Development of the Rapid Assessment, Prioritisation and Referral Tool (RAPaRT) for multidisciplinary teams in emergency care settings

Objective This investigation utilised the expertise of allied members of multidisciplinary teams working in emergency care settings to develop and validate a Rapid Assessment Prioritisation and Referral Tool (RAPaRT). This instrument is intended for use among patients (with non-life threatening acuity) presenting to emergency care settings to indicate when referral to an allied member of the multidisciplinary team is warranted. Method This three stage instrument development and validation study included: a Delphi panel process to determine key criteria to guide instrument development and identify potential items to be carried forward for testing (stage 1); a prospective cohort of consecutive admissions (n=153) to investigate item sensitivity and specificity and retain only the most suitable items (stage 2); then final consultation with the Delphi panel to ensure the final instrument was clinically amenable (stage 3). Results 23 potential items were identified following stage 1. At the completion of item sensitivity and specificity analysis and in consultation with the Delphi panel, seven items were retained in the instrument. Area under the receiver operating characteristic curve was 0.803 for these seven items in predicting when a referral was warranted. Final consultation with the Delphi panel members also resulted in the addition of an open ended (eighth) item to allow description of any infrequent, but important, reason for referral. Conclusions The RAPaRT has demonstrated substantial promise as an efficient clinically amenable instrument to assist multidisciplinary teams in emergency care settings. Further research to investigate the wider implementation of the RAPaRT is warranted.

Towards fairer assessment

Drawing on the largest Australian collection and analysis of empirical data on multiple facets of Aboriginal and Torres Strait Islander education in state schools to date, this article critically analyses the systemic push for standardized testing and improved scores, and argues for a greater balance of assessment types by providing alternative, inclusive, participatory approaches to student assessment. The evidence for this article derives from a major evaluation of the Stronger Smarter Learning Communities. The first large-scale picture of what is occurring in classroom assessment and pedagogy for Indigenous students is reported in this evaluation yet the focus in this article remains on the issue of fairness in student assessment. The argument presented calls for “a good balance between formative and summative assessment” (OECD, Synergies for Better Learning An International Perspective on Evaluation and Assessment, Pointers for Policy Development, 2013) at a time of unrelenting high-stakes, standardized testing in Australia with a dominance of secondary as opposed to primary uses of NAPLAN data by systems, schools and principals. A case for more “intelligent accountability in education” (O’Neill, Oxford Review of Education 39(1):4–16, 2013) together with a framework for analyzing efforts toward social justice in education (Cazden, International Journal of Educational Psychology 1(3):178–198, 2012) and fairer assessment make the case for more alternative assessment practices in recognition of the need for teachers’ pedagogic practice to cater for increased diversity.

How neoliberalism and ecological modernization shaped environmental policy in Australia

‘Sustainability’ provides the dominant frame within which environmental policy debate occurs, notwithstanding its divergent meanings. However, how different discourses combine to shape understanding of the environment, the causes of environmental issues, and the responses required, is less clear cut. Drawing primarily on the approach to critical discourse analysis (CDA) developed by Fairclough, this paper explores the way in which neoliberal and ecologically modern discourses combine to shape environmental policy. Environmental scholars have made relatively little use of this approach to CDA to date, despite the significant interest in the discursive aspects of environmental issues, and its wide use in other areas of policy interest. Using the case of environmental policy-making in Victoria, Australia, this paper illustrates how neoliberalism and weak ecological modernization represented sustainability in ways that seriously limited the importance of environmental issues.

A bioengineered 3D ovarian cancer model for the assessment of peptidase-mediated enhancement of spheroid growth and intraperitoneal spread

Cancer-associated proteases promote peritoneal dissemination and chemoresistance in malignant progression. In this study, kallikrein-related peptidases 4, 5, 6, and 7 (KLK4-7)-cotransfected OV-MZ-6 ovarian cancer cells were embedded in a bioengineered three-dimensional (3D) microenvironment that contains RGD motifs for integrin engagement to analyze their spheroid growth and survival after chemotreatment. KLK4-7-cotransfected cells formed larger spheroids and proliferated more than controls in 3D, particularly within RGD-functionalized matrices, which was reduced upon integrin inhibition. In contrast, KLK4-7-expressing cell monolayers proliferated less than controls, emphasizing the relevance of the 3D microenvironment and integrin engagement. In a spheroid-based animal model, KLK4-7-overexpression induced tumor growth after 4 weeks and intraperitoneal spread after 8 weeks. Upon paclitaxel administration, KLK4-7-expressing tumors declined in size by 91% (controls: 87%) and showed 90% less metastatic outgrowth (controls: 33%, P<0.001). KLK4-7-expressing spheroids showed 53% survival upon paclitaxel treatment (controls: 51%), accompanied by enhanced chemoresistance-related factors, and their survival was further reduced by combination treatment of paclitaxel with KLK4/5/7 (22%, P=0.007) or MAPK (6%, P=0.006) inhibition. The concomitant presence of KLK4-7 in ovarian cancer cells together with integrin activation drives spheroid formation and proliferation. Combinatorial approaches of paclitaxel and KLK/MAPK inhibition may be more efficient for late-stage disease than chemotherapeutics alone as these inhibitory regimens reduced cancer spheroid growth to a greater extent than paclitaxel alone.

