Markers and risk factors for HCV, HBV and HIV in a network of injecting drug users in Melbourne

Background and aims: Current injecting drug users (IDU) in major street drug markets within greater Melbourne were recruited to a longitudinal study on blood borne viruses. Here we investigated risk factors for hepatitis C virus (HCV), hepatitis B virus (HBV) and HIV infection in these IDU at the time of their recruitment.

Methods : Three hundred and eighty-two IDU completed detailed questionnaires on their drug use and risk behaviours, and provided blood samples for serology testing. These data were analysed using univariate and multivariate techniques.

Results : The overall prevalence of exposure to HCV, HBV and HIV was estimated at 70%, 34% and <1%, respectively. Independent predictors of HCV exposure were history of imprisonment (RR 1.34, 95% CI 1.19–1.52), use of someone else's needle or syringe (RR 1.23, 95% CI 1.07–1.42), >7.6 years length of time injecting (RR 1.21, 95% CI 1.07–1.37), and originating from Vietnam (RR 1.12, 95% CI 1.07–1.18). Independent predictors of HBV exposure were HCV exposure (RR 2.15, 95% CI 1.35–3.43), >7.6 years length of time injecting (RR 1.57, 95% CI 1.17–2.13) and originating from outside Australia (RR 1.60, 95% CI 1.22–2.10). Neither prison- nor community-applied tattoos predicted HCV or HBV exposure. Up to 31% of IDU who injected for 1 year or less were HCV antibody positive, as were 53% of those who injected for 2 years or less.

Conclusions : Ongoing engagement with young IDU, through the provision of harm reduction education and resources, is critical if we are to address blood borne viral infections and other health and social harms associated with injecting drug use.

NDRG2, a novel regulator of myoblast proliferation, is regulated by anabolic and catabolic factors

Skeletal muscle tissue undergoes adaptive changes in response to stress and the genes that control these processes are incompletely characterised. NDRG2 (N-myc downstream-regulated gene 2), a stress- and growth-related gene, was investigated in skeletal muscle growth and adaption. While NDRG2 expression levels were found to be up-regulated in both differentiated human and mouse myotubes compared with undifferentiated myoblasts, the suppression of NDRG2 in C2C12 myoblasts resulted in slowed myoblast proliferation. The increased expression levels of the cell cycle inhibitors, p21 Waf1/Cip1 and p27 Kip1, and of various muscle differentiation markers in NDRG2-deficient myoblasts indicate that a lack of NDRG2 promoted cell cycle exiting and the onset of myogenesis. Furthermore, the analysis of NDRG2 regulation in C2C12 myotubes treated with catabolic and anabolic agents and in skeletal muscle from human subjects following resistance exercise training revealed NDRG2 gene expression to be down-regulated during hypertrophic conditions, and conversely, up-regulated during muscle atrophy. Together, these data demonstrate that NDRG2 expression is highly responsive to different stress conditions in skeletal muscle and suggest that the level of NDRG2 expression may be critical to myoblast growth and differentiation.

Does an evidence-based sedation protocol improve practice and patient outcomes in critical care?

Learning Objective 1: compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients in an Australian critical care.

Learning Objective 2: explain the contrasting international research findings on sedation protocol implementation.
Minimization of sedation in critical care patients has recently received widespread support. Professional organizations internationally have published sedation management guidelines for critically ill patients to improve the use of research in practice, decrease practice variability and shorten mechanical ventilation duration. Innovations in practice have included the introduction of decision making protocols, daily sedation interruptions and new drugs and monitoring technologies. The aim of this study was to compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients in an Australian critical care setting.

A randomized, controlled trial design was used to study 312 mechanically ventilated adult patients in a general critical care unit at an Australian metropolitan teaching hospital. Patients were randomly assigned to receive protocol directed sedation management developed from evidence based guidelines (n=153) or usual clinical practice (n=159).

