Identifying risk factors and protective factors for venous leg ulcer recurrence using a theoretical approach : a longitudinal study

Background The high recurrence rate of chronic venous leg ulcers has a significant impact on an individual’s quality of life and healthcare costs. Objectives This study aimed to identify risk and protective factors for recurrence of venous leg ulcers using a theoretical approach by applying a framework of self and family management of chronic conditions to underpin the study. Design Secondary analysis of combined data collected from three previous prospective longitudinal studies. Setting The contributing studies’ participants were recruited from two metropolitan hospital outpatient wound clinics and three community-based wound clinics. Participants Data were available on a sample of 250 adults, with a leg ulcer of primarily venous aetiology, who were followed after ulcer healing for a median follow-up time of 17 months after healing (range: 3 to 36 months). Methods Data from the three studies were combined. The original participant data were collected through medical records and self-reported questionnaires upon healing and every 3 months thereafter. A Cox proportion-hazards regression analysis was undertaken to determine the influential factors on leg ulcer recurrence based on the proposed conceptual framework. Results The median time to recurrence was 42 weeks (95% CI 31.9–52.0), with an incidence of 22% (54 of 250 participants) recurrence within three months of healing, 39% (91 of 235 participants) for those who were followed for six months, 57% (111 of 193) by 12 months, 73% (53 of 72) by two years and 78% (41 of 52) of those who were followed up for three years. A Cox proportional-hazards regression model revealed that the risk factors for recurrence included a history of deep vein thrombosis (HR 1.7, 95% CI 1.07–2.67, p=0.024), history of multiple previous leg ulcers (HR 4.4, 95% CI 1.84–10.5, p=0.001), and longer duration (in weeks) of previous ulcer (HR 1.01, 95% CI 1.003–1.01, p<0.001); while the protective factors were elevating legs for at least 30 minutes per day (HR 0.33, 95% CI 0.19–0.56, p<0.001), higher levels of self-efficacy (HR 0.95, 95% CI 0.92–0.99, p=0.016), and walking around for at least three hours/day (HR 0.66, 95% CI 0.44–0.98, p=0.040). Conclusions Results from this study provide a comprehensive examination of risk and protective factors associated with leg ulcer recurrence based on the chronic disease self and family management framework. These results in turn provide essential steps towards developing and testing interventions to promote optimal prevention strategies for venous leg ulcer recurrence.

From certificate chasing to genuine engagement : the contribution of curriculum design to students' career intent in a subfield

Many students enter business degrees without a defined career goal beyond working in the business world and adopt a scattergun approach to employability by accumulating certifications accessed through individual subjects. Yet, space and time limitations commonly prevent extended exposure to rewarding and interesting career subfields within main specialisations. This case study draws on student feedback collected over three years exploring students’ career interest following an elective human resource development subject in the final stage of a human resources major. Project-based curriculum provided students with scaffolded learning while undertaking key multiphase human resource development tasks. Subsequently, students reported human resource development career interest and intent, attributed to more realistic appreciation of human resource development’s activities, scope, and values. The paper makes an important contribution illustrating how curriculum design can transform instrumentalism into logically, emotionally, and intuitively based career engagement. Further, human resource development is a study and career area little mentioned in higher education or careers literature.

Instructional objectives to core-gameplay : a serious game design technique

This paper explores a gap within the serious game design research. That gap is the ambiguity surrounding the process of aligning the instructional objectives of serious games with their core-gameplay i.e. the moment-to-moment activity that is the core of player interaction. A core-gameplay focused design framework is proposed that can work alongside existing, more broadly focused serious games design frameworks. The framework utilises an inquiry-based approach that allows the serious game designer to use key questions as a means to clearly outline instructional objectives with the core-gameplay. The use of this design framework is considered in the context of a small section of gameplay from an educational game currently in development. This demonstration of the framework brings shows how instructional objectives can be embedded into a serious games core-gameplay.

