1000 voices: reflective online multimodal narrative inquiry as a research methodology for disability research

This article outlines the research approach used in the international 1000 Voices Project. The 1000 Voices project is an interdisciplinary research and public awareness project that uses a customised online multimodal storytelling platform to explore the lives of people with disability internationally. Through the project, researchers and partners have encouraged diverse participants to select the modes of storytelling (e.g. images, text, videos and combinations thereof) that suit them best and to self-define what both ‘disability’ and ‘life story’ mean to them. The online reflective component of the approach encourages participants to organically and reflectively develop story events and revisions over time in ways that suit them and their emerging lives. This article provides a detailed summary of the project's theoretical and methodological development alongside suggestions for future development in social work and qualitative research.

Differential subcellular and extracellular localisations of proteins required for insulin-like growth factor- and extracellular matrix-induced signalling events in breast cancer progression

Background: Cancer metastasis is the main contributor to breast cancer fatalities as women with the metastatic disease have poorer survival outcomes than women with localised breast cancers. There is an urgent need to develop appropriate prognostic methods to stratify patients based on the propensities of their cancers to metastasise. The insulin-like growth factor (IGF)-I:IGF binding protein (IGFBP):vitronectin complexes have been shown to stimulate changes in gene expression favouring increased breast cancer cell survival and a migratory phenotype. We therefore investigated the prognostic potential of these IGF- and extracellular matrix (ECM) interaction-induced proteins in the early identification of breast cancers with a propensity to metastasise using patient-derived tissue microarrays. Methods: Semiquantitative immunohistochemistry analyses were performed to compare the extracellular and subcellular distribution of IGF- and ECM-induced signalling proteins among matched normal, primary cancer and metastatic cancer formalin-fixed paraffin-embedded breast tissue samples. Results: The IGF- and ECM-induced signalling proteins were differentially expressed between subcellular and extracellular localisations. Vitronectin and IGFBP-5 immunoreactivity was lower while β1 integrin immunoreactivity was higher in the stroma surrounding metastatic cancer tissues, as compared to normal breast and primary cancer stromal tissues. Similarly, immunoreactive stratifin was found to be increased in the stroma of primary as well as metastatic breast tissues. Immunoreactive fibronectin and β1 integrin was found to be highly expressed at the leading edge of tumours. Based on the immunoreactivity it was apparent that the cell signalling proteins AKT1 and ERK1/2 shuffled from the nucleus to the cytoplasm with tumour progression. Conclusion: This is the first in-depth, compartmentalised analysis of the distribution of IGF- and ECM-induced signalling proteins in metastatic breast cancers. This study has provided insights into the changing pattern of cellular localisation and expression of IGF- and ECM-induced signalling proteins in different stages of breast cancer. The differential distribution of these biomarkers could provide important prognostic and predictive indicators that may assist the clinical management of breast disease, namely in the early identification of cancers with a propensity to metastasise, and/or recur following adjuvant therapy.

Sequential monitoring of hospital adverse events when control charts fail : the example of fall injuries in hospitals

Objective To evaluate methods for monitoring monthly aggregated hospital adverse event data that display clustering, non-linear trends and possible autocorrelation. Design Retrospective audit. Setting The Northern Hospital, Melbourne, Australia. Participants 171,059 patients admitted between January 2001 and December 2006. Measurements The analysis is illustrated with 72 months of patient fall injury data using a modified Shewhart U control chart, and charts derived from a quasi-Poisson generalised linear model (GLM) and a generalised additive mixed model (GAMM) that included an approximate upper control limit. Results The data were overdispersed and displayed a downward trend and possible autocorrelation. The downward trend was followed by a predictable period after December 2003. The GLM-estimated incidence rate ratio was 0.98 (95% CI 0.98 to 0.99) per month. The GAMM-fitted count fell from 12.67 (95% CI 10.05 to 15.97) in January 2001 to 5.23 (95% CI 3.82 to 7.15) in December 2006 (p<0.001). The corresponding values for the GLM were 11.9 and 3.94. Residual plots suggested that the GLM underestimated the rate at the beginning and end of the series and overestimated it in the middle. The data suggested a more rapid rate fall before 2004 and a steady state thereafter, a pattern reflected in the GAMM chart. The approximate upper two-sigma equivalent control limit in the GLM and GAMM charts identified 2 months that showed possible special-cause variation. Conclusion Charts based on GAMM analysis are a suitable alternative to Shewhart U control charts with these data.

