Most relevant strategies for preventing surgical site infection after total hip arthroplasty : guideline recommendations and expert opinion

BACKGROUND: Numerous strategies are available to prevent surgical site infections in hip arthroplasty, but there is no consensus on which might be the best. This study examined infection prevention strategies currently recommended for patients undergoing hip arthroplasty. METHODS: Four clinical guidelines on infection prevention/orthopedics were reviewed. Infection control practitioners, infectious disease physicians, and orthopedic surgeons were consulted through structured interviews and an online survey. Strategies were classified as "highly important" if they were recommended by at least one guideline and ranked as significantly or critically important by >/=75% of the experts. RESULTS: The guideline review yielded 28 infection prevention measures, with 7 identified by experts as being highly important in this context: antibiotic prophylaxis, antiseptic skin preparation of patients, hand/forearm antisepsis by surgical staff, sterile gowns/surgical attire, ultraclean/laminar air operating theatres, antibiotic-impregnated cement, and surveillance. Controversial measures included antibiotic-impregnated cement and, considering recent literature, laminar air operating theatres. CONCLUSIONS: Some of these measures may already be accepted as routine clinical practice, whereas others are controversial. Whether these practices should be continued for this patient group will be informed by modeling the cost-effectiveness of infection prevention strategies. This will allow predictions of long-term health and cost outcomes and thus inform decisions on how to best use scarce health care resources for infection control.

Youth Alcohol and Drug Practice Guide 3 : Practice Strategies and Interventions

This guide canvasses a range of practice strategies and interventions utilised by workers and services who engage with young people experiencing problematic AOD use whilst also exploring the many and varied challenges associated with this type of work.