From music student to industry professional: An entrepreneurial learning design

This design-based research project addresses the gap between formal music education curricula and the knowledge and skills necessary to enter the professional music industry. It analyses the work of a teacher/researcher who invited her high school students to start their own business venture, Youth Music Industries (YMI). YMI also functioned as a learning environment informed by the theoretical concepts of communities of practice and social capital. The students staged cycles of events of various scales over a three-year period, as platforms for young artists to engage and develop new, young audiences across Queensland, Australia. The study found that students developed an entrepreneurial mindset through acquisition of specific skills and knowledge. Their learning was captured and distilled into a set of design principles, a pedagogical approach transferrable across the creative industries more broadly.

The future passenger experience: A shift from physical to virtual design

The importance of passenger experience in aviation has become well understood in the last several years. It is now generally accepted that the provision of good passenger experience is not an option, but a necessity, from an aviation profitability perspective. In this paper, we paint a picture of the future passenger experience by consolidating a number of industry and research perspectives. Using the future passenger experience as a starting point, we explore the components needed to enable this future vision. From this bottom-up approach, we identify the need to resolve data formatting and data ownership issues. The resolution of these data integration issues is necessary to enable the seamless future travel experience that is envisioned by the aviation industry. By looking at the passenger experience from this bottom-up, data centric perspective, we identify a potential shift in the way that future passenger terminals will be designed. Whereas currently the design of terminals is largely an architectural practice, in the near future, the design of the terminal building may become more of a virtual technology practice. This of course will pose a new set of challenges to designers of airport terminal environments.

Renewable energy distribution in public spaces: Analyzing the case of Ballast Point Park in Sydney, using a triple bottom line approach

As cities are rapidly developing new interventions against climate change, embedding renewable energy in public spaces is an important strategy. However, most interventions primarily include environmental sustainability while neglecting the social and economic interrelationships of electricity production. Although there is a growing interest in sustainability within environmental design and landscape architecture, public spaces are still awaiting viable energy-conscious design and assessment interventions. The purpose of this paper is to investigate this issue in a renowned public space—Ballast Point Park in Sydney—using a triple bottom line (TBL) case study approach. The emerging factors and relationships of each component of TBL, within the context of public open space, are identified and discussed. With specific focus on renewable energy distribution in and around Ballast Point Park, the paper concludes with a general design framework, which conceptualizes an optimal distribution of onsite electricity produced from renewable sources embedded in public open spaces.

Driving toward user-centered engineering in automotive design

In an industry worth more than €500 billion annually, producing more than 80 million vehicles worldwide each year and consisting of over 50 major manufacturers worldwide, the automotive industry represents a lucrative but highly competitive manufacturing industry (Deloitte, 2009a; European Automobile Manufacturers Association, 2012). With sales falling in Europe in 2013 for the sixth consecutive year (Boston and Curtin, 2014), automotive manufacturers are increasingly turning to new strategies to retain their share of sales in a contracting market. Some strategies have focused on the industry approach to manufacturing, namely, a technically focused push for a build-toorder process rather than the current build-to-stock approach in order to reduce overall value-chain costs and to increase efficiency (Parry and Roehrich, 2013, p. 13). However, others stress a more customer-orientated approach, striving to develop products that meet customer requirements (Oliver Wyman Group, 2007).

Specificity and context in post-exercise recovery: It is not a one-size-fits-all approach

The concept of specificity of exercise prescription and training is a longstanding and widely accepted foundation of the exercise sciences. Simply, the principle holds that training adaptations are achieved relative to the stimulus applied. That is, the manipulation of training variables (e.g. intensity or loading, mode, volume and frequency) directly influences the acute training stimulus, and so the long-term adaptive response (Young et al., 2001; Bird et al., 2005). Translating this concept to practice then recommends that exercise be prescribed specific to the desired outcomes, and the more closely this is achieved, the greater the performance gain is likely to be. However, the cardiovascular and metabolic adaptations traditionally associated with long, slow distance training types, similarly achieved using high-intensity training methods (for a review see Gibala et al., 2012), highlights understanding of underlying physiology as paramount for effective training program design. Various other factors including illness, sleep and psychology also impact on the training stimulus (Halson, 2014) and must be managed collectively with appropriate post-exercise recovery to continue performance improvements and reduce overtraining and injury risks (Kenttä and Hassmén, 1998).

