Advance care planning for older people in Australia presenting to the emergency department from the community or residential aged care facilities

The purpose of this retrospective, cross-sectional study was to determine the prevalence of advance care planning (ACP) among older people presenting to an Emergency Department (ED) from the community or a residential aged care facility. The study sample comprised 300 older people (aged 65+ years) presenting to three Victorian EDs in 2011. A total of 150 patients transferred from residential aged care to ED were randomly selected and then matched to 150 people who lived in the community and attended the ED by age, gender, reason for ED attendance and triage category on arrival. Overall prevalence of ACP was 13.3% (n = 40/300); over one-quarter (26.6%, n = 40/150) of those presenting to the ED from residential aged care had a documented Advance Care Plan, compared to none (0%, n = 0/150) of the people from the community. There were no significant differences in the median ED length of stay, number of investigations and interventions undertaken in ED, time seen by a doctor or rate of hospital admission for those with an Advance Care Plan compared to those without. Those with a comorbidity of cerebrovascular disease or dementia and those assessed with impaired brain function were more likely to have a documented Advance Care Plan on arrival at ED. Length of hospital stay was shorter for those with an Advance Care Plan [median (IQR) = 3 days (2–6) vs. 6 days (2–10), P = 0.027] and readmission lower (0% vs. 13.7%). In conclusion, older people from the community transferred to ED were unlikely to have a documented Advance Care Plan. Those from residential aged care who were cognitively impaired more frequently had an Advance Care Plan. In the ED, decisions of care did not appear to be influenced by the presence or absence of Advance Care Plans, but length of hospital admission was shorter for those with an Advance Care Plan.

The global burden of musculoskeletal conditions for 2010: an overview of methods.

The objective of this paper is to provide an overview of methods used for estimating the burden from musculoskeletal (MSK) conditions in the Global Burden of Diseases 2010 study. It should be read in conjunction with the disease-specific MSK papers published in Annals of Rheumatic Diseases. Burden estimates (disability-adjusted life years (DALYs)) were made for five specific MSK conditions: hip and/or knee osteoarthritis (OA), low back pain (LBP), rheumatoid arthritis (RA), gout and neck pain, and an 'other MSK conditions' category. For each condition, the main disabling sequelae were identified and disability weights (DW) were derived based on short lay descriptions. Mortality (years of life lost (YLLs)) was estimated for RA and the rest category of 'other MSK', which includes a wide range of conditions such as systemic lupus erythematosus, other autoimmune diseases and osteomyelitis. A series of systematic reviews were conducted to determine the prevalence, incidence, remission, duration and mortality risk of each condition. A Bayesian meta-regression method was used to pool available data and to predict prevalence values for regions with no or scarce data. The DWs were applied to prevalence values for 1990, 2005 and 2010 to derive years lived with disability. These were added to YLLs to quantify overall burden (DALYs) for each condition. To estimate the burden of MSK disease arising from risk factors, population attributable fractions were determined for bone mineral density as a risk factor for fractures, the occupational risk of LBP and elevated body mass index as a risk factor for LBP and OA. Burden of Disease studies provide pivotal guidance for governments when determining health priority areas and allocating resources. Rigorous methods were used to derive the increasing global burden of MSK conditions.

Disadvantaged locations and transition: lived lives of students demonstrating resilience

This study answered what biographical experiences shape the trajectory of students demonstrating resilience during a time of transition. It charted the material conditions of agency and structures. The findings pointed to supportive social relationships, community and school resources and educational policies being critical to shaping agency.

Extreme nomadism in desert waterbirds: flights of the banded stilt

In contrast to well-studied Northern Hemisphere birds with spatially and temporally predictable seasonal migrations, waterbirds in desert biomes face major challenges in exploiting stochastic, rich, yet short-lived resource pulses in vast arid landscapes, leading to the evolution of nomadic behaviour. An extreme example is the banded stilt (Cladorhynchus leucocephalus), an opportunistic colonial breeder at remote inland salt lakes after infrequent rain events. Using satellite telemetry on 21 birds (tracked for a mean of 196.2 days), we reveal extensive, rapid and synchronized movement among individuals to and from salt lakes. Two birds left coastal refugia for the inland following rain, flying 1000-2000 km, while 12 others rapidly moved a mean of 684 km (range 357-1298 km) away from drying inland sites to the coast. Two individuals moved longitudinally across the continent, departing and arriving at the same points, yet travelling very different routes; one bird moving more than 2200 km in less than 2.5 days, the other more than 1500 km in 6 days. Our findings reveal movements nearly twice as long and rapid as recorded in other desert waterbirds. We reveal capability to rapidly detect and exploit ephemeral wetland resource pulses across the stochastic Australian desert.

