A survey to evaluate the implementation of a national clinical assessment form

Purpose: The Australian Universities Radiation Therapy Student Clinical Assessment Form (AURTSCAF) was designed to assess the clinical skills of radiation therapy (RT) students from the six universities that offer entry level RT programs. Given the AURTSCAF has now been in use for over two years, the Radiation Therapy Program Coordinators (RTPC) group initiated a post implementation evaluation survey. This formed the final phase of the AURTSCAF project and was funded by the Radiation Oncology Division of the Department of Health and Ageing. Methods: A cross-sectional designed survey using purposive sampling was distributed via email to all RT clinical sites. The survey asked questions about the requirements of a pass grade for students at different stages of their program, and the addition of a new category of assessment related to fitness to practise. Response types included both forced choice closed ended responses and open ended responses. There was also a section for open comments about the AURTSCAF. Results: There were 100 responses (55%) from clinicians who had utilised the assessment form over the previous 12 month period. Responses highlighted several positives with regard to the utility and implementation of the form. Comments regarding areas for improvement with the standardisation of the grading of students and consensus for the addition of a new domain in fitness for practise have informed the recommended changes proposed for 2012. Conclusion: This evaluation has provided a representative sample of the views of clinicians involved in assessing students on clinical placement. Recommendations include the addition of the sixth domain of assessment: Fitness for practise, the addition of descriptors and prompts for this domain in the user guide, the addition of a consensus statement about the use of the rating scale and dissemination of the proposed changes nationally.

Development of self-efficacy questionnaire for Chinese family caregivers

The purpose of this study was to develop a Self-Efficacy Questionnaire for Chinese Family Caregivers. Semi-structured interviews with 10 family caregivers of people with dementia were conducted to explore how Chinese caregivers manage caregiving and what difficulties they face. The findings of the study assisted in the development of the instrument. Five categories of caregiver behaviours were identified from the qualitative data: gathering information about treatment, symptoms, and health care; obtaining support; responding to behaviour disturbances; managing household, personal, and medical care; and managing distress associated with caregiving. The challenges of caregiving were also identified, including deterioration of care recipients, particularly their behaviour disturbances, a shortage of supportive resources, stigmatization of dementia among the general population, as well as increased distress and decreased social activities due to increased care demand. The findings were used to develop the Self-Efficacy Questionnaire for Chinese Family Caregivers, and 35 items comprising five subscales (representing the above five categories of caregiver behaviour) were generated.

Testing a model of physical activity among mothers and fathers of young children: integrating self-determined motivation, planning, and the theory of planned behavior

Parents are at risk for inactivity; however, research into understanding parental physical activity (PA) is scarce. We integrated self-determined motivation, planning, and the theory of planned behavior (TPB) to better understand parental PA. Parents (252 mothers, 206 fathers) completed a main questionnaire assessing measures underpinning these constructs and a 1-week follow-up of PA behavior to examine whether self-determined motivation indirectly influenced intention via the TPB variables (i.e., attitude, subjective norm, and perceived behavioral control) and intention indirectly influenced behavior via planning. We found self-determined motivation on intention was fully mediated by the TPB variables and intention on behavior was partially mediated by the planning variables. In addition, slight differences in the model’s paths between the sexes were revealed. The results illustrate the range of important determinants of parental PA and provide support for the integrated model in explaining PA decision making as well as the importance of examining sex differences.

Designing a self-service technology to increase self-efficacy and maintain breastfeeding

Despite the significant health benefits attributed to breastfeeding, rates in countries, such as Australia, continue to remain static or to decline. Typically, the tangible support offered for women to support breastfeeding behaviours takes the form of face-to-face advice from health professionals, peer counselling via not-for-profit organizations such as the ABA, and provision of information through websites, pamphlets, and books. Prior research indicates that face-to-face support is more effective than telephone contact (Britton, McCormic, Renfrew, Wade, & King, 2009). Given the increasing costs associated with the provision of personalized face-to-face professional support and the need for some women to maximize privacy, discretion, and judgment-free consultations, there is a gap that could be filled by the use of m-technologies such as text messaging and other social media. The research team developed MumBubConnect; a two-way SMS system which combined the personalized aspects of face-to-face contact but maintained levels of privacy. The use of SMS was immediate, portable, and overcame many of the barriers associated with embarrassment. An Page 205 of 312 online survey of 130 breastfeeding mothers indicated that MumBubConnect facilitated the seeking of social support using m-technology, increased self-efficacy and maintained the desire behaviour.