Friendship group motives for alcohol consumption: A midstream social marketing approach

Alcohol has been estimated to cost Australia $36 Billion per year, almost double that of all illegal drugs combined. This thesis uncovered seven friendship group-level motives for alcohol consumption, these motives were: Competition, Copying, Commitments, Conformity, Winding down, Play, and Confidence. These motives were then measured and their correlation with self-reported alcohol consumption was assessed. Using these results will allow social marketers to design targeted programmes that achieve meaningful behaviour change that goes beyond merely informing or raising awareness about the dangers of alcohol.

Initial design and physical characterization of a polymeric device for osmosis-driven delayed burst delivery of vaccines

Achieving the combination of delayed and immediate release of a vaccine from a delivery device without applying external triggers remains elusive in implementing single administration vaccination strategies. Here a means of vaccine delivery is presented, which exploits osmosis to trigger delayed burst release of an active compound. Poly(-caprolactone) capsules of 2 mm diameter were prepared by dip-coating, and their burst pressure and release characteristics were evaluated. Burst pressures (in bar) increased with wall thickness (t in mm) following Pburst = 131.t + 3.4 (R2 = 0.93). Upon immersion in PBS, glucose solution-filled capsules burst after 8.7 ± 2.9 days. Copolymers of hydrophobic  -caprolactone and hydrophilic polyethylene glycol were synthesized and their physico-chemical properties were assessed. With increasing hydrophilic content, the copolymer capsules showed increased water uptake rates and maximum weight increase, while the burst release was earlier: 5.6 ± 2.0 days and 1.9 ± 0.2 days for 5 and 10 wt% polyethylene glycol, respectively. The presented approach enables the reproducible preparation of capsules with high versatility in materials and properties, while these vaccine delivery vehicles can be prepared separately from, and independently of the active compound.

Principles of experience design for airport terminals

In this thesis, the issue of airport terminal design is examined from a novel perspective: that of the passenger rather than the airport operator. A qualitative approach, based on interviews with 199 passengers at Brisbane International Terminal was adopted. The outcomes of this research make the following three key contributions to existing knowledge: (i) identification of a paradox in the Level of Service metrics, (ii) development of a conceptual model of passenger experience and six design principles and (iii) contribution towards advancing the theoretical knowledge about passengers and their experience in airport terminals.

Overcoming acculturation: Physical education recruits' experiences of an alternative pedagogical approach to games teaching

Background Physical education teacher education (PETE) programmes have been identified as a critical platform to encourage the exploration of alternative teaching approaches by pre-service teachers. However, the socio-cultural constraint of acculturation or past physical education and sporting experiences results in the maintenance of the status quo of a teacher-driven, reproductive paradigm. Previous studies have reported successfully overcoming the powerful influence of acculturation, resulting in a change in PETE students’ custodial teaching beliefs and receptiveness to alternative teaching approaches. However, to date, limited information has been reported about how PETE students’ acculturation shaped their receptiveness to an alternative teaching approach. This is particularly the case for PETE recruits identified in the literature as most resistant to change. Purpose To explore the features and experiences of an alternative games teaching approach that appealed to PETE recruits’ identified as most resistant to change, requiring a specific sample of PETE recruits with strong, custodial, traditional physical education teaching beliefs, and whom are high achieving sporting products of this traditional culture. The alternative teaching approach explored in this study is the constraints-led approach (CLA), which is similar operationally to TGfU, but distinguished by a neurobiological theoretical framework (nonlinear pedagogy) that informs learning design. Participants and Setting A purposive sample of 10 Australian PETE students was recruited for the study. All participants initially had strong, custodial, traditional physical education teaching beliefs, and were successful sporting products of this teaching approach. After experiencing the CLA as learners during a games unit, participants demonstrated receptiveness to the alternative pedagogy. Data Collection and Analysis Semi-structured interviews and written reflections were sources of data collection. Each participant was interviewed separately, once prior to participation in the games unit to explore their positive physical education experiences, and then again after participation to explore the specific games unit learning experiences that influenced their receptiveness to the alternative pedagogy. Participants completed written reflections about their personal experiences after selected practical sessions. Data were qualitatively analysed using grounded theory. Findings: Thorough examination of the data resulted in establishment of two prominent themes related to the appeal of the CLA for the participants: (i) psychomotor (effective in developing skill), and (ii), inclusivity (included students of varying skill level). The efficacy of the CLA in skill development was clearly an important mediator of receptiveness for highly successful products of a traditional culture. This significant finding could be explained by three key factors: the acculturation of the participants, the motor learning theory underpinning the alternative pedagogy and the unit learning design and delivery. The inclusive nature of the CLA provided a solution to the problem of exclusion, which also made the approach attractive to participants. Conclusion PETE educators could consider these findings when introducing an alternative pedagogy aimed at challenging PETE recruits’ custodial, traditional teaching beliefs. To mediate receptiveness, it is important that the learning theory underpinning the alternative approach is operationalised in a research-informed pedagogical learning design that facilitates students’ perceptions of the effectiveness of the approach through experiencing and or observing it working.