The median (95% CI) duration of ventilation was 58 hrs (44–78 hrs) for patients in the non-protocol group and 79 hrs (56–93) for those patients in the protocol group (p=0.20). Results were not significant for length of stay in critical care or hospital, the frequency of tracheostomies, and unplanned extubations. A Cox proportional hazards model estimated that protocol directed sedation management was associated with a 22% decrease (95% CI: 40% decrease to 2% increase, p=0.07) in the occurrence of successful weaning from mechanical ventilation.

Few randomized controlled trials have evaluated the effectiveness of protocol-directed sedation outside of North America. This study highlights the lack of transferability between different settings and different models of care. Qualified, high intensity nursing in the Australian critical care setting facilitates rapid, responsive decisions for sedation management and an increased success rate for weaning from mechanical ventilation.

Treatment readiness in violent offenders : the influence of cognitive factors on engagement in violence programs

Advances in offender rehabilitation theory have led to the development of a clear framework of the factors that need consideration for an offender to be ready for therapy and thus gain maximum benefits. Here, we examine in greater detail the role of cognition in readiness for rehabilitation in violent offenders. We assess how cognitive processes and distortions common in violent offenders may affect and hamper rehabilitation readiness. Methods for remediation of cognitive factors that diminish readiness, including motivational interviewing, are discussed. We conclude that cognitive factors are critical in the assessment of readiness in violent offenders and therapeutic efforts to enhance engagement.

Small firm e-business adoption : a critical analysis of theory

Purpose – The paper critiques a range of theories and evaluates their ability to provide a lens for explaining the idiosyncratic nature of small firms and their e-business adoption decisions.

Design/methodology/approach – This literature review firstly summarises the existing research evidence that shows that small firms are idiosyncratic when it comes to e-business adoption. It then critiques theories commonly used in the literature in this field to examine the extent to which they take this small firm idiosyncrasy into account when explaining e-business adoption decisions.

Findings – The critical analysis shows that no commonly-used theory adequately explains small firm adoption of e-business because each omits important aspects of small firm idiosyncrasy. The analysis suggests that an integrated theoretical framework is needed. Preliminary ideas on this framework are provided.

Originality/value – Existing research generally applies a small number of selected theories and formulates research models of adoption factors. However, there is no systematic analysis of theories in this field and no consensus about theoretical frameworks. This paper addresses this limitation of the literature by critically evaluating the commonly used theories in terms of their individual suitability as lenses for explaining small firm e-business adoption.

Relating practice to theory in indigenous entrepreneurship : a pilot investigation of the Kitsaki partnership portfolio

In Canada and elsewhere around the world, Indigenous Peoples are struggling to rebuild their "nations" and improve the socioeconomic circumstances of their people. Many see economic development as the key to success. This is certainly true for Indigenous people in Canada (the First Nations, Metis, and Inuit, collectively called Aboriginal or Indigenous people). Among them, participation in the global economy through entrepreneurship and business development is widely accepted as the key to economy building and nation "re-building." As elaborated in the next section, the demand is that this participation must be on their own terms for their own purposes, and traditional lands, history, culture, and values play a critical role. There is an intriguing symmetry between the modernity of the desire for global business competence and competitiveness and the insistence upon the distinctive importance of cultural heritage in developing new enterprise. The way that the two superficially contrasting concepts of innovation and heritage are combined in the field of Indigenous entrepreneurship has been expounded by Hindle and Lansdowne.1

Recognizing the challenges they face in attempting to compete in the global economy on their own terms, Indigenous people are increasingly developing enterprises in the form of partnerships of all types among themselves and with non-Indigenous enterprises. As both a form and a context of business organization, the partnership or alliance model is particularly fraught with the need to blend the old with the new, heritage with innovation. This study is a preliminary investigation of the Kitsaki initiative of the Lac La Ronge Indian band. In it we:

* explore several ventures involved in the partnership, asking key operatives for their opinions about the factors that explain success and failure;

* distill the explanations into as few, all-embracing factors as possible;

* relate the findings to the emerging theory of Indigenous entrepreneurship, with particular reference to the suggested paradigm of Indigenous entrepreneurship developed by Hindle and Lansdowne (2002);

* project the results of the investigation into suggestions for a more structured program of future research.