Barriers to primary care clinician adherence to clinical guidelines for the management of low back pain: protocol of a systematic review and meta-synthesis of qualitative studies.

INTRODUCTION: Low back pain is the highest ranked condition contributing to years lived with disability, and is a significant economic and societal burden. Evidence-based clinical practice guidelines are designed to improve quality of care and reduce practice variation by providing graded recommendations based on the best available evidence. Studies of low back pain guideline implementation have shown no or modest effects at changing clinical practice. OBJECTIVES: To identify enablers and barriers to adherence to clinical practice guidelines for the management of low back pain. METHODS AND ANALYSIS: A systematic review and meta-synthesis of qualitative studies that will be conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines. Eight databases will be searched using a priori inclusion/exclusion criteria. Two independent reviewers will conduct a structured review and meta-synthesis, and a third reviewer will arbitrate where there is disagreement. This protocol has been registered on PROSPERO 2014. ETHICS AND DISSEMINATION: Ethical approval is not required. The systematic review will be published in a peer-reviewed journal. The review will also be disseminated electronically, in print and at conferences. Updates of the review will be conducted to inform and guide healthcare translation into practice. TRIAL REGISTRATION NUMBER: PROSPERO 2014:CRD42014012961. Available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014012961.

Writer-as-narrator: engaging the debate around the (un)reliable narrator in memoir and the personal essay

Subjective and personal forms of nonfiction writing are enjoying exponential popularity in English language publishing currently, as an interested public engages with ‘true’ stories of society and culture. Yet a paradox exists at the centre of this form of writing. As readers, we want to know who the writer is and what she has to tell us. Yet as writers we use a persona, a constructed character, a narrator who is only partially the writer, to deliver the narrative. How is a writer able to convey ‘true’ stories that are inherently reliant on memory, within a constructed narrative persona?We find a ‘gap’ between the writer and the narrator/protagonist on the page, an empowered creative space in which composition occurs, facilitating a balance between the facts and lived experiences from which ‘true’ stories are crafted, and the acknowledged fallibility of human memory. While the gap between writer and writer-as-narrator provides an enabling space for creative composition, it also creates space for the perception of unreliability. The width of this gap, we argue, is crucial. Only if the gap is small, if writer and writer-as-narrator share a set of passionately held values, can the writer-as-narrator become a believable entity, satisfying the reader with the ‘truth’ of their story.

Asian Cities: Cultural heritage and the interplay between nation building and internationalism

It is over a decade since the volume The Disappearing Asian City (Logan 2002) was published. An edited volume bringing together a number of experts on the region, the book identified the threats facing buildings, archaeological sites and the historic character of cities, as well as the myriad of challenges of raising civic and regulatory awareness about the value of cultural heritage in times of rapid transformation. It was a set of concerns and arguments that remain as pertinent as ever. Those who have lived and worked in different parts of Asia over the past decade on cultural heritage issues, frequently use the terms 'extraordinary' or 'bewildering' to describe the scale and speed of transformation that has taken place. Indeed, for those concerned about maintaining continuities between past and present - whether they be social, spiritual or material - the development of cities, the wholesale movements of communities in and out of urban landscapes, together with the dramatic increase in industries like tourism, has often been disorienting, and in some cases deeply confronting: both professionally and emotionally. And yet, to focus on loss and destruction would miss a whole set of other fascinating, emergent and important trends. As numerous publications in the intervening period have shown, cultural heritage has become a topic of intense interest and debate in the majority of Asian societies, for a host of reasons (Askew 2010; Broudehoux 2004; Pai 2013).

Mobility as ‘becoming’ : a Bourdieuian analysis of the factors shaping international student mobility

This paper unpacks the meanings and implications of the mobility of international students in vocational education – an under-researched group in the field of international education. This four-year study found that transnational mobility is regarded as a resourceful vehicle to help international students ‘become’ the kind of person they want to be. The paper justifies the value of re-conceptualising student mobility as a process of ‘becoming’. Mobility as ‘becoming’ encompasses students’ aspirations for educational, social, personal and professional development. Theorising mobility as ‘becoming’ captures international students’ lived realities and has the potential to facilitate the re-imagining of international student mobility with new outlooks. By theorising mobility as ‘becoming’, this research suggests the importance of drawing on the integrated and transformative nature of Bourdieu’s forms of capital in understanding the logics and practice of the social field – international student mobility.

