Clinical indicators of quality for Australian residential aged care facilities : establishing reliability, validity, and quality thresholds

Background: In response to the need for more comprehensive quality assessment within Australian residential aged care facilities, the Clinical Care Indicator (CCI) Tool was developed to collect outcome data as a means of making inferences about quality. A national trial of its effectiveness and a Brisbane-based trial of its use within the quality improvement context determined the CCI Tool represented a potentially valuable addition to the Australian aged care system. This document describes the next phase in the CCI Tool.s development; the aims of which were to establish validity and reliability of the CCI Tool, and to develop quality indicator thresholds (benchmarks) for use in Australia. The CCI Tool is now known as the ResCareQA (Residential Care Quality Assessment). Methods: The study aims were achieved through a combination of quantitative data analysis, and expert panel consultations using modified Delphi process. The expert panel consisted of experienced aged care clinicians, managers, and academics; they were initially consulted to determine face and content validity of the ResCareQA, and later to develop thresholds of quality. To analyse its psychometric properties, ResCareQA forms were completed for all residents (N=498) of nine aged care facilities throughout Queensland. Kappa statistics were used to assess inter-rater and test-retest reliability, and Cronbach.s alpha coefficient calculated to determine internal consistency. For concurrent validity, equivalent items on the ResCareQA and the Resident Classification Scales (RCS) were compared using Spearman.s rank order correlations, while discriminative validity was assessed using known-groups technique, comparing ResCareQA results between groups with differing care needs, as well as between male and female residents. Rank-ordered facility results for each clinical care indicator (CCI) were circulated to the panel; upper and lower thresholds for each CCI were nominated by panel members and refined through a Delphi process. These thresholds indicate excellent care at one extreme and questionable care at the other. Results: Minor modifications were made to the assessment, and it was renamed the ResCareQA. Agreement on its content was reached after two Delphi rounds; the final version contains 24 questions across four domains, enabling generation of 36 CCIs. Both test-retest and inter-rater reliability were sound with median kappa values of 0.74 (test-retest) and 0.91 (inter-rater); internal consistency was not as strong, with a Chronbach.s alpha of 0.46. Because the ResCareQA does not provide a single combined score, comparisons for concurrent validity were made with the RCS on an item by item basis, with most resultant correlations being quite low. Discriminative validity analyses, however, revealed highly significant differences in total number of CCIs between high care and low care groups (t199=10.77, p=0.000), while the differences between male and female residents were not significant (t414=0.56, p=0.58). Clinical outcomes varied both within and between facilities; agreed upper and lower thresholds were finalised after three Delphi rounds. Conclusions: The ResCareQA provides a comprehensive, easily administered means of monitoring quality in residential aged care facilities that can be reliably used on multiple occasions. The relatively modest internal consistency score was likely due to the multi-factorial nature of quality, and the absence of an aggregate result for the assessment. Measurement of concurrent validity proved difficult in the absence of a gold standard, but the sound discriminative validity results suggest that the ResCareQA has acceptable validity and could be confidently used as an indication of care quality within Australian residential aged care facilities. The thresholds, while preliminary due to small sample size, enable users to make judgements about quality within and between facilities. Thus it is recommended the ResCareQA be adopted for wider use.

Azoporphyrin : the porphyrin analogue of azobenzene

Azobenzenes (1,2-diaryldiazenes) are very important organic pigments, and they have a unique place in the field of photoresponsive conjugated molecules due to their (usually) reversible E/Z photoisomerisation. The current intense interest in molecular analogues of mechanical components and information storage and processing elements has stimulated research into conjugated molecules whose shape and/or optical properties can be switched electro- or photochemically. Among the classes of conjugated pigments being explored in these contexts are the porphyrinoids, which offer advantages of intense light absorption, a variety of accessible oxidation states, and synthetic control of properties through peripheral or central substitution. Extension of porphyrinoid conjugation can be achieved by linking the peripheral carbons either by three direct bonds (as in the “porphyrin tapes” of Osuka et al.) or through potentially conjugating bridges such as alkenes or, even better, alkynes.