Strategies for improved disease resistance in micro-propagated bananas

Bananas (Musa sp) are one of the most important food crops in the world and provide a staple food and source of income in many households especially in Africa. Diseases are a major constraint to production with bunchy top, caused by Banana bunchy top virus (BBTV) generally considered the most important virus disease of bananas worldwide. Of the fungal diseases, Fusarium wilt, caused by the Fusarium oxysporum f.sp cubense (Foc), and black Sigatoka, caused by Mycosphaerella fijiensis, are arguably two of the most important and cause significant yield losses. The low fertility of commercially important banana cultivars has hampered efforts to generate disease resistance using conventional breeding. Possible alternative strategies to generate or increase disease resistance are through genetic engineering or by manipulation of the innate plant defence mechanisms, namely systemic acquired resistance (SAR). The first research component of this thesis describes attempts to generate BBTV-resistant banana plants using a genetic modification approach. The second research component of the thesis focused on the identification of a potential marker gene associated with SAR in banana plants and a comparison of the expression levels of the marker gene in response to biotic and abiotic stresses, and chemical inducers. Previous research at QUT CTCB showed that replication of BBTV DNA components in banana embryogenic cell suspensions (ECS) was abolished following co-bombardment with 1.1mers of mutated BBTV DNA-R. BBTV DNA-R encodes the master replication protein (Rep) and is the only viral protein essential for BBTV replication. In this study, ECS of banana were stably transformed with the same constructs, each containing a different mutation in BBTV DNA-R, namely H41G, Y79F and K187M, to examine the effect on virus replication in stably transformed plants. Cells were also transformed with a construct containing a native BBTV Rep. A total of 16, 16, 11 and five lines of stably transformed banana plants containing the Y79F, H41G, K187M and native Rep constructs, respectively, were generated. Of these, up to nine replicates from Y79F lines, four H41G lines, seven K187M lines and three native Rep lines were inoculated with BBTV by exposure to viruliferous aphids in two separate experiments. At least one replicate from each of the nine Y79F lines developed typical bunchy top symptoms and all tested positive for BBTV using PCR. Of the four H41G lines tested, at least one replicate from three of the lines showed symptoms of bunchy top and tested positive using PCR. However, none of the five replicates of one H41G line (H41G-3) developed symptoms of bunchy top and none of the plants tested positive for BBTV using PCR. Of the seven K187M lines, at least one replicate of all lines except one (K187M-1) developed symptoms of bunchy top and tested positive for BBTV. Importantly, none of the four replicates of line K187M-1 showed symptoms or tested positive for BBTV. At least one replicate from each of the three native Rep lines developed symptoms and tested positive for BBTV. The H41G-3 and K187M-1 lines possibly represent the first transgenic banana plants generated using a mutated Rep strategy. The second research component of this thesis focused on the identification of SAR-associated genes in banana and their expression levels in response to biotic and abiotic stresses and chemical inducers. The impetus for this research was the observation that tissue-cultured (TC) banana plants were more susceptible to Fusarium wilt disease (and possibly bunchy top disease) than plants grown from field-derived suckers, possibly due to decreased levels of SAR gene expression in the former. In this study, the pathogenesis-related protein 1 (PR-1) gene was identified as a potential marker for SAR gene expression in banana. A quantitative real-time PCR assay was developed and optimised in order to determine the expression of PR-1, with polyubiquitin (Ubi-1) found to be the most suitable reference gene to enable relative quantification. The levels of PR-1 expression were subsequently compared in Lady Finger and Cavendish (cv. Williams) banana plants grown under three different environmental conditions, namely in the field, the glass house and in tissue-culture. PR-1 was shown to be expressed in both cultivars growing under different conditions. While PR-1 expression was highest in the field grown bananas and lowest in the TC bananas in Lady Finger cultivar, this was not the case in the Cavendish cultivar with glass house plants exhibiting the lowest PR-1 expression compared with tissue culture and field grown plants. The important outcomes of this work were the establishment of a qPCR-based assay to monitor PR-1 expression levels in banana and a preliminary assessment of the baseline PR-1 expression levels in two banana cultivars under three different growing conditions. After establishing the baseline PR-1 expression levels in Cavendish bananas, a study was done to determine whether PR-1 levels could be increased in these plants by exposure to known banana pathogens and non-pathogens, and a known chemical inducer of SAR. Cavendish banana plants were exposed to pathogenic Foc subtropical race 4 (FocSR4) and non-pathogenic Foc race 1 (Foc1), as well as two putative inducers of resistance, Fusarium lycopersici (Fol) and the chemical, acibenzolar-S-methyl (BION®). Tissue culture bananas were acclimatised under either glass house (TCS) or field (TCH) conditions and treatments were carried out in a randomised complete block design. PR-1 expression was determined using qPCR for both TCS and TCH samples for the period 12-72h post-exposure. Treatment of TCH plants using Foc1 and FocSR4 resulted in 120 and 80 times higher PR-1 expression than baseline levels, respectively. For TCS plants treated with Foc1, PR-1 expression was 30 times higher than baseline levels at 12h post-exposure, while TCS plants treated with FocSR4 showed the highest PR-1 expression (20 times higher than baseline levels) at 72h post-exposure. Interestingly, when TCS plants were treated with Fol there was a marked increase of PR-1 expression at 12 h and 48 h following treatment which was 4 and 8 times higher than the levels observed when TCS plants were treated with Foc1 and FocSR4, respectively. In contrast, when TCH plants were treated with Fol only a slight increase in PR-1 expression was observed at 12 h, which eventually returned to baseline levels. Exposure of both TCS and TCH plants to BION® resulted in no effect on PR-1 expression levels at any time-point. The major outcome of the SAR study was that the glass house acclimatised tissue culture bananas exhibited lower PR-1 gene expression compared to field acclimatised tissue culture plants and the identification of Fol as a good candidate for SAR induction in banana plants exhibiting low PR-1 levels. A number of outcomes that foster understanding of both pathogen-derived and plant innate resistance strategies in order to potentially improve banana resistance to diseases were explored in this study and include identification of potential inducers of systemic acquired resistance and a promising mutated Rep approach for BBTV resistance. The work presented in this thesis is the first report on the generation of potential BBTV resistant bananas using the mutated Rep approach. In addition, this is the first report on the status of SAR in banana grown under different conditions of exposure to the biotic and abiotic environment. Further, a robust qPCR assay for the study of gene expression using banana leaf samples was developed and a potential inducer of SAR in tissue culture bananas identified which could be harnessed to increase resistance in tissue culture bananas.