Women IN Sport or Women OR Sport - The search for work/sport/life balance.

The current ‘holy grail’ for our health and well-being centres around the search for, and establishment of, a work/life balance. For many individuals, this appears to be an ever-elusive goal – forever slipping from our grasp as we juggle the day-to-day battle for our attention and time from an array of sources. When we add the word ‘Women’ to this mix, often the number of sources related to these demands multiplies in alignment with the number of roles we fill. To take this to even another level, consider the addition of the words ‘Sport’ or ‘Elite Athlete’ to ‘Women’ and ‘Work/Life Balance’, and the search for the ‘holy grail’ becomes more literal! Many sportswomen at the elite level face significant challenges in balancing working to support themselves and/or their families, studying to lay the foundations of a post-sport career, (often) spending the equivalent of full-time hours training towards their sporting goals, and additionally investing in the things that are important for them outside of these two areas – the ‘Life’ component. Getting the work/life balance ‘balanced’ has been suggested to be a key component of investing in our health and well-being. The same is applicable to sportswomen, with the added suggestion that if the balance between work/sport/life is achieved, this can positively impact upon sporting performance itself. These ideas and observations will be explored via experience within the Australian elite sporting environment from a psychologist’s perspective, with questions and invitations for further discussion.

Street reads - Creating mobile walking events

By 2012 mobile devices had become the main interface for people to access information about anything from their current GPS position to the latest book reviews. What was less accessible were tools and techniques for writers to leverage this new technology to construct and distribute located stories. This project began with a series of master classes for local Brisbane writers to demonstrate processes and techniques for imagining, constructing and distributing stories. Most significantly, this project equipped writers with how to identify and adopt various mobile services and applications to research, produce and deliver packaged multi-modal content for readers to access and experience stories in the very locations from which they were inspired. Four stories by four writers were selected to be developed and published as location-based events in four different neighbourhoods across Brisbane. These writers were mentored throughout the writing process and a model was developed for them to simply upload several multi-modal chapters for access on location by readers using QR codes. These activities culminated in a major 25 day event presented by Brisbane City Council and supported by Brisbane Writers Festival and Queensland Writers Centre. The 'Street Reads' event presented the four stories on location in Cannon Hill, Darra, Toowong and West End. The significance of the Street Reads project went beyond extending the capacity for writers to access mobile technologies as a new platform for distributing stories. This event also motivated readers to travel to neighbourhoods to experience them in ways that had not previously imagined possible. These located stories were fictionalisations of actual events and characters that have current and historic importance to these places. These histories are hidden from view and yet can provide locals and visitors with a new found appreciation for the past and set an example for how neighbourhoods can become active stages for the sharing of stories inspiring a deeper connection with each other and an agency for participating in the development of the identity of the local places they inhabit together. Due to the success of the project and by employing more advanced tools now available, Street reads has been further developed by Brisbane City Council and is now available as a the Story City App available for download at itunes.