A pre-clinical functional assessment of an acellular scaffold intended for the treatment of hard-to-heal wounds

Dermal wound healing is a biochemical and cellular process critical to life. While the majority of the population will only ever experience successful wound healing outcomes, some 1-3 % of those aged over 65 years will experience wound healing delay or perpetuation. These hard-to-heal wounds are comprised of degraded and dysfunctional extracellular matrix, yet the integrity of this structure is critical in the processes of normal wound healing. As such, extracellular matrix replacements have been devised that can replace dysfunctional extracellular matrix in hard-to-heal wounds with the aim of restoring normal wound healing processes. Here we evaluated a novel synthetic matrix protein for its ability to act as an acellular scaffold that can replace dysfunctional extracellular matrix. In this regard the synthetic protein demonstrated an ability to rapidly adsorb to the dermal surface, permit cell attachment and facilitate the cellular functions essential to wound healing. When applied to deep partial thickness wounds in a porcine animal model the matrix protein also demonstrated the ability to reduce wound duration. These data provide evidence that the synthetic matrix protein has the ability to function as an acellular scaffold for wound healing purposes.

Objectifying the Subjective : Assessment and Feedback in Creative Arts Studio Learning and Teaching

This paper examines the Assessment and Feedback aspects of Studio Teaching as Creative Arts pedagogy. Prompted by USQ’s newly offered Bachelor of Creative Arts (BCA), the author has developed an Assessment Matrix specifically designed to satisfy a number of imperatives, including: • ‘objectifying’ the subjective aspects of creative practice as assessable coursework/research • providing the means by which accurate, detailed, personalised and confidential feedback may be provided to students individually • providing consistent, accurate, meaningful assessment records for student, lecturer, and institution • ensuring consistency, continuity, and transparency of assessment processes and records to satisfy quality audits • minimising marking and assessment time, whilst maximising assessment integrity and depth • requiring only basic level skills and knowledge of a computer application already in common use (Microsoft Excel) • adaptability to a range of creative courses ‐ across disciplines This Assessment Matrix has been in development (and trialled) since January 2009.

Bayesian networks in environmental and resource management

This overview article for the special series “Bayesian Networks in Environmental and Resource Management” reviews 7 case study articles with the aim to compare Bayesian network (BN) applications to different environmental and resource management problems from around the world. The article discusses advances in the last decade in the use of BNs as applied to environmental and resource management. We highlight progress in computational methods, best-practices for model design and model communication. We review several research challenges to the use of BNs in environmental and resource management that we think may find a solution in the near future with further research attention.

The development of shared understandings of assessment policy : travelling between global and local contexts

In this paper, teachers’ enactment of assessment policy within demands for accountability and consistency of teacher judgements is considered. Evidence is drawn from a qualitative study involving 50 middle school teachers from Queensland, Australia, who participated in online social moderation meetings with teachers located in dispersed areas around the state. The study presents how travelling policy is embedded in local histories and cultures, in particular within systems of accountability; and the different layers of what may be considered ‘local’. The paper examines the intersections of travelling and embedded policy, and global and local contexts as these are enacted through online moderation meetings.

Physiotherapists have accurate expectations of their patients’ future health-related quality of life after first assessment in a subacute rehabilitation setting

