Negotiating life choices : living with motor neurone disease

Motor neurone disease (MND) is an uncommon neurodegenerative disease that is terminal and has an insidious onset. With no known cause or cure, the disease triggers progressive death of motor neurones that causes increasing difficulties with mobility, communication, breathing and nutrition. Most research focuses on the disease process, but little is known of the illness experience from the perspective of those diagnosed with the disease. The aim of this study was to explore what it is like to live with MND and how people with the disease negotiate with others to exercise choice over the way they live. A grounded theory methodology was used to explore the life world of people diagnosed and living with MND. Data were collected via in-depth interviews, their stories and photographs, poems and books participants identified as important and fieldnotes. The textual data were analysed using constant comparative analysis. The majority of participants experienced difficulty with verbal communication. Some invited a third person to interpret their speech and others used assistive technologies such as Lightwriters and computers. Analysis revealed three constructs that, together, told the story of the MND illness experience. First, was the “diagnosis story” that described the devastating process of repeated tests had on the participants, shattering their trust in the competence of the health care system. The second construct revealed the process of living with MND as cyclical and repetitive requiring constant decision-making to adapt to the ongoing changes connected with the disease. The core theme and basic social process of “maintaining personal integrity” evolved as the third construct. This process underpinned and explained participants’ decision-making. Finally a substantive theory was conceptualised as the illness experience: “maintaining personal integrity in the face of ongoing change and adaptation”. This theory illustrates that the basic social process of maintaining personal integrity is central to decision and choice making while living with MND. The findings have implications for people with MND, their carers, health professionals and service providers. Recommendations include improved counselling services for people at the time of diagnosis; the introduction of nurse specialists to support health professionals, people diagnosed with the disease and their families; open, accessible, realistic health and funding policies.

Getting your life back on track after stroke : a phase II multi-centered, single-blind, randomized, controlled trial of the Stroke Self-Management Program vs. the Stanford Chronic Condition Self-Management Program or standard care in stroke survivors

Background Self-management is seen as a primary mechanism to support the optimization of care for people with chronic diseases such as symptomatic vascular disease. There are no established and evidence-based stroke-specific chronic disease self-management programs. Our aim is to evaluate whether a stroke-specific program is safe and feasible as part of a Phase II randomized-controlled clinical trial.
Methods Stroke survivors are recruited from a variety of sources including: hospital stroke services, local paper advertisements, Stroke South Australia newsletter (volunteer peer support organization), Divisions of General Practice, and community service providers across Adelaide, South Australia. Subjects are invited to participate in a multi-center, single-blind, randomized, controlled trial. Eligible participants are randomized to either;
• standard care,
• standard care plus a six week generic chronic condition self-management group education program, or,
• standard care plus an eight week stroke specific self-management education group program.
Interventions are conducted after discharge from hospital. Participants are assessed at baseline, immediate post intervention and six months.
Study Outcomes The primary outcome measures determine study feasibility and safety, measuring, recruitment, participation, compliance and adverse events.
Secondary outcomes include:
• positive and active engagement in life measured by the Health Education Impact Questionnaire,
• improvements in quality of life measured by the Assessment of Quality of Life instrument,
• improvements in mood measured by the Irritability, Depression and Anxiety Scale,
• health resource utilization measured by a participant held diary and safety.

Conclusion The results of this study will determine whether a definitive Phase III efficacy trial is justified.

An evaluation of a community aged care nurse practitioner service

Evaluation aims: An evaluation is presented that aimed to augment current understandings of the nurse practitioner role by investigating potential outcomes of a community aged care nurse practitioner (ACNP) service on clients and the health care team.

Background: In Australia, the nurse practitioner role is being implemented in a variety of health care settings and is characterized by extended practice: prescribing of medications, requests for diagnostic investigations, referral to medical specialists and admitting clients to inpatient facilities.

Design: An exploratory qualitative evaluation method through data collection by interview and thematic analysis was undertaken.