The dual orexin/hypocretin receptor antagonist, almorexant, in the ventral tegmental area attenuates ethanol self-administration

Recent studies have implicated the hypocretin/orexinergic system in reward-seeking behavior. Almorexant, a dual orexin/hypocretin R1 and R2 receptor antagonist, has proven effective in preclinical studies in promoting sleep in animal models and was in Phase III clinical trials for sleep disorders. The present study combines behavioral assays with in vitro biochemical and electrophysiological techniques to elucidate the role of almorexant in ethanol and sucrose intake. Using an operant self-administration paradigm, we demonstrate that systemic administration of almorexant decreased operant selfadministration of both 20% ethanol and 5% sucrose. We further demonstrate that intraventral tegmental area (VTA) infusions, but not intra substantia nigra infusions, of almorexant reduced ethanol self-administration. Extracellular recordings performed in VTA neurons revealed that orexin-A increased firing and this enhancement of firing was blocked by almorexant. The results demonstrate that orexin/hypocretin receptors in distinct brain regions regulate ethanol and sucrose mediated behaviors.

Teaching planning beyond the national context : pedagogic analyses of international fieldtrip experiences

Urban and regional planners, in the era of globalization, require being equipped with skill sets to better deal with complex and rapidly changing economic, socio-cultural, political and environmental fabrics of cities and their regions. In order to provide such skill sets, urban and regional planning curriculum of Queensland University of Technology (Brisbane, Australia) offers regional planning practice in the international context. This paper reports the findings of the pedagogic analyses from the regional planning practice fieldtrips to Malaysia, Korea, Turkey, Taiwan, and discusses the opportunities and constraints of exposure of students to regional planning practice beyond the national context.

Urban, suburban, and rural variations in separation/divorce rape/sexual assault : results from the National Crime Victimization Survey

To date, no large study has looked at whether separation/divorce sexual assault varies across urban, suburban, and rural areas. The authors use 1992-2009 NCVS (National Crime Victimization Survey) data to estimate the percentage of separation/divorce sexual assault against women in urban, suburban, and rural communities. In addition, the authors identify and compare the relative risk of sexual assault victimization for women across areas. Findings indicate that a higher percentage of rural divorced/separated women were victims of rape/sexual assault than were urban divorced/separated women. In addition, rural separated women are victims of intimate rape/sexual assault at significantly higher rates than their suburban and urban counterparts.

Exeter short stems compared with standard length Exeter stems : experience from the Australian Orthopaedic Association National Joint Replacement Registry

The standard Exeter stem has a length of 150mm with offsets 37.5mm to 56mm. Shorter stems of lengths 95mm, 115mm and 125mm with offsets 35.5mm or less are available for patients with smaller femurs. Concern has been raised regarding the behaviour of the smaller implants. This paper analysed data from the Australian Orthopaedic Association National Joint Replacement Registry comparing survivorship of stems of offset 35.5mm or less with the standard stems of 37.5mm offset or greater. At seven years there was no significant difference in the Cumulative Percent Revision Rate in the short stems (3.4%, 95% CI 2.4-4.8%) compared with the standard length stems (3.5%, 95% CI 3.3-3.8%) despite its use in a greater proportion of potentially more difficult developmental dysplasia of the hip cases.