MobileMums: A randomized controlled trial of an SMS-based physical activity intervention

Background Postnatal women (<12 months postpartum) are at increased risk of physical inactivity. Purpose To evaluate the efficacy and feasibility of a theory-based physical activity (PA) intervention delivered to postnatal women primarily via mobile telephone short message service (SMS). Methods Eighty-eight women were randomized to the intervention (n=45) or minimal contact control (n=43) condition. The 12-week intervention consisted of a face-to-face PA goal-setting consultation, a goal-setting magnet, three to five personally tailored SMS/week and a nominated support person who received two SMS per week. SMS content targeted constructs of social cognitive theory. Frequency (days/week) and duration (min/week) of PA participation and walking for exercise were assessed via self-report at baseline, 6 and 13 weeks. Results Intervention participants increased PA frequency by 1.82 days/week (SE±0.18) by 13 weeks (F(2,85)=4.46, p=0.038) and walking for exercise frequency by 1.08 days/ week (SE±0.24) by 13 weeks (F(2,85)=5.38, p=0.02). Positive trends were observed for duration (min/week) of PA and walking for exercise. Conclusions Intervention exposure resulted in increased frequency of PA and walking for exercise in postnatal women.

Embedding gifted education in preservice teacher education : a collaborative school-university approach

A country’s prosperity relies on the creative potential of its people. Educating gifted students must be a priority for educators and education systems if society is to capitalise on their potential to contribute to an economical and sustainable future. Given the importance of teachers in supporting academic achievement, educating preservice teachers on how to cater for gifted students commences the process as they can foster the implementation of current teaching practices that draw on substantial research into the education of gifted children. This study investigated preservice teachers’ perceptions for teaching gifted students after participating in a school-based intervention with gifted students. The teachers implemented differentiated curriculum activities that catered for the diverse needs of learners. Participants (n=22) were surveyed at the end of the program on their perceptions of how to differentiate the curriculum for meeting the needs of the student. Analysis of the survey indicated these preservice teachers agreed or strongly agreed they had developed skills in curriculum planning (91%) with well-designed activities (96%), and lesson preparation skills (96%). They also claimed they were enthusiastic for teaching (91%) and had understanding of school practices and policies (96%). However, only 46% agreed they had knowledge of syllabus documents with 50% claiming an ability to provide written feedback on the student’s learning. Furthermore, only 64% suggested they had educational language from the syllabus and effective student management strategies. Preservice teachers require direction on how to cater for diversity by building knowledge from direct gifted education experiences. The survey may be used as a diagnostic tool to determine areas for developing education experiences related to the education of the gifted for preservice teachers.

High-challenge teaching for senior English as an Additional Language (EAL) learners in times of change

This paper will present a brief overview of the recent shifts within English and EAL/D (English as an additional language/dialect) curriculum documents and their focus on critical literacy, using the Queensland context as a case in point. The English syllabus landscape in Queensland has continued to morph in recent years. From 2002 to 2009, teachers of senior English and English as an Additional Language (EAL/D) have witnessed no less than four separate syllabus documents that impact on their daily work. The Australian Curriculum, when finally implemented, will also require teachers to navigate and grapple with its particular obligations and affordances. The combined effect of the shifts and tensions between recent policy documents has led to confusion about exactly how to cater for EAL/D learners in mainstream English. We discuss the possible effects of this on teachers as the agents of policy implementation and argue that in spite of such contradictions, EAL/D teachers can productively use syllabus frameworks to craft pedagogy to cater for their EAL/D learners’ language and literacy needs. Following this, we present aspects of the teaching practice of four teachers of senior EAL/D, who provide intellectually-engaging, critical literacy pedagogy that takes into account the language proficiency level of their learners, within the required curriculum. Such practice provides teachers with valuable pedagogic possibilities to meet EAL/D learners’ needs within continually varying policy terrain.

Exploiting system fluctuations. Differential training in physical prevention and rehabilitation programs for health and exercise

Background: Traditional causal modeling of health interventions tends to be linear in nature and lacks multidisciplinarity. Consequently, strategies for exercise prescription in health maintenance are typically group based and focused on the role of a common optimal health status template toward which all individuals should aspire. ----- ----- Materials and methods: In this paper, we discuss inherent weaknesses of traditional methods and introduce an approach exercise training based on neurobiological system variability. The significance of neurobiological system variability in differential learning and training was highlighted.----- ----- Results: Our theoretical analysis revealed differential training as a method by which neurobiological system variability could be harnessed to facilitate health benefits of exercise training. It was observed that this approach emphasizes the importance of using individualized programs in rehabilitation and exercise, rather than group-based strategies to exercise prescription.----- ----- Conclusion: Research is needed on potential benefits of differential training as an approach to physical rehabilitation and exercise prescription that could counteract psychological and physical effects of disease and illness in subelite populations. For example, enhancing the complexity and variability of movement patterns in exercise prescription programs might alleviate effects of depression in nonathletic populations and physical effects of repetitive strain injuries experienced by athletes in elite and developing sport programs.

