Study protocol of the YOU CALL - WE CALL TRIAL: Impact of a multimodal support intervention after a "mild" stroke

Background More than 60% of new strokes each year are "mild" in severity and this proportion is expected to rise in the years to come. Within our current health care system those with "mild" stroke are typically discharged home within days, without further referral to health or rehabilitation services other than advice to see their family physician. Those with mild stroke often have limited access to support from health professionals with stroke-specific knowledge who would typically provide critical information on topics such as secondary stroke prevention, community reintegration, medication counselling and problem solving with regard to specific concerns that arise. Isolation and lack of knowledge may lead to a worsening of health problems including stroke recurrence and unnecessary and costly health care utilization. The purpose of this study is to assess the effectiveness, for individuals who experience a first "mild" stroke, of a sustainable, low cost, multimodal support intervention (comprising information, education and telephone support) - "WE CALL" compared to a passive intervention (providing the name and phone number of a resource person available if they feel the need to) - "YOU CALL", on two primary outcomes: unplanned-use of health services for negative events and quality of life. Method/Design We will recruit 384 adults who meet inclusion criteria for a first mild stroke across six Canadian sites. Baseline measures will be taken within the first month after stroke onset. Participants will be stratified according to comorbidity level and randomised to one of two groups: YOU CALL or WE CALL. Both interventions will be offered over a six months period. Primary outcomes include unplanned use of heath services for negative event (frequency calendar) and quality of life (EQ-5D and Quality of Life Index). Secondary outcomes include participation level (LIFE-H), depression (Beck Depression Inventory II) and use of health services for health promotion or prevention (frequency calendar). Blind assessors will gather data at mid-intervention, end of intervention and one year follow up. Discussion If effective, this multimodal intervention could be delivered in both urban and rural environments. For example, existing infrastructure such as regional stroke centers and existing secondary stroke prevention clinics, make this intervention, if effective, deliverable and sustainable.

Translation and psychometric properties of the Chinese version of the Leeds Attitudes to Concordance II scale

Background Concordance is characterised as a negotiation-like health communication approach based on an equal and collaborative partnership between patients and health professionals. The Leeds Attitudes to Concordance II (LATCon II) scale was developed to measure the attitudes towards concordance. The purpose of this study was to translate the LATCon II into Chinese and psychometrically test the Chinese version of LATCon II (C-LATCon II). Methods The study involved three phases: i) translation and cross-cultural adaptation; ii) pilot study, and; iii) a cross-sectional survey (n = 366). Systematic random sampling was used to recruit hypertensive patients from nine communities covering around 78,000 residents in China. Tests of psychometric properties included content validity, construct validity, criteria-related validity (correlation between the C-LATCon II and the Therapeutic Adherence Scale for Hypertensive Patients (TASHP)), internal reliability, and test-retest reliability (n = 30). Results The study found that the C-LATCon II had a satisfactory content validity (item-level Content Validity Index (CVI) = 0.83-1, scale-level CVI/universal agreement = 0.89, and scale-level CVI/averaging calculation = 0.98), construct validity (four components extracted explained 56.66% of the total variance), internal reliability (Cronbach’s alpha of overall scale and four components was 0.78 and 0.66-0.84, respectively), and test-retest reliability (Pearson’s correlation coefficient = 0.82, p < 0.001; interclass correlation coefficient = 0.82, p < 0.001; linear weighted kappa3 statistic for each item = 0.40-0.65, p < 0.05). Criteria-related validity showed a weak association (Pearson’s correlation coefficient = 0.11, p < 0.05) between patients’ attitudes towards concordance during health communication and their health behaviours for hypertension management. Conclusions The C-LATCon II is a validated and reliable instrument which can be used to evaluate the attitudes to concordance in Chinese populations. Four components (health professionals’ attitudes, partnership between two parties, therapeutic decision making, and patients’ involvement) describe the attitudes towards concordance during health communication.