BACKGROUND Expectations held by health professionals and their patients are likely to affect treatment choices in subacute inpatient rehabilitation settings for older adults. There is a scarcity of empirical evidence evaluating whether health professionals expectations of the quality of their patients' future health states are accurate. METHODS A prospective longitudinal cohort investigation was implemented to examine agreement (kappa coefficients, exact agreement, limits-of-agreement, and intraclass-correlation coefficients) between physiotherapists' (n = 23) prediction of patients' discharge health-related quality of life (reported on the EQ-5D-3L) and the actual health-related quality of life self-reported by patients (n = 272) at their discharge assessment (using the EQ-5D-3L). The mini-mental state examination was used as an indicator of patients' cognitive ability. RESULTS Overall, 232 (85%) patients had all assessment data completed and were included in analysis. Kappa coefficients (exact agreement) ranged between 0.37-0.57 (58%-83%) across EQ-5D-3L domains in the lower cognition group and 0.53-0.68 (81%-85%) in the better cognition group. CONCLUSIONS Physiotherapists in this subacute rehabilitation setting predicted their patients' discharge health-related quality of life with substantial accuracy. Physiotherapists are likely able to provide their patients with sound information regarding potential recovery and health-related quality of life on discharge. The prediction accuracy was higher among patients with better cognition than patients with poorer cognition.

Applying the ecological model of behavior change to a physical activity trial in retirement communities : description of the study protocol

Objectives To describe the intervention protocol for the first multilevel ecological intervention for physical activity in retirement communities that addresses individual, interpersonal and community influences on behavior change. Design A cluster randomized controlled trial design was employed with two study arms: a physical activity intervention and an attention control successful aging condition. Setting Sixteen continuing care retirement communities in San Diego County. Participants Three hundred twenty older adults, aged 65 years and older, are being recruited to participate in the trial. In addition, peer leaders are being recruited to lead some study activities, especially to sustain the intervention after study activities ceased. Intervention Participants in the physical activity trial receive individual, interpersonal and community intervention components. The individual level components include pedometers, goal setting and individual phone counseling. The interpersonal level components include group education sessions and peer-led activities. The community level components include resource audits and enumeration, tailored walking maps, and community improvement projects. The successful aging group receives individual and group attention about successful aging topics. Measurements The main outcome is light to moderate physical activity, measured objectively by accelerometry. Other objective outcomes included physical functioning, blood pressure, physical fitness, and cognitive functioning. Self report measures include depressive symptoms and health related quality of life. Results The intervention is being delivered successfully in the communities and compliance rates are high. Conclusion Ecological Models call for interventions that address multiple levels of the model. Previous studies have not included components at each level and retirement communities provide a model environment to demonstrate how to implement such an intervention.

Assessment of freestanding membranes prepared from Antheraea pernyi silk fibroin as a potential vehicle for corneal epithelial cell transplantation

Freestanding membranes created from Bombyx mori silk fibroin (BMSF) offer a potential vehicle for corneal cell transplantation since they are transparent and support the growth of human corneal epithelial cells (HCE). Fibroin derived from the wild silkworm Antheraea pernyi (APSF) might provide a superior material by virtue of containing putative cell- attachment sites that are absent from BMSF. Thus we have investigated the feasibility of producing transparent, freestanding membranes from APSF and have analysed the behaviour of HCE cells on this material. No significant differences in cell numbers or phenotype were observed in short term HCE cell cultures established on either fibroin. Production of transparent freestanding APSF membranes, however, proved to be problematic as cast solutions of APSF were more prone to becoming opaque, displayed significantly lower permeability and were more brittle than BMSF-membranes. Cultures of HCE cells established on either membrane developed a normal stratified morphology with cytokeratin pair 3/12 being immuno-localized to the superficial layers. We conclude that while it is feasible to produce transparent freestanding membranes from APSF, the technical difficulties associated with this biomaterial, along with an absence of enhanced cell growth, currently favours the continued development of BMSF as a preferred vehicle for corneal cell transplantation. Nevertheless, it remains possible that refinement of techniques for processing APSF might yet lead to improvements in the handling properties and performance of this material.

Wrongful birth assessment of damages : judgment pending

Damages issues regarding the costs of raising the child argued in a case currently before the NSW Supreme Court - Waller v James litigation pre-dated the Health Care Liability Act 2001 and the Civil Liability Act 2002.

Wrongful birth assessment of damages : judgment pending

Wrongful birth - assessment of damages - overview of damages issues raised in current and previous litigation - breach of duty and causation - cost of raising a child - key damages assessment issues - application of civil liability legislation.

The development of a carrying capacity assessment model for the Australian socio-environmental context

A key aim of this research was to highlight how society's understanding of constraints to the productive capacity of its resource base is vital to its long-term survival. This was achieved through the development of an online model, the Carrying Capacity Dashboard. The Dashboard was developed to estimate how much land Australian populations require for the production of their food, textiles, timber and liquid fuel. Findings reveal that Australia's estimated carrying capacity is currently over 40 million people but longer-term and more regional analyses suggest a much smaller number. Carrying capacity assessment also indicates that optimal resource security is to be found in balancing both small and large-scale self-sufficiency.