Interpreting and comparing risks in the presence of competing events

Competing events are common in medical research. Ignoring them in the statistical analysis can easily lead to flawed results and conclusions. This article uses a real dataset and a simple simulation to show how standard analysis fails and how such data should be analysed

Doctors' knowledge of the law on withholding and withdrawing life-sustaining medical treatment

Objectives To examine the level of knowledge of doctors about the law on withholding and withdrawing life-sustaining treatment from adults who lack decision-making capacity, and factors associated with a higher level of knowledge. Design, setting and participants Postal survey of all specialists in emergency medicine, geriatric medicine, intensive care, medical oncology, palliative medicine, renal medicine and respiratory medicine on the AMPCo Direct database in New South Wales, Victoria and Queensland. Survey initially posted to participants on 18 July 2012 and closed on 31 January 2013. Main outcome measures Medical specialists’ levels of knowledge about the law, based on their responses to two survey questions. Results Overall response rate was 32%. For the seven statements contained in the two questions about the law, the mean knowledge score was 3.26 out of 7. State and specialty were the strongest predictors of legal knowledge. Conclusions Among doctors who practise in the end-of-life field, there are some significant knowledge gaps about the law on withholding and withdrawing life-sustaining treatment from adults who lack decision-making capacity. Significant consequences for both patients and doctors can flow from a failure to comply with the law. Steps should be taken to improve doctors’ legal knowledge in this area and to harmonise the law across Australia.

Save Your Life Tonight : Heads Up

Save Your Life Tonight is a factual entertainment series produced by WildBear Entertainment for the Australian Broadcasting Corporation (ABC) and was filmed in front of a live studio audience at Royal Brisbane and Women's Hospital (RBWH). Save Your Life Tonight is a unique studio based medical series that explores Australia’s top 10 health issues in an exciting and entertaining way. Driven by charismatic host Andrew Daddo, along with resident GP Dr Liz Marles and a panel of leading experts, each episode is a fast-paced, dynamic exploration of the causes, symptoms, treatments and, most importantly, prevention of these leading health issues. But Save Your Life Tonight doesn't just talk about the issues, it shows the issues! Save Your Life Tonight features real patients, real doctors, real tests, real diagnoses, and real surgical procedures – live on stage! For the "Heads Up" episode, the program explores the issues of mental health. Only half of the Australians suffering from severe mental heath issues are receiving treatment. Featuring Ian Hickie on the panel, we also see a young mum face her crippling bird phobia with the help of a Wedge Tailed Eagle.

Physical activity, walking and quality of life in women with depressive symptoms

Background Physical activity (PA) has a positive association with health-related quality of life (HRQL) in the general population. The association between PA and HRQL in those with poor mental health is less clear. Purpose To examine the concurrent and prospective dose-response relationships between total physical activity (TPA) and walking only with HRQL in women aged 50-55 with depressive symptoms in 2001. Methods Participants were 1904 women born in 1946-1951 who completed mailed surveys for the Australian Longitudinal Study on Women's Health in 2001, 2004, 2007 and 2010 and who, in 2001, reported depressive symptoms. At each time point, they reported their weekly minutes of walking, moderate PA, and vigorous PA. A summary TPA score was created that accounted for differences in energy expenditure among the three PA types. Mixed models were used to examine associations between TPA and HRQL (SF-36 component and subscale scores) and between walking and HRQL, for women who reported walking as their only PA. Analyses were conducted in 2013-2014. Results Concurrently, higher levels of TPA and walking were associated with better HRQL (p<0.05). The strongest associations were found for physical functioning, vitality, and social functioning subscales. In prospective models, associations were attenuated, yet compared with women doing no TPA or walking, women doing “sufficient” TPA or walking had significantly better HRQL over time for most SF-36 scales. Conclusions This study extends previous work by demonstrating trends between both TPA and walking and HRQL in women reporting depressive symptoms.

Age, physical inactivity, obesity, health conditions, and health-related quality of life among patients receiving conservative management for musculoskeletal disorders