An Aboriginal nurse-led working model for success in graduating Indigenous Australian nurses

Australia needs more Indigenous nurses. This is widely recognised in both academic literature and government policy. In 2012, only 0.8 percent of the Australian nursing workforce was Indigenous (AIHW, 2012). In spite of the clear need, there is little discussion about how to successfully recruit, retain and graduate Indigenous nursing students. This paper describes a successful program being implemented at the University of Southern Queensland (USQ). Between 2000 and 2012, USQ graduated 80 Indigenous nurses and midwives, at both undergraduate and postgraduate levels. In this paper, the authors outline the journey they undertook to develop the successful program at USQ: the Indigenous Nursing Support (INS) Model: Helping Hands. They argue that four elements underpin success for Indigenous nursing students: the availability of Indigenous academics, Indigenous health content in the nursing curriculum, Indigenous-specific recruitment materials, and individual mentoring and nurturing of Indigenous students.

Patient reported adherence to hypertension treatment: A revalidation study

Background Adherence to hypertension management in patients with hypertension is known to influence their blood pressure control. It is important to measure patients’ adherence behaviours to assist with designing appropriate interventions to improve blood pressure control. Aims The purposes of this study were to use confirmatory factor analysis to revalidate the Therapeutic Adherence Scale for Hypertensive Patients (TASHP), and to calculate the cut-off score for classifying adherence behaviours into two groups: satisfactory and low adherence behaviours. Methods Systematic random sampling was used to recruit patients with hypertension in China. Demographic characteristics, the TASHP and blood pressure were collected. The psychometric tests of the TASHP included: construct validity, criteria-related validity, internal reliability, and split-half reliability. The area under the receiver operating characteristics curve and Youden index were used to identify the cut-off score of the TASHP for blood pressure control. Results This study involved 366 patients. Confirmatory factor analysis supported the four-component structure of the TASHP proposed in the original scale development study. The TASHP has a satisfactory internal reliability (Cronbach’s α > 0.7) and a satisfactory split-half reliability (Spearman–Brown coefficients > 0.7). The patients with overall scores of the TASHP ⩾ 109 points were considered to have satisfactory adherence behaviours. Conclusion The TASHP is a validated and reliable instrument to measure the adherence to hypertension management in Chinese patients with hypertension. The cut-off score of 109 points can be considered as an effective measure to classify the level of adherence into satisfactory and low adherence behaviours.

Factors associated with depression among male casual laborers in urban Vietnam

This study examined the level, the prevalence of and the factors associated with depression among male casual laborers in Hanoi. Social mapping was done to recruit and interview 450 men aged over 18 years, mostly unskilled and unregistered laborers from 135 street venues across 13 districts of the city using a structured questionnaire. Most were from rural and mountainous provinces and did manual works such as motorbike taxi drivers, porters, construction workers, small traders and others in the current city. The prevalence of self-reported depressive symptoms (25 %) was high. Structural equation modeling showed that marriage, family separation and living with peers or partners were three significant distal risk factors, while illicit drug use and low social connectedness were proximal predictors of depression. Of all factors, social connectedness appeared to be the most important because it plays a mediating role. Drug use was an independent risk factor. This study provides a model to understand the mental health of male casual laborers and to develop culturally appropriate intervention programs for these men

Conformational Changes Triggered by Mg2+ Mediate Transactivator Function

Transactivator protein C of bacteriophage mu is essential for the transition from middle to late gene expression during the phage life cycle. The unusual, multistep activation of mom promoter (Pmom) by C protein involves activator-mediated promoter unwinding to recruit RNA polymerase and subsequent enhanced promoter clearance of the enzyme. To achieve this, C binds its site overlapping the -35 region of the mom promoter with a very high affinity, in Mg2+-dependent fashion. Mg2+-mediated conformational transition in C is necessary for its DNA binding and transactivation. We have determined the residues in C which coordinate Mg2+, to induce allosteric transition in the protein, required for the specific interaction with DNA. Residues E26 and D40 in the putative metal binding motif (E26X10D37X2D40) present toward the N-terminus of the protein are found to be important for Mg2+ ion binding. Mutations in these residues lead to altered Mg2+-induced conformation, compromised DNA binding, and reduced levels of transcription activation. Although Mg2+ is widely used in various DNA transaction reactions, this report provides the first insights on the importance of the metal ion-induced allosteric transitions in regulating transcription factor function.

