is a history of Indigenous artists in Australia being treated unethically; by misappropriation and misrepresentation of their work, inequity of payment for their creativity and little acknowledgement of their cultural contribution to collaborative fashion product sold globally. This has created an atmosphere of bad press for fashion, as well as a fear for emerging designers to include/collaborate with Indigenous artists for textile prints. This fear has been so intense that many emerging Australian designers are now seeking collaboration with other countries’ Indigenous communities, thus missing out on a rich cultural and diverse aesthetic that could brand a truly unique Australian label in the international marketplace. The fashion brands that have collaborated with Indigenous Australian artists have traditionally been a ONE designer label incorporating Indigenous prints, for collections that have little acknowledgement of the artist’s contribution and strong branding for the label and/or fashion designer. This collection seeks to create an equitable and profitable fashion collection under one brand where all artists and designers receive equal payment, equal promotion/credibility, as well as equal royalties for any garments ordered by retailers. Research question Is it possible to curate an ethical, luxury, retail-ready, international fashion brand with a collaboration of five (5) emerging designers and five (5) Indigenous artists? Research contribution In the fashion industry, existing collaborations for Australian Indigenous artists have been with ONE fashion designer or one existing fashion label. This is the first fashion collection created under one brand name with equal credibility and profits for both artists and designers. The process involved presenting workshops ranging from understanding the logistics and timing of the fashion supply chain, costing of garments, the process of ‘ranging’ fashion product for a collection and creating repeat prints from a specific artwork, ready for digital printing. A workshop was also facilitated so both designer and artist could work together to create (and co-own) unique t shirt prints. Lawyers were consulted and ethical contracts were drawn up to cover all participants in this innovative collaboration. While the collaboration of artist and designer was important, the collection required curation of all elements so that the final collection came together as a professional and cohesive, quality, retail- ready product. This could only be created by experienced practitioners. Research significance The Akin Collection is the first Australian fashion brand to be created as a collaboration between five equally recognised Indigenous artists and five emerging fashion designers. It has familiarized the Indigenous artists to the logistics and culture of the fashion industry and the emerging fashion designers have been familiarized to the logistics and culture of how to collaborate with the unique Indigenous artwork that exists in Australia. After only three months, this culminated in a fashion parade showcasing the Akin collection to over 400 members of the public, government, media and retail. Feedback has been strong from the media and the industry, and a lookbook and photoshoot has been organised to promote and sell the collection both nationally and internationally. These concepts plus the curation outlined, has created a successful, luxury, quality collection ready for the international runways. This project has devised an ethical template for other Indigenous artists and emerging designers to create fashion collections that offer a unique aesthetic that could position and brand Australian fashion in the international marketplace. Key Words Indigenous artists, emerging fashion designers, Australian fashion design, ethical fashion, luxury Australian brand

Assessing Cardiovascular Risk in Regional Areas: The Healthy Hearts – Beyond City Limits Program

Background: Cardiovascular disease (CVD) is more prevalent in regional and remote Australia compared to metropolitan areas. The aim of Healthy Hearts was to determine age and sex specific CVD risk factor levels and the potential value of national risk clinics. Methods: Healthy Hearts was an observational research study conducted in four purposefully selected higher risk communities in regional Victoria, Australia. The main outcome measures were the proportion of participants with CVD risk factors with group comparisons to determine the adjusted likelihood of elevated risk factor levels. Trained personnel used a standardized protocol over four weeks per community to measure CVD risk factor levels, estimate absolute CVD risk and provide feedback and advice. Results: A total of 2125 self-selected participants were assessed (mean age 58 ± 15 years, 57% women). Overall, CVD risk factors were highly prevalent. More men than women had ≥ 2 modifiable CVD risk factors (76% vs. 68%, p < .001), pre-existing CVD (20 vs. 15%, p < .01) and a major ECG abnormality requiring follow-up (15% vs. 7%, p < .001) . Less men reported depressive symptoms compared to women (28% vs. 22%, p < .01). A higher proportion of women were obese (adjusted OR 1.36, 95% CI 1.13 to 1.63), and physically inactive (adjusted OR 1.32, 95% CI 1.07 to 1.63). Conclusions: High CVD risk factor levels were confirmed for regional Victoria. Close engagement with individuals and communities provides scope for the application of regional risk management clinics to reduce the burden of CVD risk in regional Australia.