Influence of hydrocarbon contamination on clay soil microstructure

Microstructural (fabric, forces and composition) changes due to hydrocarbon contamination in a clay soil were studied using Scanning Electron Microscope (micro-fabric analysis), Atomic Force Microscope (forces measurement) and sedimentation bench test (particle size measurements). The non-polluted and polluted glacial till from north-eastern Poland (area of a fuel terminal) were used for the study. Electrostatic repelling forces for the polluted sample were much lower than for the non-polluted sample. In comparison to non-polluted sample, the polluted sample exhibited lower electric charge, attractive forces on approach and strong adhesion on retrieve. The results of the sedimentation tests indicate that clay particles form larger aggregates and settle out of the suspension rapidly in diesel oil. In non-polluted soil, the fabric is strongly aggregated – densely packed, dominate the face-to-face and edge-to-edge types of contacts, clay film tightly adheres to the surface of larger grains and interparticle pores are more common. In polluted soil, the clay matrix is less aggregated – loosely packed, dominate the edge-to-face types of contacts and inter-micro-aggregate pores are more frequent. Substantial differences were observed in the morphometric and geometrical parameters of pore space. The polluted soil micro-fabric proved to be more isotropic and less oriented than in non-polluted soil. The polluted soil, in which electrostatic forces were suppressed by hydrocarbon interaction, displays more open porosity and larger voids than non-polluted soil, which is characterized by occurrence of the strong electrostatic interaction between clay particles.

Digital dawn : a revolution in movie distribution?

How will the digital technology revolution impact the movie business? Hollywood developed a highly successful industrial system that has functioned well for almost a century in the sense that it enabled the Major film studios to largely control and dominate the industry. However, the new digital technology may now be propelling Hollywood toward the biggest technological transition since the creation of the studio system almost a century ago. For example, Major Hollywood studios are already beginning to provide video-on-demand (VOD) digital distribution of movies over the Internet. This article examines what is happening, and why. It sets out the background and the incipient changes already occurring. It makes an argument regarding the fundamental strategic dynamics, that acetate film was the key to the control of the Hollywood system, and speculates about how a shift away from acetate film to digital video may transform that system. The focus is on the impact on how the Major studios release and market their movies, and how new market and marketing opportunities for the low-budget independent filmmaking sector may arise.

Note on similarity solutions for viscous flow over an impermeable and non-linearly (quadratic) stretching sheet

Similarity solutions for flow over an impermeable, non-linearly (quadratic) stretching sheet were studied recently by Raptis and Perdikis (Int. J. Non-linear Mech. 41 (2006) 527–529) using a stream function of the form ψ=αxf(η)+βx2g(η). A fundamental error in their problem formulation is pointed out. On correction, it is shown that similarity solutions do not exist for this choice of ψ

Double standards in cultural judgements

The author, a teacher of television and film from a cultural studies perspective, endeavours to persuade his students to give up snobbery when they judge culture. The author has found that most students enter university with a series of middle class value judgements very strongly in place. Essentially, the judgements are that commercial culture is 'bad' and non-commercial culture is 'good'.

Does institutional location protect from political influence? the case of a minimum labour standards enforcement agency in Australia

Among the many factors that influence enforcement agencies, this article examines the role of the institutional location (and independence) of agencies, and an incumbent government's ideology. It is argued that institutional location affects the level of political influence on the agency's operations, while government ideology affects its willingness to resource enforcement agencies and approve regulatory activities. Evidence from the agency regulating minimum labour standards in the Australian federal industrial relations jurisdiction (currently the Fair Work Ombudsman) highlights two divergences from the regulatory enforcement literature generally. First, notions of independence from political interference offered by institutional location are more illusory than real and, second, political need motivates political action to a greater extent than political ideology.