Strategies for mentoring pedagogical knowledge

Fundamental for mentoring a preservice teacher is the mentor’s articulation of pedagogical knowledge, which in this research draws upon specific practices, viz: planning, timetabling lessons, preparation, teaching strategies, content knowledge, problem solving, questioning, classroom management, implementation, assessment, and viewpoints for teaching. Mentoring is haphazard; consequently mentors need a pedagogical knowledge framework and a repertoire of pedagogical knowledge strategies to guide a preservice teacher’s development. Yet, what are strategies for mentoring pedagogical knowledge practices? This qualitative research investigates mentoring strategies assigned to pedagogical knowledge from 27 experienced mentor teachers. Findings showed that there were multiple strategies that can be linked to specific pedagogical knowledge practices. For example, mentoring strategies associated with planning for teaching can include co-planning, verbally reflecting on planning with the mentee, and showing examples of the mentor teacher’s planning (e.g., teacher’s plans, school plans, district and state plans). This paper provides a bank of practical strategies for mentoring pedagogical knowledge practices to assist a preservice teacher’s development.

Why trust the Head? : key strategies for transformational school leaders for building a purposeful relationship of trust

Trust is widely recognised as one of the key qualities that a successful leader needs to bring about change within their organization. Browning’s study aimed to identify practices which a school leader can effectively use to inspire, build, and maintain trust between themselves, their staff and Chair of governing body. The study was undertaken in two phases. Phase One was the identification of four highly trusted transformational leaders from the Australian independent schooling sector. Phase Two was a multicase study of the four school leaders. The findings provide practical advice for school leaders wishing to have a positive impact on the outcomes of the students in their school.

Climate change adaptation in urban systems : strategies for planning regimes

Adaptation is increasingly being viewed as a necessary response tool in respect of climate change effects. Though the subject of significant scholarly and professional attention, adaptation still continues to lag behind mitigation in the climate change discourse. However, this situation looks likely to change over the coming years due to a increasing scientific acceptance that certain climate change effects are now inevitable. The purpose of this research is to illustrate, consider and demonstrate how urban planning regimes can use some of their professional tools to develop adaptation strategies and interventions in urban systems. These tools include plan-making, development management, urban design and place-making. Urban systems contribute disproportionately to climate change and will also likely suffer considerably from the resulting effects. Moreover, the majority of the world’s population is now urbanised, suggesting that adaptation will be crucial in order to develop urban systems that are resilient to climate change effects. Informed by a reflexive, qualitative methodology, this paper offers an informed understanding and illustration of adaptation as a climate change response, its use in urban systems and some of the roles and strategies that planning may take in developing and implementing urban adaptation. It concludes that urban planning regimes can have key roles in adapting urban systems to numerous climate change effects.

Developing targets and strategies for school-based injury prevention programs to reduce alcohol associated transport risks

Background There is considerable and ongoing debate about the role and effectiveness of school-based injury prevention programs in reducing students’ later involvement in alcohol associated transport injuries. Most relevant literature is concerned with pre-driving and licensing programs for middle age range adolescents (15-17 years). This research team is concerned with prevention at an earlier stage by targeting interventions to young adolescents (13-14 years). There is strong evidence that young adolescents who engage in unsafe and illegal alcohol associated transport risks are significantly likely to incur serious related injuries in longitudinal follow up. For example, a state-wide representative sample of male adolescents (mean age 14.5 years) who reported being passengers of drink drivers were significantly more likely to have incurred a hospitalised injury related to traffic events at a 20 year follow up. Aim This paper reports on first aid training integrated with peer protection and school connectedness within the Skills for Preventing Injury in Youth (SPIY) program. A component of the intervention is concerned with providing strategies to reduce the likelihood of being a passenger of a drink driver and effectiveness is followed up at six months post-intervention. Method In early 2012 the study was undertaken in 35 high schools throughout Queensland that were randomly assigned to intervention and control conditions. A total of 2,521 Year 9 students (mean age 13.5years, 43% male) completed surveys prior to the intervention. Results Of these students 316 (13.7%) reported having ridden in a car with someone who has been drinking. This is a traffic safety behaviour that is particularly relevant to a peer protection intervention and the findings of the six month follow up will be reported. Discussion and conclusions This research will provide evidence as to whether this approach to the introduction of first aid skills within a school-based health education curriculum has traffic safety implications.