Method: All clients referred to the ACNP service between June and August 2003, and a convenience sample of health professionals, were invited to participate in individual semi-structured interviews.

Results: Findings suggested that an ACNP could provide a high quality of holistic nursing care and positively affect clients' physical and psychological symptom management, enhance clients' quality of life, assist with supplies, provide health education and assist with advocacy. Health professionals commented on effective collaboration with the ACNP service during their partnerships in client care provision.

Conclusions: Overall, the positive effects of the ACNP service on clients and the health care team support the full implementation of the role within the community setting.

Relevance to clinical practice: Funding support for the nurse practitioner role is a vital addition to consideration in the development of international policy on advanced practice nursing. Without adequate funding, the full benefits of the nurse practitioner role in clinical practice, as suggested by the findings presented in this evaluation, will be compromised.

The impact of caring for a child with cerebral palsy : quality of life for mothers and fathers

Background:  Although it is expected that caring for a child with cerebral palsy (CP) can impact on the quality of life (QOL) of caregivers, the QOL of carers' has yet to be adequately examined. The aims of this study are to: (1) explore the QOL of mothers and fathers of children with CP aged 3–18 years; and (2) examine whether the impact of caring for a child with CP changes from childhood to adolescence.

Method: A qualitative study was conducted utilizing a grounded theory framework. Twenty-four mothers and 13 fathers of children and adolescents with CP aged 3–7 years (n = 15), 8–12 years (n = 10) and 13–18 years (n = 12) and with varying levels of impairment (GMFCS Level I = 1, II = 4, II = 3, IV = 5, V = 12) participated in semi-structured interviews about their QOL. The transcripts were analysed to identify issues affecting parental QOL.

Results: There were no differences in parental QOL among subgroups (i.e. mothers and fathers, age groups, GMFCS levels). Parental QOL ranged across a wide spectrum. Caring for a child with CP affects a parent's physical well-being, social well-being, freedom and independence, family well-being and financial stability. Parents indicated that they often feel unsupported by the services they access.

Conclusions: Caring for a child with CP can both positively and negatively impact on a parent's life. There is value for both parents and children if parental concerns and determinants of QOL are considered in overall programme planning and service delivery for children and their families.

Improving contaminated land remediation practices for service station sites in Queensland

The research aims to provide improvements to remediation practices for land contaminated by service station activities in the period 1988-2004 by assessing previous methods of remediation. Thirty-four such Queensland sites were examined. The resultes will be useful to government, developers, land holders, consultants and the community.

An autonomic management system for service oriented enterprise grid computing

Grid computing and service oriented architectures improve the way computational tasks are performed. Through this research a management system, utilising the autonomic characteristics of self discovery and negotiation, self configuration and self healing, was designed and implemented, ultimately removing the need for users to know the intricacies of these systems.

Evaluation of the childhood obesity prevention program kids - go for your life

Background
Kids - 'Go for your life' (K-GFYL) is an award-based health promotion program being implemented across Victoria, Australia. The program aims to reduce the risk of childhood obesity by improving the socio-cultural, policy and physical environments in children's care and educational settings. Membership of the K-GFYL program is open to all primary and pre-schools and early childhood services across the State. Once in the program, member schools and services are centrally supported to undertake the health promotion (intervention) activities. Once the K-GFYL program 'criteria' are reached the school/service is assessed and 'awarded'. This paper describes the design of the evaluation of the statewide K-GFYL intervention program.

Methods/Design
The evaluation is mixed method and cross sectional and aims to:
1) Determine if K-GFYL award status is associated with more health promoting environments in schools/services compared to those who are members only;
2) Determine if children attending K-GFYL award schools/services have higher levels of healthy eating and physical activity-related behaviors compared to those who are members only;
3) Examine the barriers to implementing and achieving the K-GFYL award; and
4) Determine the economic cost of implementing K-GFYL in primary schools
Parent surveys will capture information about the home environment and child dietary and physical activity-related behaviors. Environmental questionnaires in early childhood settings and schools will capture information on the physical activity and nutrition environment and current health promotion activities. Lunchbox surveys and a set of open-ended questions for kindergarten parents will provide additional data. Resource use associated with the intervention activities will be collected from primary schools for cost analysis.