Where do entrepreneurs have the best chances of success? The Asia-Pacific regulatory environment for entrepreneurial Micro And Medium Sized Enterprises (MMES)

Why do some entrepreneurs succeed while others fail in international competition? Perhaps it is better to turn the question around and ask, why is it that a particular country or economy becomes the home base for competitive globally-oriented entrepreneurs? What makes Australia a global leader in wine exports? How did New Zealand make it to global ranks in the creative industries? Why does Singapore have the most businessfriendly environment for entrepreneurs? Why is it “location, location, location”? One of the most powerful factors is the regulatory environment.

Asia-Pacific country-specific and region-specific regulations are diverse, and they seriously affect the climate for start-up entrepreneurs. They range from best-in-the world (e.g. Australia, New Zealand and Singapore) to the dreadful (Indonesia), according to the World Bank. Costs and profits can be affected as much by a government regulation as by a management decision. Fundamental entrepreneurial decisions--such as which lines of business to go into, which products and services to produce and introduce, which investments to finance, how and where to make goods and how to market them, and what prices to charge--are increasingly subject to governmental control.

In this short paper, we examine World Bank and Transparency International data on Asia-Pacific regulatory environments and make statements about how the economies compare to best practice. While I use data collected by other sources, I believe the added value comes through comparing and contrast the regulatory environments of our region in a justifiable and easily understood manner.

Risk allocation in public-private partnership projects : an innovative model with an intelligent approach

Both the increasing private participation in public projects and the critical importance of appropriate risk allocation to the success of Public-private partnership (PPP) projects justify specific research on how to establish effective risk allocation strategies in PPP projects. Partner’s risk management capability is currently the main concern to risk allocation in PPP projects. Following the transaction cost economics, it is argued that factors such as partner’s commitment and risk management structure should be considered simultaneously in order to develop effective risk allocation strategies. Based on the holistic capability-commitment governance-driven view, this paper proposed a model for generating an optimal risk allocation strategy in PPP projects. The model is demonstrated and described. An artificial intelligent technique integrated with fuzzy logic for model testing and validation is then introduced and justified. The innovative model is expected to provide a logical and complete understanding of the risk allocation strategy selection process, and to provide stakeholders with a richer framework than previously existing ones to guide their decision-making on risk allocation strategies.

Investigating health, economic and socio-political factors that need consideration when establishing Victorian Aboriginal land management projects

This article focuses on three Victorian Aboriginal¹ groups (Bangerang, Boonwurrung and Yorta Yorta) to explore elements that provide or discourage development of land management projects. Results from this small qualitative study show that a number of distinct health, socio-political and economic factors need to be considered when developing Aboriginal land management projects. This study indicates that a greater involvement in Aboriginal land management projects -- critical to Aboriginal peoples' health, economic and social structures - will only occur through increased community consultation, respect, training, consistency between all stakeholders involved, resources and the provision of employment opportunities. Further research is required to strengthen this evidence, allowing policy-makers to be progressive when developing land management projects for Aboriginal Victorian people as a health promoting tool.

Situational and dispositional indicators of performance : competing models in education