Driver sleepiness self-regulation : physiological and subjective evidence

Introduction: Sleepiness contributes to a substantial proportion of fatal and severe road crashes. Efforts to reduce the incidence of sleep-related crashes have largely focussed on driver education to promote self-regulation of driving behaviour. However, effective self-regulation requires accurate self-perception of sleepiness. The aim of this study was to assess capacity to accurately identify sleepiness, and self-regulate driving cessation, during a validated driving simulator task. Methods: Participants comprised 26 young adult drivers (20-28 years) who had open licenses. No other exclusion criteria where used. Participants were partially sleep deprived (05:00 wake up) and completed a laboratory-based hazard perception driving simulation, counterbalanced to either at mid-morning or mid-afternoon. Established physiological measures (i.e., EEG, EOG) and subjective measures (Karolinska Sleepiness Scale), previously found sensitive to changes in sleepiness levels, were utilised. Participants were instructed to ‘drive’ on the simulator until they believed that sleepiness had impaired their ability to drive safely. They were then offered a nap opportunity. Results: The mean duration of the drive before cessation was 36.1 minutes (±17.7 minutes). Subjective sleepiness increased significantly from the beginning (KSS=6.6±0.7) to the end (KSS=8.2±0.5) of the driving period. No significant differences were found for EEG spectral power measures of sleepiness (i.e., theta or alpha spectral power) from the start of the driving task to the point of cessation of driving. During the nap opportunity, 88% of the participants (23/26) were able to reach sleep onset with an average latency of 9.9 minutes (±7.5 minutes). The average nap duration was 15.1 minutes (±8.1 minutes). Sleep architecture during the nap was predominately comprised of Stages I and II (combined 92%). Discussion: Participants reported high levels of sleepiness during daytime driving after very moderate sleep restriction. They were able to report increasing sleepiness during the test period despite no observed change in standard physiological indices of sleepiness. This increased subjective sleepiness had behavioural validity as the participants had high ‘napability’ at the point of driving cessation, with most achieving some degree of subsequent sleep. This study suggests that the nature of a safety instruction (i.e. how to view sleepiness) can be a determinant of driver behaviour.

Miscarriage, preterm delivery, and stillbirth: Large variations in rates within a cohort of Australian women

Objectives We aimed to use simple clinical questions to group women and provide their specific rates of miscarriage, preterm delivery, and stillbirth for reference. Further, our purpose was to describe who has experienced particularly low or high rates of each event. Methods Data were collected as part of the Australian Longitudinal Study on Women's Health, a national prospective cohort. Reproductive histories were obtained from 5806 women aged 31–36 years in 2009, who had self-reported an outcome for one or more pregnancy. Age at first birth, number of live births, smoking status, fertility problems, use of in vitro fertilisation (IVF), education and physical activity were the variables that best separated women into groups for calculating the rates of miscarriage, preterm delivery, and stillbirth. Results Women reported 10,247 live births, 2544 miscarriages, 1113 preterm deliveries, and 113 stillbirths. Miscarriage was correlated with stillbirth (r = 0.09, P<0.001). The calculable rate of miscarriage ranged from 11.3 to 86.5 miscarriages per 100 live births. Women who had high rates of miscarriage typically had fewer live births, were more likely to smoke and were more likely to have tried unsuccessfully to conceive for ≥12 months. The highest proportion of live preterm delivery (32.2%) occurred in women who had one live birth, had tried unsuccessfully to conceive for ≥12 months, had used IVF, and had 12 years education or equivalent. Women aged 14–19.99 years at their first birth and reported low physical activity had 38.9 stillbirths per 1000 live births, compared to the lowest rate at 5.5 per 1000 live births. Conclusion Different groups of women experience vastly different rates of each adverse pregnancy event. We have used simple questions and established reference data that will stratify women into low- and high-rate groups, which may be useful in counselling those who have experienced miscarriage, preterm delivery, or stillbirth, plus women with fertility intent.

Self-identified experts lost on the interwebs

Security cues found in web browsers are meant to alert users to potential online threats, yet many studies demonstrate that security indicators are largely ineffective in this regard. Those studies have depended upon self-reporting of subjects' use or aggregate experimentation that correlate responses to sites with and without indicators. We report on a laboratory experiment using eye-tracking to follow the behavior of self-identified computer experts as they share information across popular social media websites. The use of eye-tracking equipment allows us to explore possible behavioral differences in the way experts perceive web browser security cues, as opposed to non-experts. Unfortunately, due to the use of self-identified experts, technological issues with the setup, and demographic anomalies, our results are inconclusive. We describe our initial experimental design, lessons learned in our experimentation, and provide a set of steps for others to follow in implementing experiments using unfamiliar technologies, eye-tracking specifically, subjects with different experience with the laboratory tasks, as well as individuals with varying security expertise. We also discuss recruitment and how our design will address the inherent uncertainties in recruitment, as opposed to design for an ideal population. Some of these modifications are generalizable, together they will allow us to run a larger 2x2 study, rather than a study of only experts using two different single sign-on systems.