Discussion
The K-GFYL award program is a community-wide intervention that requires a comprehensive, multi-level evaluation. The evaluation design is constrained by the lack of a non-K-GFYL control group, short time frames and delayed funding of this large scale evaluation across all intervention settings. However, despite this, the evaluation will generate valuable evidence about the utility of a community-wide environmental approach to preventing childhood obesity which will inform future public health policies and health promotion programs internationally.

Trial Registration
ACTRN12609001075279

A descriptive interview with 64 patients discharged from an acute-psyciatric-inpatient service

Background Acute-mental-health services receive hundreds of admissions every year. Some of these patients will continue to be case-managed by community mental-health teams on discharge from the acute unit while others will not remain in contact with the mental-health service. This study compares the findings of comprehensive interviews conducted with current and past patients of the community mental-health service 3 or more years following case closure from the community ambulatory service.
Methods Between 1 July 1999 and 30 June 2001, there were 2245 closed cases identified at Barwon Health. Letters of invitation to participate in a research project were sent to people who had suffered from psychotic illnesses, and had been case-closed by community mental-health services between the above dates and had not been in contact with the Community and Mental Health Service for at least 6 months. A second group of participants was recruited from people who had also been case-closed by community mental health teams in Barwon Health during the 1999–2001 2-year-time window but whose cases had been re-opened and who were in case management with Barwon Health at the time of the study. All participants were interviewed using the Diagnostic Interview for Psychosis.
Results Letter responses were received from 17 men and 18 women, aged 40.7 ± 12.0 (mean ± SD), who were interviewed. A second group of 17 men and 12 women, aged 40.9 ± 9.6 (mean ± SD) of currently case-managed patients was interviewed. All interviewees reported a detailed history of mental illness. Persistent social dysfunction and impaired quality of life were reported in both groups.
Conclusion Patients suffering from psychotic disorders who had been case-closed by community mental-health teams and had been discharged to the care of their general practitioners or elsewhere continued to show evidence of significant impairment due to mental illness 3 years after being case-closed.

Dialysis residential care : a future dialysis service model

People with chronic kidney disease are ageing and have increasing co-morbidities. The current delivery of renal replacement therapy, dialysis and transplantation, needs to adjust to changing patient needs. This paper proposes a potential future service delivery model featuring a dialysis residential care facility and a care coordination focus. The residential care facility would be composed of four levels of care; high, hostel, independent and outpatient. The paper argues that this model may result in decreased morbidity, improved patient quality of life and may prove cost effective. Patients' nutritional status, medication adherence and transport efficiency may be improved. We propose this model to stimulate further debate in order to meet the needs of current and future chronic kidney disease patients.

Multi-market industrial organizational economic models for the internationalization process by small and medium enterprise construction design service firms

Small and medium enterprises (SMEs) are critical to strategic initiatives in an economy; however, their contribution to foreign trade is not as significant. SMEs are one of the principal driving forces in economic development. One of the greatest challenges is the internationalization process for longevity rather than seeing the process as initial market entry. The internationalization process research has typically involved four key constructs: market selection, decision to enter, entry modes and factors affecting entry modes. Past research has focused on large manufacturing firms. The export of architectural, engineering and construction (AEC) firms has undergone growth, yet there is still significant opportunity for further growth. The majority of AEC firms are SMEs. Notwithstanding assistance provided through international trade missions, organized export firm support networks and information packages by a burgeoning number of government agencies, there are still perceived barriers to market entry and long-term economic sustainability for SMEs. There are a number of problems faced by SMEs acting in foreign trade. This investigation explores the successful initial internationalization process constructs and identifies unique project-oriented sector characteristics. The study identified similarities and differences between two firms that have been exporting to various localities, including Eastern Europe, Africa, Middle East, UK, Asia and South America, for more than two decades. The similarities and differences were identified within eight major constructs: purpose, firm type, market image and design philosophy, entry mode strategy, institutional arrangement, factors affecting mode of entry, market selection and firm strategy in relation to project selection. The primary reasons for internationalization were associated with the firms' motivations related to growth and financial viability. This article discusses the various internationalization processes and strategies intrinsic to each case study and establishes a detailed set of empirical observations from which to develop further a grounded theoretical model of reflexive capability for the internationalization process. This study contributes to the body of knowledge around the SME AEC design service firm's internationalization process, as a dynamic, evolving and continuously adaptable construct for project-based sectors.