Analysis of Object-Specific Authorization Protocol (OSAP) using coloured Petri nets

The use of Trusted Platform Module (TPM) is be- coming increasingly popular in many security sys- tems. To access objects protected by TPM (such as cryptographic keys), several cryptographic proto- cols, such as the Object Specific Authorization Pro- tocol (OSAP), can be used. Given the sensitivity and the importance of those objects protected by TPM, the security of this protocol is vital. Formal meth- ods allow a precise and complete analysis of crypto- graphic protocols such that their security properties can be asserted with high assurance. Unfortunately, formal verification of these protocols are limited, de- spite the abundance of formal tools that one can use. In this paper, we demonstrate the use of Coloured Petri Nets (CPN) - a type of formal technique, to formally model the OSAP. Using this model, we then verify the authentication property of this protocol us- ing the state space analysis technique. The results of analysis demonstrates that as reported by Chen and Ryan the authentication property of OSAP can be violated.

Responding to the 5Rs : an alternate perspective of Slowmation

This paper is a response to Hoban and Neilsen's (2010) Five Rs model for understanding how learners engage with slowmation. An alternative model (the Learning MMAEPER Model) that builds on the 5Rs model is explained in terms of its use in secondary science preservice teacher education. To probe into the surface and deep learning that can occur during the creation of a slowmation, the learning and relearning model is explored in terms of learning elements. This model can assist teachers to monitor the learning of their students and direct them to a deeper understanding of science concepts.

Child car restraints : mandating type and seating row according to age with positive effect in regional city in Queensland, Australia

Road trauma is a leading cause of child injury worldwide. In highly motorised countries, injury as a passenger represents a major proportion of all child road deaths and hospitalisations. Australia is no exception, particularly since there are high levels of private motor vehicle travel to school in most Australian states. Recently the legislation governing the type of car restraints required for children aged under 7 years has changed in Australia, aligning requirements better with accepted best practice. However, it is unclear what effect these changes have had on children’s seating positions or the types of restraints used. A mixed methods evaluation of the impact of the new legislation on compliance was conducted at three times: baseline (Time 1); after announcement that changes were going to be implemented but before enforcement began (Time 2); and after enforcement commenced (Time 3). Measures of compliance were obtained using two methods: road-side observations of vehicles with child passengers; and parental self-report (intercept interviews conducted at Time 2 and Time 3 only). Results from the observations suggested an overall positive effect. Proportions of children occupying front seats decreased overall and use of dedicated child seats increased to almost 40% of the observed children by Time 3. However, almost a quarter of the children observed still occupied front seats. These results differed from those of the interview study where almost no children were reported as usually travelling in the front seat, and reported use of dedicated restraints with children was almost 90%, over twice that of the observations.

Physical activity in three regional communities in Queensland

Objective. To describe physical activity participation in three Queensland regional communities. Design. Cross-sectional mail survey of randomly selected residents, stratified by age and sex. Setting. Esk, Mareeba and Mount Isa. Participants. 1219 (58% female) adults, with a mean age 46.7 (SD 14.7) years. Main outcome measures. Proportion of people inactive, meeting Australian activity guidelines (a minimum of 150 minutes/week and 5 sessions/week), and walking a dog daily; time spent walking and cycling for transport; location and type of recreational physical activities. Results. Overall, 18% of respondents were inactive, with the highest proportions among women (22.3%) and older adults in Mount Isa (24.3%). The proportion meeting activity guidelines was 47% with the lowest proportions among women in Mount Isa (40.4%). Although 63% reported owning a dog, only 22% reported walking a dog daily. Few people reported walking or cycling for transport. The most common types of activities were walking, home-based exercise, running/jogging, and swimming, and the most common location was at or near home. Conclusions. Physical activity levels were lower in these regional communities than the state average. The findings indicate a need for physical activity policy and intervention strategies targeting regional and rural areas. This could focus on women and older adults, dog walking, and physical activity opportunities in or near the home.

Does teaching sequence matter when teaching high school chemistry with scientific visualisations?

Five Canadian high school Chemistry classes in one school, taught by three different teachers, studied the concepts of dynamic chemical equilibria and Le Chatelier’s Principle. Some students received traditional teacher-led explanations of the concept first and used an interactive scientific visualisation second, while others worked with the visualisation first and received the teacher-led explanation second. Students completed a test of their conceptual understanding of the relevant concepts prior to instruction, after the first instructional session and at the end of instruction. Data on students’ academic achievement (highest, middle or lowest third of the class on the mid-term exam) and gender were also collected to explore the relationship between these factors, conceptual development and instructional sequencing. Results show, within this context at least, that teaching sequence is not important in terms of students’ conceptual learning gains.