The attainment of high grades on the Victorian Certificate of Education (VCE) is critical to the future study and employment prospects of many Australian adolescents. Thus it is important to understand the factors that contribute to performance in the VCE. The aims of this study were twofold: the main aim was to test competing models of academic performance, subsuming a range of situational and dispositional variables based on a) self-efficacy theory, b) target and purpose goals, c) cognitive skills and self-regulatory strategies, and d) positive psychology. These models were each tested in terms of English performance and mathematics performance as these units contribute proportionally the most to overall VCE scores. In order to study whether pressures peculiar to the VCE impact on performance, the competing models were tested in a sample of Victorian students prior to the VCE (year 10) and then during the VCE (year 11). A preliminary study was conducted in order to develop and test four scales required for use in the major study, using an independent sample of 302 year nine students. The results indicated that these new scales were psychometrically reliable and valid. Three-hundred and seven Australian students participated in the year 10 and 11 study. These students were successively asked to provide their final years 9, 10 and 11 English and mathematics grades at times one, three and five and to complete a series of questionnaires at times two and four. Results of the year 10 study indicated that models based on self-efficacy theory were the best predictors of both English and mathematics performance, with high past grades, high self-efficacy and low anxiety contributing most to performance. While the year 10 self-efficacy models, target goal models, positive psychology models, self-regulatory models and cognitive skill based models were each robust in the sample in year 11, a substantial increase in explained variance was observed from year 10 to year 11 in the purpose goal models. Results indicated that students’ mastery goals and their performance-approach goals became substantially more predictive in the VCE than they were prior to the VCE. This result can be taken to suggest that these students responded in very instrumental ways to the pressures, and importance, of their VCE. An integrated model based on a combination of the variables from the competing models was also tested in the VCE. Results showed that these models were comparable, both in English and mathematics, to the self-efficacy models, but explained less variance than the purpose goal models. Thus in terms of parsimony the integrated models were not preferred. The implications of these results in terms of teaching practices and school counseling practices are discussed. It is recommended that students be encouraged to maintain a positive outlook in relation to their schoolwork and that they be encouraged to set their VCE goals in terms of a combination of self-referenced (mastery) and other-referenced (performance-approach) goals.

Factors affecting the engagement of experienced teachers in schools

With the changing age profile of teachers in Australian schools, considerable numbers of experienced teachers need to feature as educational leaders, before their workplace knowledge and expertise will be lost to schools with retirement. Stereotypes of veteran teachers depict individuals, wearied by decades of work experiences, entering professional decline when educational systems need these experienced practitioners to remain connected, communicative and motivated in their work. This thesis explores the careers and contemporary professional lives of experienced practitioners — predominantly classroom teachers — currently working in a school with a long standing commitment to student-centred education. The research identified the factors that influenced their career pathways and affected their engagement with their work. Critical incidents in the teachers’ careers and professional lives are discussed in relation to the theories of motivation and the nature of Professional Learning Communities. The study showed that necessary factors for engagement were: mutual alignment with a well-articulated and practised ethos; supportive leadership; experiencing professional influence; opportunities for learning; and variety in work. Disillusion resulted if school actions were contrary to the espoused ethos. Severely negative experiences of performance management were survived by withdrawing, and enduring management tenures but these remain very poignant memories. The teachers had few career regrets yet reflection revealed the arbitrary nature of their career progression. The research identified a need to recognise the global and societal factors influencing the nature of teachers’ work. It is argued that schools and systems need to have a greater alignment between these external forces and their internal goals whilst recapturing the moral purpose of education. Furthermore, it is asserted that educational systems need to provide better human resource management for the teaching workforce through emphasising life-balance and well-being. Additionally, professional appraisal and staff management would benefit from strong recognition and deployment of the workplace knowledge and expertise of experienced teachers. A serendipitous outcome of the research was the benefit participants gained from reflecting on their careers which proved extremely affirming, and contributed to enhanced professional identities and changed career plans.