Changing pre-service teachers' purposes of education through existential crises

This article considers changing the purposes of education held by pre-service teachers. It argues that purposes of education are inextricably linked to life meanings and purposes. Employing an existential perspective, mainly through Kierkegaard, Nietzsche, Heidegger, Sartre and Morris, the fundamental beliefs that one has regarding the meaning and purpose of life are understood to serve as the basis for formulating purposes of education. An attempt to change these purposes is recommended by drawing upon the existential crisis and Kierkegaard's doctrine of 'how'. Importance is placed not so much on the object or what of purposes and understandings, but on how the individual relates to them.

Preparing pre-service physical education teachers for uncertain future(s) : a scenario-based learning case study from Australia

Background: A key aim of a physical education teacher education (PETE) program is to promote wide and deep knowledge, enabling students to establish connections and understand contexts within and beyond education, physical education and their life worlds. Most often PETE programs equip students with content knowledge and pedagogical strategies that help them address current challenges, but less attention is directed to helping the students anticipate future challenges and engage with opportunities they may face as teachers.
Purpose: This paper presents a case study of scenario-based learning as it was implemented in a final year PETE program in an Australian university, as a means of preparing students for their future teaching careers.
Participants and setting: Twenty-five final year pre-service physical education teachers enrolled in the culminating unit of their physical education degree.
Data collection: Scenario-based learning was introduced to the students via class discussion and assigned tasks. Examples of student-written scenarios and reflection on the experience from the lecturer and student perspectives are analysed.
Findings: Although the cohort found the process of scenario-based learning daunting the post-unit questionnaires revealed that it was a valued and valuable means of exploring professional issues they will face in the future. Scenario-based learning was a powerful tool of learning as well as modelling a pedagogy students could use in the upper levels of secondary school.
Conclusion: This paper argues that scenario-based learning should be a key component of forward-looking PETE programs that encourage their graduates to solve problems about issues they may face as beginning teachers.

Life in PBL : two PBL teams

Problem-based learning (PBL) continues to challenge educational institutions in terms of demonstrating its effectiveness. Prior studies have offered insight into the methods, application, and experiences of teaching using PBL. However, student behaviours and the learning cultures that develop in PBL settings are also important. In this paper, we present the ways students of a first year engineering course at an Australian university approach PBL. A number of PBL teams in the same subject were observed throughout two semesters with their consent. This paper reports on two of these teams. Some observations were video taped to aid analysis. The purpose of this study was to analyse and compare learning approaches that help or hinder successful group outcomes. It is evident from the data that individuals in the groups have a strong influence on what is learnt. Some students also focus more on exploiting the assessment system than on maximising their learning.

Context-aware meta search engine for distributed web service

The ubiquity of the Internet and Web has led to the emergency of several Web search engines with varying capabilities. A weakness of existing search engines is the very extensive amount of hits that they can produce. Moreover, only a small number of web users actually know how to utilize the true power of Web search engines. Therefore, there is a need for searching infrastructure to help ease and guide the searching efforts of web users toward their desired objectives. In this paper, we propose a context-based meta-search engine and discuss its implementation on top of the actual Google.com search engine. The proposed meta-search engine benefits the user the most when the user does not know what exact document he or she is looking for. Comparison of the context-based meta-search engine with both Google and Guided Google shows that the results returned by context-based meta-search engine is much more intuitive and accurate than the results returned by both Google and Guided Google.