Investigating the effectiveness of teacher education for early career teachers in diverse settings: the longitudinal research we have to have

There have been more than 100 reports focusing on the effectiveness of teacher education in Australia over the last 35 years with many positioning teacher education as flawed and in need of reform. These frequent criticisms have drawn attention to the difficulty teacher educators can experience when trying to interrupt or contest this representation: a situation not unique to Australia. In the United States, for example, Pam Grossman has suggested that those in teacher education “seem ill prepared to respond to critics who question the value of professional education for teachers with evidence of our effectiveness” (Grossman in J Teach Educ 59(1):10–23, 2008). A key question facing teacher educators, therefore, concerns the kinds of research that will most effectively allow us to lead debates about teacher preparation. This paper outlines an approach to the conceptualization and conduct of research into the effectiveness of teacher education that seeks to move debates in new directions. Drawing upon the theoretical resources of Soja (Thirdspace: journeys to Los Angeles and other real-and-imagined places, 1996) and Lefebre (The production of space, 1991) we outline the ways in which a spatial approach to conceptualizing teacher education influenced the design and conduct of a large scale, longitudinal project that investigated the question of the effectiveness of teacher education in Australia. In exploring the design features of this ARC linkage grant the paper demonstrates how research changes when teacher education is conceptualised from a spatial point of view and illustrates the ways in which consideration of the conceived, perceived and lived spaces of teacher education can move research about effectiveness into new directions.

A sibling romance: the sound of romance reimagined

 A Sibling Romance: The Sound of Romance Reimagined explores the interplay between lived perceptual and sensual experience and the visual representation of it in the romantic novel and asks what happens to and within a creative artifact if the hierarchy of the senses is reimagined.

The use of kernel density estimation to examine associations between neighborhood destination intensity and walking and physical activity

BACKGROUND: Local destinations have previously been shown to be associated with higher levels of both physical activity and walking, but little is known about how the distribution of destinations is related to activity. Kernel density estimation is a spatial analysis technique that accounts for the location of features relative to each other. Using kernel density estimation, this study sought to investigate whether individuals who live near destinations (shops and service facilities) that are more intensely distributed rather than dispersed: 1) have higher odds of being sufficiently active; 2) engage in more frequent walking for transport and recreation. METHODS: The sample consisted of 2349 residents of 50 urban areas in metropolitan Melbourne, Australia. Destinations within these areas were geocoded and kernel density estimates of destination intensity were created using kernels of 400m (meters), 800m and 1200m. Using multilevel logistic regression, the association between destination intensity (classified in quintiles Q1(least)-Q5(most)) and likelihood of: 1) being sufficiently active (compared to insufficiently active); 2) walking≥4/week (at least 4 times per week, compared to walking less), was estimated in models that were adjusted for potential confounders. RESULTS: For all kernel distances, there was a significantly greater likelihood of walking≥4/week, among respondents living in areas of greatest destinations intensity compared to areas with least destination intensity: 400m (Q4 OR 1.41 95%CI 1.02-1.96; Q5 OR 1.49 95%CI 1.06-2.09), 800m (Q4 OR 1.55, 95%CI 1.09-2.21; Q5, OR 1.71, 95%CI 1.18-2.48) and 1200m (Q4, OR 1.7, 95%CI 1.18-2.45; Q5, OR 1.86 95%CI 1.28-2.71). There was also evidence of associations between destination intensity and sufficient physical activity, however these associations were markedly attenuated when walking was included in the models. CONCLUSIONS: This study, conducted within urban Melbourne, found that those who lived in areas of greater destination intensity walked more frequently, and showed higher odds of being sufficiently physically active-an effect that was largely explained by levels of walking. The results suggest that increasing the intensity of destinations in areas where they are more dispersed; and or planning neighborhoods with greater destination intensity, may increase residents' likelihood of being sufficiently active for health.

The health profile of people living with Parkinson's Disease managed in a comprehensive care setting

Background: Globally there are few reports of the impairments, disabilities and medications used in people living with idiopathic Parkinson’s disease. Caregiver characteristics and caregiver burden have seldom been reported. We examined the health status in a large cohort of people living with Parkinson’s disease and their caregivers managed in a comprehensive health care setting.

Methods/Design: A prospective, cross sectional analysis of impairments, disabilities and Parkinson’s disease medication use was conducted in a sample of 100 people with Parkinson’s disease rated I-IV on the modified Hoehn & Yahr scale. Participants were recruited from the Victorian Comprehensive Parkinson Program in Melbourne, Australia. Their caregivers were invited to provide their views on the burden of care, services provided and support received.