Temporal and Spatial Patterns in Recruitment of Three Penaeid Prawns in Moreton Bay, Queensland, Australia

The size at recruitment, temporal and spatial distribution, and abiotic factors influencing abundance of three commercially important species of penaeid prawns in the sublittoral trawl grounds of Moreton Bay (Queensland, Australia) were compared. Metapenaeus bennettae and Penaeus plebejus recruit to the trawl grounds at sizes which are relatively small (14-15 mm carapace length, CL) and below that at which prawns are selected for, and retained, in the fleet's cod-ends. In contrast, Penaeus esculenlus recruit at the relatively large size of 27 mm CL from February to May, well above the size ranges selected for. Recruitment of M. bennettae extends over several months, September-October and February March, and was thus likely to be bi-annual, while the recruitment period of P. plebejus was distinct, peaking in October-November each year. Size classes of M . bennettae were the most spatially stratified of the three species. Catch rates of recruits were negatively correlated with depth for all three species, and were also negatively correlated with salinity for M. bennettae.

Drink and drug driving in Australian young adult users and non-users of illicit stimulants

- Introduction There is limited understanding of how young adults’ driving behaviour varies according to long-term substance involvement. It is possible that regular users of amphetamine-type stimulants (i.e. ecstasy (MDMA) and methamphetamine) may have a greater predisposition to engage in drink/drug driving compared to non-users. We compare offence rates, and self-reported drink/drug driving rates, for stimulant users and non-users in Queensland, and examine contributing factors. - Methods The Natural History Study of Drug Use is a prospective longitudinal study using population screening to recruit a probabilistic sample of amphetamine-type stimulant users and non-users aged 19-23 years. At the 4 ½ year follow-up, consent was obtained to extract data from participants’ Queensland driver records (ATS users: n=217, non-users: n=135). Prediction models were developed of offence rates in stimulant users controlling for factors such as aggression and delinquency. - Results Stimulant users were more likely than non-users to have had a drink-driving offence (8.7% vs. 0.8%, p < 0.001). Further, about 26% of ATS users and 14% of non-users self-reported driving under the influence of alcohol during the last 12 months. Among stimulant users, drink-driving was independently associated with last month high-volume alcohol consumption (Incident Rate Ratio (IRR): 5.70, 95% CI: 2.24-14.52), depression (IRR: 1.28, 95% CI: 1.07-1.52), low income (IRR: 3.57, 95% CI: 1.12-11.38), and male gender (IRR: 5.40, 95% CI: 2.05-14.21). - Conclusions Amphetamine-type stimulant use is associated with increased long-term risk of drink-driving, due to a number of behavioural and social factors. Inter-sectoral approaches which target long-term behaviours may reduce offending rates.

Perceptions on the causes of individual and fraudulent co-offending: Views of forensic accountants

Individual and/or co-offenders fraudulent activities can have a devastating effect on a company’s reputation and credibility. Enron, Xerox, WorldCom, HIH Insurance and One.Tel are examples where stakeholders incurred substantial financial losses as a result of fraud and led to a loss of confidence in corporate dealings by the public in general. There are numerous theoretical approaches that attempt to explain how and why fraudulent acts occur, drawing on the fields of sociology, organisational, management and economic literature, but there is limited empirical evidence published in accounting literature. This qualitative inductive study analyses perceptions and experiences of forensic accountants to gain insights into individual fraud and co-offending in order to determine whether the conceptual framework developed from literature accurately depicts the causes of fraud committed by individuals and groups in the twenty-first century. Findings from the study both support and extend the conceptual framework, demonstrating that strain and anomie can result in fraud, that deviant sub-groups recruit and coerce members by providing relief from strain, and that inadequate corporate governance mechanisms both contribute to fraud occurring, and provide the opportunity for fraudulent activities to be executed and often remain undetected. Additional factors emerging from this study (the ‘technoconomy’, addiction and IT measures) were also identified as contributors to fraud, particularly relevant to the twenty-first century, and consequently, a refined conceptual framework is presented in the discussion and conclusion to the paper.