MBA experience by distance education : an ethnographic study of a professional development program

The author's ethnographic study of a professional development program for managers and aspiring managers taught at a distance intends to make a substantial contribution to both the theory and practice of continuing education for professionals. The study focused on a group of Deakin University Master of Business Administration (MBA) participants and their experiences of the final two years of the program. Theorising on the professional development experience was based on data gathered from the direct observation of participants working in their study groups and at residential schools. Moreover, data drawn from end-of-year interviews with participants and discussions with MBA teachers also contributed to the theorising process. Theorising spanned a broad set of interactions encompassing participants' formal educational, professional and personal worlds. The thesis is devoted to two aspects of the professional development experience, namely: participants' interactions in their study groups and at residential schools; and participants' attempts to grow and develop as competent professional practitioners during their MBA studies. Interactions with key learning contexts orchestrated by the teaching institution (i.e. study groups and residential schools) are grounded in an analysis of the changing group cultures observed to accommodate the different educational demands of the program. Group interaction on a broader scale is also analysed in the context of the residential schools. The residential school provided a powerful forum for the development of participant activism over the future development of the MBA program. The analysis of the study groups in action led the author to identify the key characteristics of effective educational work groups. The implications of the success of these essentially egalitarian and leaderless groups for the formation of self-managed groups in the workplace is examined. On the matter of professional development, the author reveals the relationships between the nature of participants' jobs, their search for professional integration, their stage of professional empowerment, the strategies they pursued either to empower themselves or others in their organisations and the barriers which were encountered in the pursuit of empowerment. Dramatic examples of professional disempowerment are analysed indicating that interaction between formal off-the-job learning and professional practice in the workplace is not necessarily a smooth and positive experience. The group of participants studied are seen to be heterogeneous in relation to the above factors characterising professional development The implications of the theorising are considered in relation to professional pedagogies, assessment strategies and distance education. Distance education is seen to socially construct the roles of both teachers and students in the educational process. Specifically, teachers are seen to be somewhat marginalised during the program in use whereas the participants are located at the centre of the educational experience. The primacy of participants in the educational process is highlighted through the growing reliance on self-and peer-group assessment skills as participants progressed through the program. It is argued that the teaching institution should encourage and maintain the development of these skills as they represent a major learning outcome of the professional development experience, i.e. the ability to engage in the process of critical self-reflection and informed action.

Evaluation of the effectiveness of marine protected areas in temperate waters of Australasia