National Institute for Clinical Studies Report for Phase 1, Evidence Uptake Network : Best Practice Community Care for Clients with Chronic Venous Leg Ulcers

Chronic leg ulcers cause significant pain, cost, decreased quality of life and morbidity for a considerable segment of the older population (Graham et al., 2003a). At any given time the prevalence of patients with open leg ulcers receiving treatment is between 0.11% - 0.18% (Briggs & Closs 2003). Chronic leg ulcers occur in approximately 1 - 2% of the over 60 population in the US, UK, Europe and Australia (Baker & Stacey 1994; Johnson 1995; Lees & Lambert 1992; Margolis et al. 2002). Considerable research has been undertaken to determine the best treatment practices that will aid in the management and the healing of these ulcers, and practical and effective strategies and techniques for healing venous leg ulcers have been trialled to demonstrate their beneficial effects (Nelson et al. 2004; Cullum et al. 2001)...

The relationship between drivers’ perceptions toward police speed enforcement and self-reported speeding behaviour

Exceeding the speed limit and driving too fast for the conditions are regularly cited as significant contributing factors in traffic crashes, particularly fatal and serious injury crashes. Despite an extensive body of research highlighting the relationship between increased vehicle speeds and crash risk and severity, speeding remains a pervasive behaviour on Australian roads. The development of effective countermeasures designed to reduce the prevalence of speeding behaviour requires that this behaviour is well understood. The primary aim of this program of research was to develop a better understanding of the influence of drivers’ perceptions and attitudes toward police speed enforcement on speeding behaviour. Study 1 employed focus group discussions with 39 licensed drivers to explore the influence of perceptions relating to specific characteristics of speed enforcement policies and practices on drivers’ attitudes towards speed enforcement. Three primary factors were identified as being most influential: site selection; visibility; and automaticity (i.e., whether the enforcement approach is automated/camera-based or manually operated). Perceptions regarding these enforcement characteristics were found to influence attitudes regarding the perceived legitimacy and transparency of speed enforcement. Moreover, misperceptions regarding speed enforcement policies and practices appeared to also have a substantial impact on attitudes toward speed enforcement, typically in a negative direction. These findings have important implications for road safety given that prior research has suggested that the effectiveness of speed enforcement approaches may be reduced if efforts are perceived by drivers as being illegitimate, such that they do little to encourage voluntary compliance. Study 1 also examined the impact of speed enforcement approaches varying in the degree of visibility and automaticity on self-reported willingness to comply with speed limits. These discussions suggested that all of the examined speed enforcement approaches (see Section 1.5 for more details) generally showed potential to reduce vehicle speeds and encourage compliance with posted speed limits. Nonetheless, participant responses suggested a greater willingness to comply with approaches operated in a highly visible manner, irrespective of the corresponding level of automaticity of the approach. While less visible approaches were typically associated with poorer rates of driver acceptance (e.g., perceived as “sneaky” and “unfair”), participants reported that such approaches would likely encourage long-term and network-wide impacts on their own speeding behaviour, as a function of the increased unpredictability of operations and increased direct (specific deterrence) and vicarious (general deterrence) experiences with punishment. Participants in Study 1 suggested that automated approaches, particularly when operated in a highly visible manner, do little to encourage compliance with speed limits except in the immediate vicinity of the enforcement location. While speed cameras have been criticised on such grounds in the past, such approaches can still have substantial road safety benefits if implemented in high-risk settings. Moreover, site-learning effects associated with automated approaches can also be argued to be a beneficial by-product of enforcement, such that behavioural modifications are achieved even in the absence of actual enforcement. Conversely, manually operated approaches were reported to be associated with more network-wide impacts on behaviour. In addition, the reported acceptance of such methods was high, due to the increased swiftness of punishment, ability for additional illegal driving behaviours to be policed and the salutary influence associated with increased face-to-face contact with authority. Study 2 involved a quantitative survey conducted with 718 licensed Queensland drivers from metropolitan and regional areas. The survey sought to further examine the influence of the visibility and automaticity of operations on self-reported likelihood and duration of compliance. Overall, the results from Study 2 corroborated those of Study 1. All examined approaches were again found to encourage compliance with speed limits, such that all approaches could be considered to be “effective”. Nonetheless, significantly greater self-reported likelihood and duration of compliance was associated with visibly operated approaches, irrespective of the corresponding automaticity of the approach. In addition, the impact of automaticity was influenced by visibility; such that significantly greater self-reported likelihood of compliance was associated with manually operated approaches, but only when they are operated in a less visible fashion. Conversely, manually operated approaches were associated with significantly greater durations of self-reported compliance, but only when they are operated in a highly