Predicting dispersal and recruitment of Miconia calvescens (Melastomataceae) in Australian tropical rainforests

Miconia calvescens (Melastomataceae) is a serious invader in the tropical Pacific, including the Hawaiian and Tahitian Islands, and currently poses a major threat to native biodiversity in the Wet Tropics of Australia. The species is fleshy-fruited, small-seeded and shade tolerant, and thus has the potential to be dispersed widely and recruit in relatively intact rainforest habitats, displacing native species. Understanding and predicting the rate of spread is critical for the design and implementation of effective management actions. We used an individual-based model incorporating a dispersal function derived from dispersal curves for similar berry-fruited native species, and life-history parameters of fecundity and mortality to predict the spatial structure of a Miconia population after a 30 year time period. We compared the modelled population spatial structure to that of an actual infestation in the rainforests of north Queensland. Our goal was to assess how well the model predicts actual dispersion and to identify potential barriers and conduits to seed movement and seedling establishment. The model overpredicts overall population size and the spatial extent of the actual infestation, predicting individuals to occur at a maximum 1,750 m from the source compared with the maximum distance of any detected individual in the actual infestation of 1,191 m. We identify several characteristic features of managed invasive populations that make comparisons between modelled outcomes and actual infestations difficult. Our results suggest that the model’s ability to predict both spatial structure and spread of the population will be improved by incorporating a spatially explicit element, with dispersal and recruitment probabilities that reflect the relative suitability of different parts of the landscape for these processes.

New efforts at biological control of Mikania micrantha H.B.K. (Asteraceae) in Papua New Guinea and Fiji.

New efforts at biological control of Miconia calvescens (Melastomataceae) is a serious invader in the tropical Pacific, including the Hawaiian and Tahitian Islands, and currently poses a major threat to native biodiversity in the Wet Tropics of Australia. The species is fleshy-fruited, small-seeded and shade tolerant, and thus has the potential to be dispersed widely and recruit in relatively intact rainforest habitats, displacing native species. Understanding and predicting the rate of spread is critical for the design and implementation of effective management actions. We used an individual-based model incorporating a dispersal function derived from dispersal curves for similar berry-fruited native species, and life-history parameters of fecundity and mortality to predict the spatial structure of a Miconia population after a 30 year time period. We compared the modelled population spatial structure to that of an actual infestation in the rainforests of north Queensland. Our goal was to assess how well the model predicts actual dispersion and to identify potential barriers and conduits to seed movement and seedling establishment. The model overpredicts overall population size and the spatial extent of the actual infestation, predicting individuals to occur at a maximum 1,750 m from the source compared with the maximum distance of any detected individual in the actual infestation of 1,191 m. We identify several characteristic features of managed invasive populations that make comparisons between modelled outcomes and actual infestations difficult. Our results suggest that the model’s ability to predict both spatial structure and spread of the population will be improved by incorporating a spatially explicit element, with dispersal and recruitment probabilities that reflect the relative suitability of different parts of the landscape for these processes. Mikania micrantha H.B.K. (Asteraceae) in Papua New Guinea and Fiji.

Variation in exotic and native seed arrival and recruitment of bird dispersed species in subtropical forest restoration and regrowth

Invasive bird-dispersed plants often share the same suite of dispersers as co-occurring native species, resulting in a complex management issue. Integrated management strategies could incorporate manipulation of dispersal or establishment processes. To improve our understanding of these processes, we quantified seed rain, recruit and seed bank density, and species richness for bird-dispersed invasive and native species in three early successional subtropical habitats in eastern Australia: tree regrowth, shrub regrowth and native restoration plantings. We investigated the effects of environmental factors (leaf area index (LAI), distance to edge, herbaceous ground cover and distance to nearest neighbour) on seed rain, seed bank and recruit abundance. Propagule availability was not always a good predictor of recruitment. For instance, although native tree seed rain density was similar, and species richness was higher, in native plantings, compared with tree regrowth, recruit density and species richness were lower. Native plantings also received lower densities of invasive tree seed rain than did tree regrowth habitats, but supported a similar density of invasive tree recruits. Invasive shrub seed rain was recorded in highest densities in shrub regrowth sites, but recruit density was similar between habitats. We discuss the role of microsite characteristics in influencing post-dispersal processes and recruit composition, and suggest ways of manipulating these processes as part of an integrated management strategy for bird-dispersed weeds in natural areas.