An evaluation of the effectiveness of Marine Protected Areas (MPAs) in temperate waters of Australasia has been conducted for this thesis. The aim was to identify key elements needed in a strategy for establishment and management of MPA’s in temperate waters of Australasia. This aim was achieved by assessing how effective a sample of MPA’s has been in meeting the conservation objectives for their establishment and by identifying factors that have contributed to success or failure of the MPA’s in meeting these objectives. Particular attention was paid to the objectives of ecological sustainability and biodiversity preservation. A MPA for the purposes of this research was defined as an area of coastal or marine environment, with a substantial subtidal component, set aside by law primarily for conservation purposes. The study region encompassed the coastal zones of Victoria, Tasmania and South Australia (Australia) and New Zealand. The questions posed in order to address the aim of this thesis were; a) Have existing MPA’s been effective in achieving conservation objectives? b) What have been the important influences on effectiveness of existing MPA’s? c) What are the key elements required for implementation of effective MPA’s? The thesis is divided into three parts. Part I is a review of the literature on implementation and effectiveness of MPA’s. Part II presents a detailed evaluation of one MPA: Point Lonsdale Marine Reserve (PLMR), Victoria, Australia. Part in is an evaluation of a number of Australasian temperate MPA’s based on information provided in a survey of people involved in management of MPA’s, and from a variety of published and unpublished documents. The MPA’s are described, evidence about ecological effectiveness is presented and factors that have enhanced and limited the ability of these MPA’s to achieve conservation objectives are derived. A substantial amount of scientific evidence was found for increases in abundance, mean size and size range of fish and invertebrate populations within the boundaries of ‘no-take’ MPA’s, Some evidence was found for ‘spillover’ of adults and juveniles into adjacent fishing grounds. Ecological effects detected within ‘no-take’ MPA’s in Australasia matched those described in the literature. The abundance and mean size of a number of previously exploited species have increased, migration into adjacent fishing grounds has been documented, and species richness has increased in at least one MPA. The PLMR was established primarily to protect the scientifically significant intertidal rock platforms. The results of the case study suggest that this objective has been achieved. Opinions about effectiveness were obtained for 28 MPA’s. Of these 19 were considered to be achieving some objectives and 10 were considered to be performing well in terms of overall ecological effectiveness. Positive effects on biodiversity were generally assumed as a result of reduction of damaging anthropogenic effects on habitat. Many questionnaire respondents noted an increase in community awareness about and support for marine conservation as a result of proclamation of MPA’s, Overall, the results support the value of MPA’s for sustainability of fish stocks and preservation of biodiversity, but there is substantial doubt over whether some of the MPA’s are too small to maintain benefits in the long-term. ‘No-take’ MPA’s, particularly those more remote from the impacts of human activities, have been the most effective in achieving objectives. A number of interacting factors important to eventual success of MPA’s were identified. The most important enhancing factors identified for the PLMR were physical attributes that limit the extent of human use and a strong conservation ethic amongst many of the visitors to this marine reserve. Limiting factors were far more numerous. Of most concern is the inadequacy of at-site management. Almost half of visitors to the area were not aware of its marine reserve status, despite the fact many were frequent visitors. The need for better educational and interpretative material on-site is highlighted by the results of the PLMR visitor survey. A total of 56 factors that have enhanced effectiveness and 46 factors that have limited effectiveness of Australasian temperate MPA’s were identified. A number of factors were important in more than one MPA and this was used to derive a set of critical, or key, factors. For example, a conclusion of all three approaches used in this study is that failure to implement day-to-day management through lack of resources was a major constraint on effectiveness. The importance of MPA’s to marine conservation depends, in part, on how well they are managed. The key factors that influence MPA effectiveness were used as the basis for derivation of the main requirements for implementation of MPA’s that will be capable of meeting the objectives for their establishment. The most important needs are: • that ‘no-take’ areas surrounded by buffer zones form the basis for a system of MPA’s; • that a high level of protection is bestowed by legislation and regulations; • that a minimum size be set for the ‘no-take’ core areas; • that the selection of sites for MPA’s takes into account land-based impacts; • that institutional arrangements are developed specifically for MPA’s; • that funding for MPA’s is increased to enable effective management; • that day-to-day management is implemented in all MPA’s, with enforcement and education programs as priority areas; • that a monitoring program for one or more MPA in each 'State' is established to provide evidence of ecological effects of reservation; • that public and stakeholder involvement in development and implementation of MPA’s is encouraged as this will influence the degree of public support and compliance; • that community-based programs to educate the general public, stakeholders, the media and decision-makers about the value of MPA’s are essential; and • that measures to reduce financial impact on affected stakeholders be implemented.

Critical examination of clinical teaching in undergraduate nurse education

Reports on the complex work of Australian clinical nurse teachers, identifying the influence of a range of socio-political factors. Teachers worked from personal curricula and often developed maternal relationships with students. They used time to descipline student learning whilst simultaneously being desciplined in their teaching practices by time.

Relationship factors in the development and maintenance of ED : implications for treatment effectiveness

Introduction. With the advent of effective medical treatments for erectile dysfunction (ED), there has been a reduced focus in recent years on the role of relationship in the development of this disorder.
Aim. This article examines the contribution of relationship factors to the success or otherwise of different treatment
approaches for ED.
Main Outcome Measures. The results of findings in the literature on the association between relationship factors and the development and maintenance of ED.
Methods. This article reviews and evaluates the literature that relates to the role of relationship factors in the development and maintenance of ED.
Results. The current review demonstrates that relationship dynamics are frequently dysfunctional among men with ED. Research demonstrates that addressing these problems is likely to improve the effectiveness of therapy. However, there have been limited studies conducted in this area; many of these studies are methodologically flawed, and so it is difficult to determine the effectiveness of these interventions.
Conclusions. There needs to be further research on the association between relationship factors and ED. Suggestions for future research that include combined medical and psychological interventions for ED are proposed.