Porphyromonas gingivalis lipopolysaccharide alters atherosclerotic-related gene expression in oxidized low-density-lipoprotein-induced macrophages and foam cells

The molecular mechanism between atherosclerosis formation and periodontal pathogens is not clear although positive correlation between periodontal infections and cardiovascular diseases has been reported. Objective: To determine if atherosclerosis related genes were affected in foam cells during and after its formation by P. gingivalis lipopolysaccharide (LPS) stimulation. Methods: Macrophages from human THP-1 monocytes were treated with oxidized low density lipoprotein (oxLDL) to induce the formation of foam cells. P. gingivalis LPS was added to cultures of either oxLDL-induced macrophages or foam cells. The expression of atherosclerosis related genes was assayed by quantitative real time PCR and the protein production of granulocyte-macrophage colony-stimulating factor（GM-CSF）, monocyte chemotactic protein-1 (MCP-1), IL-1β, IL-10 and IL-12 was determined by ELISA. Nuclear translocation of NF-κB P65 was detected by immunocytochemistry and western blot was used to evaluate IKB-α degradation to confirm the NF-κB pathway activation. Results: P. gingivalis LPS stimulated atherosclerosis related gene expression in foam cells and increased oxLDL induced expression of chemokines, adhesion molecules, growth factors, apoptotic genes, and nuclear receptors in macrophages. Transcription of the pro-inflammatory cytokines IL-1β and IL-12 was elevated in response to LPS in both macrophages and foam cells, whereas the anti-inflammatory cytokine IL-10 was not affected. Increased NF-κB pathway activation was also observed in LPS and oxLDL co-stimulated macrophages. Conclusion: P. gingivalis LPS appears to be an important factor in the development of atherosclerosis by stimulation of atherosclerosis related gene expression in both macrophages and foam cells via activation of the NF-κB pathway.

Gender influences on the work-related stress-coping process

The increasing incidence of occupational stress is recognized as a global phenomenon that is having a detrimental impact on both individuals and organizations. This study aims to identify whether men and women adopt different stress and coping processes when subjected to stress in a work context. A total of 258 workers of various professions (males = 106, females = 152) participated in the study. Results indicated that men and women differ in their stress and coping processes, forming two very distinct groups and adopting specific process models when encountering a stressful situation at work. Limitations and implications from this study are discussed.

Development of an automated safety assessment framework for construction activities

This paper presents an ongoing research project concerning the development of an automated safety assessment framework for earthmoving and surface mining activities. This research seeks to determine data needs for safety assessment and investigates how to utilize collected data to promote more informed and efficient safety decision-making. The research first examined accidents and fatalities involved with earthmoving and surface mining activities—more specifically, those involving loading, hauling, and dumping operations,—investigated risk factors involved with the accidents, and finally identified data needs for safety assessment based on safety regulations and practices. An automated safety assessment method was then developed using the data needs that had been identified. This research is expected to contribute to the introduction of a fundamental framework for automated safety assessment and the systematic collection of safety-related data from construction activities. Implementation of the entire safety assessment process on actual construction sites remains a task for future research.

Strategies for managing osteoarthritis

Background Although there are recommendations for the management of osteoarthritis (OA), little is known about how people with OA actually manage this chronic condition. Purpose The aims of this study were to identify the non-pharmacological and pharmacological therapies most commonly used for the management of hip or knee OA, in a community-based sample of adults, and to compare these with evidence-based recommendations. Methods A questionnaire was mailed to 2200 adult members of Arthritis Queensland living in Brisbane, Australia. It included questions about OA symptoms, management therapies and demographic characteristics. Results Of the 485 participants (192 men, 293 women) with hip or knee OA who completed the questionnaire, most had mild to moderate symptoms. Ninety-six percent of participants (aged 27–95 years) reported using at least one non-pharmacological therapy, and 78% reported using at least one pharmacological therapy. The most common currently used non-pharmacological strategy was range-of-motion exercises (men 52%, women 61%, p=0.05) and the most common frequently used pharmacological strategy was glucosamine/chondroitin (men 51%, women 60%, ns). For the most highly recommended strategies, 65% of men and 54% of women had never attended an information/education course (p=0.04), and fewer than half (46% of women and 42% of men, p=0.03) were frequent users of anti-inflammatory agents. Conclusion The findings suggest that many people with knee or hip OA do not follow the most highly endorsed of the OARSI (Osteoarthritis Research Society International) recommendations for management of OA. Health professionals should be encouraged to recommend evidence-based therapies to their patients.