In their own words : adolescents strategies to prevent friend's risk taking

Injury is a significant public health problem among youth. A primary cause of adolescent injury is risk-taking behavior, including alcohol use, interpersonal violence and road-related risks. A novel approach to prevention is building on friendships by encouraging adolescents to intervene into their friends’ risk taking. Fifty-one early adolescents (13-14 years) and 44 older adolescents (16-17 years) from two Australian schools participated in focus groups, aiming to explore stories of intervening. Findings showed preference for talking to friends; however, participants also spoke to adults, monitored friends’ behavior and planned ahead. Close friendships, perceived harm, and self-efficacy influenced the likelihood of intervening. These findings have implications for the design of risk and injury prevention programs, by suggesting strategies to promote adolescents’ communicative ability for risk reduction. The findings also highlight the language and dialogue of adolescents and suggest that methods for increasing intervening behavior should focus on building social connectedness and increasing self-efficacy.

Augmenting analytical CRM strategies with social BI

Large communities built around social media on the Internet offer an opportunity to augment analytical customer relationship management (CRM) strategies. The purpose of this paper is to provide direction to advance the conceptual design of business intelligence (BI) systems for implementing CRM strategies. After introducing social CRM and social BI as emerging fields of research, the authors match CRM strategies with a re-engineered conceptual data model of Facebook in order to illustrate the strategic value of these data. Subsequently, the authors design a multi-dimensional data model for social BI and demonstrate its applicability by designing management reports in a retail scenario. Building on the service blueprinting framework, the authors propose a structured research agenda for the emerging field of social BI.

Organisational change stressor and nursing job satisfaction : the mediating effect of coping strategies

Aim To examine the mediating effect of coping strategies on the consequences of nursing and non-nursing (administrative) stressors on the job satisfaction of nurses during change management. Background Organisational change can result in an increase in nursing and nonnursing- related stressors, which can have a negative impact on the job satisfaction of nurses employed in health-care organisations. Method Matched data were collected in 2009 via an online survey at two timepoints (six months apart). Results Partial least squares path analysis revealed a significant causal relationship between Time 1 administrative and role stressors and an increase in nursing-specific stressors in Time 2. A significant relationship was also identified between job-specific nursing stressors and the adoption of effective coping strategies to deal with increased levels of change-induced stress and strain and the likelihood of reporting higher levels of job satisfaction in Time 2. Conclusions The effectiveness of coping strategies is critical in helping nurses to deal with the negative consequences of organisational change. Implications for nursing management This study shows that there is a causal relationship between change, non-nursing stressors and job satisfaction. Senior management should implement strategies aimed at reducing nursing and nonnursing stress during change in order to enhance the job satisfaction of nurses. Keywords: Australia, change management, job satisfaction, nursing and non-nursing stressors, public and non-profit sector

The university of the digital future : a reimagining based on the learning strategies of professionals in the digital media sectors

This article explores how universities might engage more effectively with the imperative to develop students’ 21st century skills for the information society, by examining learning challenges and strategies of successful digital media professionals. The findings support a significant body of literature, which argues that legacy university structures and pedagogical approaches are not conducive to optimal professional learning in the digital age. A model of one reimagining of the university is presented, which draws upon the learning preferences of the professionals in this study, as linked with extant theory relating to informal, situated, self-determined learning, communities of practice and personal learning environments.

A systematic approach for selecting lean strategies and assessing leanness in manufacturing organizations