Background Musculoskeletal conditions and insufficient physical activity have substantial personal and economic costs among contemporary aging societies. This study examined the age distribution, comorbid health conditions, body mass index (BMI), self-reported physical activity levels, and health-related quality of life of patients accessing ambulatory hospital clinics for musculoskeletal disorders. The study also investigated whether comorbidity, BMI, and self-reported physical activity were associated with patients’ health-related quality of life after adjusting for age as a potential confounder. Methods A cross-sectional survey was undertaken in three ambulatory hospital clinics for musculoskeletal disorders. Participants (n=224) reported their reason for referral, age, comorbid health conditions, BMI, physical activity levels (Active Australia Survey), and health-related quality of life (EQ-5D). Descriptive statistics and linear modeling were used to examine the associations between age, comorbidity, BMI, intensity and duration of physical activity, and health-related quality of life. Results The majority of patients (n=115, 51.3%) reported two or more comorbidities. In addition to other musculoskeletal conditions, common comorbidities included depression (n=41, 18.3%), hypertension (n=40, 17.9%), and diabetes (n=39, 17.4%). Approximately one-half of participants (n=110, 49.1%) self-reported insufficient physical activity to meet minimum recommended guidelines and 150 (67.0%) were overweight (n=56, 23.2%), obese (n=64, 28.6%), severely obese (n=16, 7.1%), or very severely obese (n=14, 6.3%), with a higher proportion of older patients affected. A generalized linear model indicated that, after adjusting for age, self-reported physical activity was positively associated (z=4.22, P<0.001), and comorbidities were negatively associated (z=-2.67, P<0.01) with patients’ health-related quality of life. Conclusion Older patients were more frequently affected by undesirable clinical attributes of comorbidity, obesity, and physical inactivity. However, findings from this investigation are compelling for the care of patients of all ages. Potential integration of physical activity behavior change or other effective lifestyle interventions into models of care for patients with musculoskeletal disorders is worthy of further investigation.

Distant Deaths : How Newspapers Report Fatal Events from Abroad

Despite the advent of globalisation and increasing interaction between people from different cultures, many people still are influenced in their opinion about people from other countries based on what they read, see or hear in the mass media. By investigating how newspapers report about deaths in their foreign news sections, this book provides an in-depth account of the journalistic decision-making behind the portrayal of people from other countries. Although there have been a few studies that examined news coverage of foreign death to some extent, this particular study presents the first comprehensive analysis of the topic. The book examines how newspapers in Australia and Germany decide on which foreign deaths to cover and, employing an innovative framework, it finds that cultural connections play a large part in the decision-making process. Differences between the newspapers in terms of linguistic and visual coverage of fatal events can also be traced along cultural lines. The book will be useful to students of journalism, international and intercultural communication as well as anyone interested in discourses about death in the public sphere.

A new life of Hans Christian Andersen : a study of the ‘peculiar nature’ of an author’s life

A review of "Hans Christian Andersen : European Witness" by Paul Binding (Yale UP, 2014). How a writer bears witness to his age is necessarily the expression of many things, not least the possibly quite peculiar nature of an author’s life. Literary works often emerge from complex upbringings, from periods of youthful isolation spent reading and writing. More still seem to have been written as a result of the fraught relationships that befall authors, perhaps because authors so often view their relationships with a degree of creative and critical distance. And yet, if a writer’s output evidences an unusual life, it also witnesses broader questions being asked by a community as a whole. At some level, even the most remarkable figures are typical of their age, and reflections of it. By the close of Paul Binding’s study of the life and works of Hans Christian Andersen (1805–75), we are reminded that extraordinary feats of originality and imagination are often the result of how unique minds enter wider discourses...

A cultural life in Samoa

A travel article about a tour of Samoa. I WAKE to the smell of smoke. Outside, a morning routine has begun - the burning of leaves that overnight settle in the backyards. Even in the capital, gardens are miniature farms. Chickens, bananas and coconuts. When the smoke haze lifts and the faint waves of a sea breeze come off Apia Harbour, the corrugated iron roofs shine through like headlights coming out of fog...

City that enjoys life

A travel article about lifestyle and architecture in Vancouver, Canada. I arrived in Vancouver on a Sunday morning and followed the smell of crepes to a café that had opened early. It was warm, and the outside tables were filling up. The others had a last-night look about them, except a family that smiled as they took the table next to mine. There were no shoppers yet, but the mall was busy with walkers and cyclists. Here and there the down-and-out found seats in the sun; their shadows ran the length of shop fronts...