Beyond energy savings: Exploring how design can extend the scope of eco-feedback for users in the home

As energy use information is becoming increasingly visible and sharable, this research aimed to inform the design of eco-feedback systems for the home. It involved observation and analysis of people's practices, which involve energy use, and their use of a domestic eco-feedback system. The question was asked: how can design best engage people with energy consumption information- making feedback more relevant to home occupants? In addressing this, a specifically bottom-up approach was employed, studying what people actually do with eco-feedback, rather than what technologists imagine eco-feedback will do to people.

Data driven and practice-based evidence : design and development of efficient and effective clinical decision support system

Decision-making is such an integral aspect in health care routine that the ability to make the right decisions at crucial moments can lead to patient health improvements. Evidence-based practice, the paradigm used to make those informed decisions, relies on the use of current best evidence from systematic research such as randomized controlled trials. Limitations of the outcomes from randomized controlled trials (RCT), such as “quantity” and “quality” of evidence generated, has lowered healthcare professionals’ confidence in using EBP. An alternate paradigm of Practice-Based Evidence has evolved with the key being evidence drawn from practice settings. Through the use of health information technology, electronic health records (EHR) capture relevant clinical practice “evidence”. A data-driven approach is proposed to capitalize on the benefits of EHR. The issues of data privacy, security and integrity are diminished by an information accountability concept. Data warehouse architecture completes the data-driven approach by integrating health data from multi-source systems, unique within the healthcare environment.

Privacy, modesty, hospitality and the design of Muslim homes in Australia

The home environment is conceptualised in prolific ways within the academic literature. A home is an unparalleled base for human settlement and habitation that embodies a sensorial space that is layered with personal memories and traces of history. The success of a home in providing a strong ‘sense of place’ depends on various factors such as geographical location, monetary funds or personal perceptions. A home too, is an influential medium that allows its dwellers to express, perform and continue their cultural traditions and religious faiths. Traditional Islamic teachings and practices involve guidelines that apply directly to the domestic space. The principles of privacy, modesty and hospitality are paramount to these guidelines and each has a significant influence upon the design of Muslim homes and the home owners’ or dwellers’ domestic behaviours. Despite a significant increase of Muslim population in Australia over the last decade, very little is known about their perceptions of domestic life and their use of domestic spaces within an Australian context. This research investigated on how Muslims in Brisbane live and adapt within their Australian homes and if these homes meet their personal and familial needs to perform their daily activities, as well as maintaining and practising their Islamic faiths and traditions. Specific attention has been given to their perceptions on tripartite principles of privacy, modesty, and hospitality (PMH) and how they achieve these three objectives. A qualitative case study approach was used to investigate six Muslim families living in four Brisbane suburbs, consisting of: a) Case Study 1: three Muslim families residing in one suburb of Brisbane and, b) Case Study 2: three international Muslim students living in three different Brisbane suburbs. This research indicates that apart from minor ‘design-related’ difficulties, case study participants were able to continue to perform their daily activities within their current homes through minor changes to the use of the available interior spaces. Above all, case study participants opined that their current Australian homes provide them with adequate safety and privacy for their families without any major disturbances. Insight gained from these cases suggests that greater research attention needs to be given to the potential development of Australian home designs that are adaptable to the ever-changing needs of the Australian multicultural society. Awareness of the multifactorial nature of the influences on Muslims’ perceptions of home and their use of domestic space is needed if architects, building designers, engineers and builders are to be properly equipped to meet the needs of their Muslim clients.