Lean strategies have been developed to eliminate or reduce manufacturing waste and thus improve operational efficiency in manufacturing processes. However, implementing lean strategies requires a large amount of resources and, in practice, manufacturers encounter difficulties in selecting appropriate lean strategies within their resource constraints. There is currently no systematic methodology available for selecting appropriate lean strategies within a manufacturer's resource constraints. In the lean transformation process, it is also critical to measure the current and desired leanness levels in order to clearly evaluate lean implementation efforts. Despite the fact that many lean strategies are utilized to reduce or eliminate manufacturing waste, little effort has been directed towards properly assessing the leanness of manufacturing organizations. In practice, a single or specific group of metrics (either qualitative or quantitative) will only partially measure the overall leanness. Existing leanness assessment methodologies do not offer a comprehensive evaluation method, integrating both quantitative and qualitative lean measures into a single quantitative value for measuring the overall leanness of an organization. This research aims to develop mathematical models and a systematic methodology for selecting appropriate lean strategies and evaluating the leanness levels in manufacturing organizations. Mathematical models were formulated and a methodology was developed for selecting appropriate lean strategies within manufacturers' limited amount of available resources to reduce their identified wastes. A leanness assessment model was developed by using the fuzzy concept to assess the leanness level and to recommend an optimum leanness value for a manufacturing organization. In the proposed leanness assessment model, both quantitative and qualitative input factors have been taken into account. Based on program developed in MATLAB and C#, a decision support tool (DST) was developed for decision makers to select lean strategies and evaluate the leanness value based on the proposed models and methodology hence sustain the lean implementation efforts. A case study was conducted to demonstrate the effectiveness of these proposed models and methodology. Case study results suggested that out of 10 wastes identified, the case organization (ABC Limited) is able to improve a maximum of six wastes from the selected workstation within their resource limitations. The selected wastes are: unnecessary motion, setup time, unnecessary transportation, inappropriate processing, work in process and raw material inventory and suggested lean strategies are: 5S, Just-In-Time, Kanban System, the Visual Management System (VMS), Cellular Manufacturing, Standard Work Process using method-time measurement (MTM), and Single Minute Exchange of Die (SMED). From the suggested lean strategies, the impact of 5S was demonstrated by measuring the leanness level of two different situations in ABC. After that, MTM was suggested as a standard work process for further improvement of the current leanness value. The initial status of the organization showed a leanness value of 0.12. By applying 5S, the leanness level significantly improved to reach 0.19 and the simulation of MTM as a standard work method shows the leanness value could be improved to 0.31. The optimum leanness value of ABC was calculated to be 0.64. These leanness values provided a quantitative indication of the impacts of improvement initiatives in terms of the overall leanness level to the case organization. Sensitivity analsysis and a t-test were also performed to validate the model proposed. This research advances the current knowledge base by developing mathematical models and methodologies to overcome lean strategy selection and leanness assessment problems. By selecting appropriate lean strategies, a manufacturer can better prioritize implementation efforts and resources to maximize the benefits of implementing lean strategies in their organization. The leanness index is used to evaluate an organization's current (before lean implementation) leanness state against the state after lean implementation and to establish benchmarking (the optimum leanness state). Hence, this research provides a continuous improvement tool for a lean manufacturing organization.

Natural and engineered plasmin inhibitors : applications and design strategies

Plasmin is the primary enzyme responsible for dissolution of fibrin in the circulatory system. Plasminogen, the zymogen of plasmin is expressed ubiquitously in the human body [1], with the predominant source being the liver [2, 3]. Plasminogen is produced as an 810 amino acid protein with a 19 amino acid leader peptide, which is cleaved during secretion to produce the mature 791 amino acid one-chain zymogen. This is converted to plasmin by cleavage of the Arg561 - Val562 scissile bond [4], resulting in an active protease consisting of two disulfide linked chains. The amino-terminal heavy chain (residues Glu1-Arg561) is comprised of a plasminogen/apple/nematode (PAN) domain [5] and five kringle domains of approximately equal size [6] while the light chain (residues Val562-Asn791) contains a serine protease domain homologous to trypsin with a catalytic triad comprising His603, Asp646 and Ser741 [7]. Both plasmin and plasminogen occur in two forms, full length and a Lys77-Lys78 activated variant produced through self catalysis (Figure 1). The former exists in a tight conformation through binding of Lys50 and/or Lys62 to kringle domain 5 [8, 9] while Lys78-plasminogen assumes a more relaxed conformation rendering it more susceptible to plasmin conversion [10, 11].

The challenges of adopting design-led innovative strategies in not for profits : the role of consumers, culture and employees

Major changes to regulations, funding and consumer demand in the Australian aged care industry are driving not for profits in this sector to reshape and rethink the services they offer and the ways in which they deliver their services to consumers. Many not for profit organisations facing these new challenges are also facing organisational cultural barriers in the development and implementation of innovative strategies. This paper presents a case study where one organisation, using design led innovation, explored consumer insights and employee values to find new ways to facilitate change.

The role of motivation and motivational strategies in Saudi students' communicative competence in English

This study explored how motivation and motivational strategies influence the communicative competence of students from Saudi Arabia. Participants included Saudi students enrolled in English courses in Australian educational institutions, and Saudi students living in Saudi Arabia studying in English language institutes in Saudi Arabia. Phase One involved interviews with16 participants. In Phase Two, 279 participants completed a questionnaire. Findings included differences between participants’ measured and self-reported communicative competence, with the Australian group having higher levels of measured and self-reported communicative competence. In addition, motivation teaching strategies were found to affect students’ motivation, but not their communicative competence.