Reducing uncertainty in the assessment of the Australian spanner crab fishery

In collaboration with the New South Wales Department of Primary Industries we compared the effectiveness of the spanner crab monitoring systems used by New South Wales and Queensland and developed a fishery-independent survey protocol acceptable to both states. The objectives of this project were to: 1. Determine the age at which spanner crabs (Ranina ranina) recruit to the fishery 2. Develop a common methodology for monitoring and assessing the Australian spanner crab stock 3. Investigate sources of variability in apparent population density.

Enhancing pasture stability and profitability for producers in Poplar Box and Silver-leaved Ironbark woodlands.

Over 7 years, this project collected data about the pasture, tree and soil surface dynamics of two major Aristida/Bothriochloa pasture types within the eucalypt woodlands of central Queensland. Six different grazing management scenarios were compared ecologically and economically, along with the effects of spring burns and tree killing. Heavy stocking (3-4 ha per adult equivalent) produced the greatest short-term financial return from healthy pastures but was not a sustainable practice and long-term cash returns were no better than those from moderate stocking. The environmental benefits of moderate grazing over heavy grazing were very clear. Light stocking produced better environmental outcomes compared to moderate stocking but was clearly inferior with respect to economic returns. Killing silver-leaved ironbark trees near Rubyvale produced no measurable improvement in pasture growth or quality for at least 6 years whereas at Injune the same treatment of poplar box trees resulted in an immediate and large enhancement in pasture production and carrying capacity. The gritty red duplex soil at Rubyvale was much more erodible than the grey solodic at Injune although the latter becomes very erodible if the stable surface soil is breached. Good seasonal rainfall produced faster changes in pasture composition than extremes of grazing management. The perennial grasses were easier to recruit than to eliminate by grazing management changes.

Feasibility of a stepped wedge cluster RCT and concurrent observational sub-study to evaluate the effects of modified ward night lighting on inpatient fall rates and sleep quality: A protocol for a pilot trial

Background: Falls among hospitalised patients impose a considerable burden on health systems globally and prevention is a priority. Some patient-level interventions have been effective in reducing falls, but others have not. An alternative and promising approach to reducing inpatient falls is through the modification of the hospital physical environment and the night lighting of hospital wards is a leading candidate for investigation. In this pilot trial, we will determine the feasibility of conducting a main trial to evaluate the effects of modified night lighting on inpatient ward level fall rates. We will test also the feasibility of collecting novel forms of patient level data through a concurrent observational sub-study. Methods/design: A stepped wedge, cluster randomised controlled trial will be conducted in six inpatient wards over 14 months in a metropolitan teaching hospital in Brisbane (Australia). The intervention will consist of supplementary night lighting installed across all patient rooms within study wards. The planned placement of luminaires, configurations and spectral characteristics are based on prior published research and pre-trial testing and modification. We will collect data on rates of falls on study wards (falls per 1000 patient days), the proportion of patients who fall once or more, and average length of stay. We will recruit two patients per ward per month to a concurrent observational sub-study aimed at understanding potential impacts on a range of patient sleep and mobility behaviour. The effect on the environment will be monitored with sensors to detect variation in light levels and night-time room activity. We will also collect data on possible patient-level confounders including demographics, pre-admission sleep quality, reported vision, hearing impairment and functional status. Discussion: This pragmatic pilot trial will assess the feasibility of conducting a main trial to investigate the effects of modified night lighting on inpatient fall rates using several new methods previously untested in the context of environmental modifications and patient safety. Pilot data collected through both parts of the trial will be utilised to inform sample size calculations, trial design and final data collection methods for a subsequent main trial.