visible manner. Taken together, the findings from Studies 1 and 2 suggest that enforcement efforts, irrespective of their visibility or automaticity, generally encourage compliance with speed limits. However, the duration of these effects on behaviour upon removal of the enforcement efforts remains questionable and represents an area where current speed enforcement practices could possibly be improved. Overall, it appears that identifying the optimal mix of enforcement operations, implementing them at a sufficient intensity and increasing the unpredictability of enforcement efforts (e.g., greater use of less visible approaches, random scheduling) are critical elements of success. Hierarchical multiple regression analyses were also performed in Study 2 to investigate the punishment-related and attitudinal constructs that influence self-reported frequency of speeding behaviour. The research was based on the theoretical framework of expanded deterrence theory, augmented with three particular attitudinal constructs. Specifically, previous research examining the influence of attitudes on speeding behaviour has typically focussed on attitudes toward speeding behaviour in general only. This research sought to more comprehensively explore the influence of attitudes by also individually measuring and analysing attitudes toward speed enforcement and attitudes toward the appropriateness of speed limits on speeding behaviour. Consistent with previous research, a number of classical and expanded deterrence theory variables were found to significantly predict self-reported frequency of speeding behaviour. Significantly greater speeding behaviour was typically reported by those participants who perceived punishment associated with speeding to be less certain, who reported more frequent use of punishment avoidance strategies and who reported greater direct experiences with punishment. A number of interesting differences in the significant predictors among males and females, as well as younger and older drivers, were reported. Specifically, classical deterrence theory variables appeared most influential on the speeding behaviour of males and younger drivers, while expanded deterrence theory constructs appeared more influential for females. These findings have important implications for the development and implementation of speeding countermeasures. Of the attitudinal factors, significantly greater self-reported frequency of speeding behaviour was reported among participants who held more favourable attitudes toward speeding and who perceived speed limits to be set inappropriately low. Disappointingly, attitudes toward speed enforcement were found to have little influence on reported speeding behaviour, over and above the other deterrence theory and attitudinal constructs. Indeed, the relationship between attitudes toward speed enforcement and self-reported speeding behaviour was completely accounted for by attitudes toward speeding. Nonetheless, the complexity of attitudes toward speed enforcement are not yet fully understood and future research should more comprehensively explore the measurement of this construct. Finally, given the wealth of evidence (both in general and emerging from this program of research) highlighting the association between punishment avoidance and speeding behaviour, Study 2 also sought to investigate the factors that influence the self-reported propensity to use punishment avoidance strategies. A standard multiple regression analysis was conducted for exploratory purposes only. The results revealed that punishment-related and attitudinal factors significantly predicted approximately one fifth of the variance in the dependent variable. The perceived ability to avoid punishment, vicarious punishment experience, vicarious punishment avoidance and attitudes toward speeding were all significant predictors. Future research should examine these relationships more thoroughly and identify additional influential factors. In summary, the current program of research has a number of implications for road safety and speed enforcement policy and practice decision-making. The research highlights a number of potential avenues for the improvement of public education regarding enforcement efforts and provides a number of insights into punishment avoidance behaviours. In addition, the research adds strength to the argument that enforcement approaches should not only demonstrate effectiveness in achieving key road safety objectives, such as reduced vehicle speeds and associated crashes, but also strive to be transparent and legitimate, such that voluntary compliance is encouraged. A number of potential strategies are discussed (e.g., point-to-point speed cameras, intelligent speed adaptation. The correct mix and intensity of enforcement approaches appears critical for achieving optimum effectiveness from enforcement efforts, as well as enhancements in the unpredictability of operations and swiftness of punishment. Achievement of these goals should increase both the general and specific deterrent effects associated with enforcement through an increased perceived risk of detection and a more balanced exposure to punishment and punishment avoidance experiences.

The WTO, the national security exception and climate change

Article XX has been a valuable instrument to justify exceptions from the anti-discrimination provisions of the GATT 1994. In general, this Article is considered by experts to be the most likely defence for any climate change mitigation measure in breach GATT 1994 obligations. That assumption is not in dispute here; rather, this article considers the requirements of the Article XX exceptions, but also explores the conditions of the National Security exception contained in Article XXI. Although it is possible that this exception could be used for climate change mitigation measures, this paper argues that it is unlikely that the National Security exception could be legitimately applied in these circumstances without member agreement to the contrary.