Parental bonding, family systems, and environmental predictors of adolescent homelessness

A multicausal model of adolescent homelessness is proposed, based upon the notion that homeless youth suffer from emotional, social, and cultural deprivation. The model was tested in a sample of homeless adolescents (n = 54) and a similar, but not homeless, control group (n = 58). Emotional deprivation was assessed on the Parental Bonding Inventory (Parker, Tupling,&Brown, 1979), whereas social and cultural deprivation were assessed on the Family Environment Scale (Moos&Moos, 1981). The homeless adolescents were found to be significantly more deprived emotionally, socially, and culturally than the controls. The results indicate support for a deprivation model of adolescent homelessness with implications for public policy and intervention planning.

Curbing resource consumption using team-based feedback : paper printing in a longitudinal case study

This paper details a team-based feedback approach for reducing resource consumption. The approach uses paper printing within office environments as a case study. It communicates the print usage of each participant’s team rather than the participant’s individual print usage. Feedback is provided weekly via emails and contains normative information, along with eco-metrics and team-based comparative statistics. The approach was empirically evaluated to study the effectiveness of the feedback method. The experiment comprised of 16 people belonging to 4 teams with data on their print usage gathered over 58 weeks, using the first 30-35 weeks as a baseline. The study showed a significant reduction in individual printing with an average of 28%. The experiment confirms the underlying hypothesis that participants are persuaded to reduce their print usage in order to improve the overall printing behaviour of their teams. The research provides clear pathways for future research to qualitatively investigate our findings.

Intra-amniotic ureaplasma infection : adverse outcomes vary depending on gestation

Background: Ureaplasmas are the most prevalent bacteria isolated from preterm deliveries and the prognosis for neonates varies depending on the gestation at delivery. Ureaplasmas vary their surface-exposed antigen (MBA, a virulence mechanism) during chronic intra-amniotic infections, but it is not known when changes first occur during gestation. Method: U. parvum serovar 3 (2x10e7CFU) was injected intra-amniotically (IA) into six experimental cohorts of pregnant ewes (of n=7), 3 days (d) or 7d before delivery at either: 100d, 124d or 140d gestation (term=145d). Control ewes received IA 10B broth. Fetuses were delivered surgically and ureaplasmas cultured from amniotic fluid (AF), chorioamnion, fetal lung (FL) and umbilical cord. Ureaplasmas were tested by western blot to demonstrate MBA variation. Results: The highest number of ureaplasmas were recovered from FL at 100d gestation after 3 days of infection (p<0.03). Six of 7(86%) 100d–3d FL demonstrated an ureaplasma MBA variant, but only 17% and 15% of FL showed an MBA variant after 3d infection at 124d and 140d gestation respectively. Greatest variation of the MBA occurred in AF and FL at 124d gestation after 7d infection. The least MBA variation was observed at 140d; however, at this time the most severe histological chorioamnionitis was observed. Conclusions: After intra-amniotic ureaplasma injections, higher numbers of ureaplasmas gained access to the FL at 100d gestation than observed at later gestations. This may exacerbate the adverse outcomes for neonates delivered early in gestation. In late gestation, ureaplasma MBA variation was minimal, but chorioamnionitis was the most severe. Adverse pregnancy outcomes associated with IA ureaplasma infection may vary depending on the duration of gestation, the number of ureaplasmas isolated from the fetal tissues and the degree of MBA variation.

Ureaplasma speioces are associated with chorioamnionitiis in late preterm placentas

Background: Preterm birth is a major cause of neonatal morbidity and mortality, with 75% of preterm births occurring late preterm. Previous studies have investigated the microbial diversity within placentas delivered early preterm but there has been no investigation of the prevalence of bacteria, particularly Ureaplasma spp. in late preterm placentas. Method: Women giving birth late preterm (320 – 366 weeks of gestation) in Cincinnati were recruited for this study. Samples of chorioamnion were collected aseptically at the time of delivery, shipped to QUT and tested for Ureaplasma spp. and other bacteria by culture and/or PCR assays. The presence of bacteria was correlated with adverse pregnancy outcomes, including histological chorioamnionitis (tissue sections read by US pathologists). Results: To date, Ureaplasma spp. have been detected in 15/270 (5.5%) of placentas by culture and 19/270 (7%) by PCR. Ureaplasma presence correlated with histological chorioamnionitis (12/19%; 63%). However, the presence of other bacteria was not associated with chorioamnionitis (5%). Chorioamnionitis was unevenly distributed in ethnic groups, with a higher incidence in African-Americans’ (6/7; 86%), compared to Caucasians’ (6/12; 50%) who were colonised with ureaplasmas. Conclusion: This study is the first to report the prevalence of ureaplasmas in women (7%) who deliver late preterm. Ureaplasma spp. were associated with a higher incidence of chorioamnionitis (63% compared to 15% for non-infected women). This data strongly suggests that ureaplasmas are a cause of late preterm deliveries and African-American women are at greater risk of chorioamnionitis.