Results: The severity of impairments and disabilities was strongly associated with disease duration (mean of 5.5 years). Those with long standing disease or more severe disease also used more Parkinson’s disease medications and participated in fewer social roles than people who were newly diagnosed or mildly affected. The severity of impairments was strongly correlated with limitations in performing activities of daily living. Limitations in performing daily activities were also found to be a significant contributing factor for health-related quality of life (PDQ-39 SI β=0.55, p=0.000; EQ-5D SI β=0.43, p=0.001). People with Parkinson’s disease lived at home with relatives. The average caregiver was a spouse or child providing approximately 3.5 hours of care per day, with the capacity to provide 9.4 hours per day and had provided care for four years. Additional support was high (63%) for 2.5 hours per day.

Conclusion: The comprehensive care setting of this cohort describes a relatively benign condition despite a wide range of disease duration and severity. This report provides a baseline with which to compare other delivery models.

To the very ground of meaning, to vary the ground of meaning

Parody may be understood as the absorption of a revolutionary impulse into the everyday production of meaning as continuous variation and soft subversion. Considered in this way, parody is transformative because it operates on the components within a system of meaning and/or the context, logic or spatial perspective that grounds the possibility of meaning. It is the conditions under which shared meaning, sense and sensation depend that I aim to unpack in order to suggest the ways in which parody can alter a person’s relationship to the world. By approaching parody as a mode of lived abstraction and as an embodied approach to affective self-organisation, body-environment co-construction and a challenge to identity, it becomes possible to move from formal concerns that have characterised parody to a set of transformative practices. Thus parody indicates where the anchors of embodied, embedded, extended, enacted and affective are dug in and hold identity and the ground of meaning in a steady state. This paper will examine how parody moves from the impulse to overthrow and invert — ‘Beneath the street, The beach’—to a collective impulse that moves the ground of meaning into a reconfigurative process that is allows totalised systems of meaning to collide and intersect. What is left is not the rubble and ruins of meaning but revitalised fragments, stems cells of meaning ready-to-be-remade.A lineage of parodic works will be paraded and discussed that directly address the tacit relation of ground, horizon, orientation and position. This parody parade will form the basis of a critique and the analysis of the ontological orientations that for example, opposing systems of perspective insert as the very ground of meaning. The implication of this line of inquiry leads to the assertion that all descriptions of the world, universe and the cosmos are parodies in search of an origin. Totalised or unified images of the ground of meaning are already parodies of a/the set of conditions by which meaning operates that also produce a trajectory that as a lived-abstraction directs or hijacks subsequent productions of meaning

Formation of defects in the graphite oxidization process: a positron study

High-resolution positron annihilation lifetime (PAL) and two-detector coincidence Doppler broadening of annihilation radiation (2D-DBAR) measurements on graphite and its oxide derivatives for defect information, differing in oxidization agents, are reported. Positron measurements were found to be very effective in the investigation of defects in graphite and its derivatives. Positrons are mainly annihilated in vacancy-like defects on the particle surface and in large open-volume holes associated with the interface of graphite and graphite oxide. Different types of defects have been detected for unexfoliated graphite oxide and exfoliated graphene oxide based on 2D-DBAR measurements, namely the vacancy cluster and vacancy-oxygen complexes. It is also interesting to observe that the calculated large open-volume diameter of graphene oxide coincides with the distance between the layers from the XRD investigation, which indicates that the annihilation of the long-lived lifetime component τ3 might take place in the area between the graphene layers; no large open-volume hole has been detected.

Long incubation bouts and biparental incubation in the nomadic Banded Stilt

Parental care strategies have been widely investigated in shorebirds that undertake long-distance regular migrations. In contrast, virtually nothing is known of the parental care of nomadic, opportunistically breeding shorebirds, although the irregular and short-lived nature of their breeding potentially accentuates the trade-offs between investment in successive clutches and between the sexes. We investigated the incubation behaviour of the nomadic, opportunistically breeding Banded Stilt (Cladorhynchus leucocephalus). Seven nests, filmed continuously with day–night cameras over 2–7 days, revealed that both sexes contributed to incubation, with males apparently the sole carer during hatching and early brood-rearing; this is a possible adaptation, which enables females to quickly produce a second clutch if favourable conditions persist. All incubator changeovers occurred after dark; incubation shifts averaged 44.8 ± 10.9 (s.e.m.) h (n = 11, 17.5–139.6 h), the longest recorded for any shorebird. Incubation constancy averaged 96.5%; this high value is possibly an adaptation to high predation and the need for rapid embryonic development in the face of ephemeral resources for breeding. Long incubation shifts may be explained by extended foraging trips to distant areas of the partially inundated salt-lake surface, where food resources had been concentrated by wind-driven water movement.