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.

The trajectory of minor stroke recovery for men and their female spousal caregivers: Literature review

Title The trajectory of minor stroke recovery for men and their female spousal caregivers: literature review Aim This paper is a report of a narrative review to examine the current state of knowledge regarding the impact of minor stroke on male patients and their female spousal caregivers’ recovery trajectory and quality of life. Background Minor stroke survivors are often discharged early in the recovery process. The perception of the healthcare community that these patients and their female spousal caregivers will experience an uneventful recovery may lead to inadequate preparation for the postdischarge period. Methods A range of databases was searched to identify papers addressing ‘minor stroke’, ‘transitions’, ‘quality of life’, ‘chronic disease’, ‘caregivers’ and ‘spouse caregivers’, including AARP Ageline, AMED, CINAHL, Evidence Based Medicine Reviews, MEDLINE and PsychInfo. Papers published in English from 1990 to December 2006 were included. Thirty-four papers were in the final data set. Results Minor stroke survivors and their female spousal caregivers may experience major challenges in adaptations postdischarge. The trajectory of minor stroke recovery may necessitate a re-evaluation of life plans, rethinking of priorities and integration of resulting disabilities into current and emerging life situations for both stroke survivors and their female spousal caregivers. In many cases these adaptations are compounded by transitions associated with the normal ageing process. Conclusion While there is extensive literature on stroke recovery and the role of caregivers in general, there is little available describing the recovery of minor stroke survivors in relation to the normal ageing process. Further research is needed examining recovery from a transitional perspective, to support nurses and other health professionals discharge planning.

Impact of adolescent peer aggression on later educational and employment outcomes in an Australian cohort

This study used prospective birth cohort data to analyse the relationship between peer aggression at 14 years of age and educational and employment outcomes at 17 years (N = 1091) and 20 years (N = 1003). Participants from the Western Australian Pregnancy Cohort (Raine) study were divided into mutually exclusive categories of peer aggression. Involvement in peer aggression was reported by 40.2% (10.1% victims; 21.4% perpetrators; 8.7% victim–perpetrators) of participants. Participants involved in any form of peer aggression were less likely to complete secondary school. Perpetrators and victim–perpetrators of peer aggression were more likely to be in the ‘No Education, Employment or Training’ group at 20 years of age. This association was explained by non-completion of secondary school. These findings demonstrate a robust association between involvement in peer aggression and non-completion of secondary school, which in turn was associated with an increased risk of poor educational and employment outcomes in early adulthood.

Uncertain species distribution: From interpolation to extrapolation

Species distribution models (SDMs) are considered to exemplify Pattern rather than Process based models of a species' response to its environment. Hence when used to map species distribution, the purpose of SDMs can be viewed as interpolation, since species response is measured at a few sites in the study region, and the aim is to interpolate species response at intermediate sites. Increasingly, however, SDMs are also being used to also extrapolate species-environment relationships beyond the limits of the study region as represented by the training data. Regardless of whether SDMs are to be used for interpolation or extrapolation, the debate over how to implement SDMs focusses on evaluating the quality of the SDM, both ecologically and mathematically. This paper proposes a framework that includes useful tools previously employed to address uncertainty in habitat modelling. Together with existing frameworks for addressing uncertainty more generally when modelling, we then outline how these existing tools help inform development of a broader framework for addressing uncertainty, specifically when building habitat models. As discussed earlier we focus on extrapolation rather than interpolation, where the emphasis on predictive performance is diluted by the concerns for robustness and ecological relevance. We are cognisant of the dangers of excessively propagating uncertainty. Thus, although the framework provides a smorgasbord of approaches, it is intended that the exact menu selected for a particular application, is small in size and targets the most important sources of uncertainty. We conclude with some guidance on a strategic approach to identifying these important sources of uncertainty. Whilst various aspects of uncertainty in SDMs have previously been addressed, either as the main aim of a study or as a necessary element of constructing SDMs, this is the first paper to provide a more holistic view.

‘True Blood’ the critical care story: An audit of blood sampling practice across three adult, paediatric and neonatal intensive care settings

Background Anaemia is common in critically ill patients, and has a significant negative impact on patients' recovery. Blood conservation strategies have been developed to reduce the incidence of iatrogenic anaemic caused by sampling for diagnostic testing. Objectives Describe practice and local guidelines in adult, paediatric and neonatal Australian intensive care units (ICUs) regarding blood sampling and conservation strategies. Methods Cross-sectional descriptive study, conducted July 2013 over one week in single adult, paediatric and neonatal ICUs in Brisbane. Data were collected on diagnostic blood samples obtained during the study period, including demographic and acuity data of patients. Institutional blood conservation practice and guidelines were compared against seven evidence-based recommendations. Results A total of 940 blood sampling episodes from 96 patients were examined across three sites. Arterial blood gas was the predominant reason for blood sampling in each unit, accounting for 82% of adult, 80% of paediatric and 47% of neonatal samples taken (p <. 0.001). Adult patients had significantly more median [IQR] samples per day in comparison to paediatrics and neonates (adults 5.0 [2.4]; paediatrics 2.3 [2.9]; neonatal 0.7 [2.7]), which significantly increased median [IQR] blood sampling costs per day (adults AUD$101.11 [54.71]; paediatrics AUD$41.55 [56.74]; neonatal AUD$8.13 [14.95]; p <. 0.001). The total volume of samples per day (median [IQR]) was also highest in adults (adults 22.3. mL [16.8]; paediatrics 5.0. mL [1.0]; neonates 0.16. mL [0.4]). There was little information about blood conservation strategies in the local clinical practice guidelines, with the adult and neonatal sites including none of the seven recommendations. Conclusions There was significant variation in blood sampling practice and conservation strategies between critical care settings. This has implications not only for anaemia but also infection control and healthcare costs.

To sonicate or not to sonicate PM filters: Reactive Oxygen Species generation upon ultrasonic irradiation

In aerosol research, a common approach for the collection of particulate matter (PM) is the use of filters in order to obtain sufficient material to undertake analysis. For subsequent chemical and toxicological analyses, in most of cases the PM needs to be extracted from the filters. Sonication is commonly used to most efficiently extract the PM from the filters. Extraction protocols generally involve 10 - 60 min of sonication. The energy of ultrasonic waves causes the formation and collapse of cavitation bubbles in the solution. Inside the collapsing cavities the localised temperatures and pressures can reach extraordinary values. Although fleeting, such conditions can lead to pyrolysis of the molecules present inside the cavitation bubbles (gases dissolved in the liquid and solvent vapours), which results in the production of free radicals and the generation of new compounds formed by reactions with these free radicals. For example, simple sonication of pure water will result in the formation of detectable levels of hydroxyl radicals. As hydroxyl radicals are recognised as playing key roles as oxidants in the atmosphere the extraction of PM from filters using sonication is therefore problematic. Sonication can result in significant chemical and physical changes to PM through thermal degradation and other reactions. In this article, an overview of sonication technique as used in aerosol research is provided, the capacity for radical generation under these conditions is described and an analysis is given of the impact of sonication-derived free radicals on three molecular probes commonly used by researchers in this field to detect Reactive Oxygen Species in PM.

Becoming-topologies of education: Deformations, networks and the database effect

This article uses topological approaches to suggest that education is becoming-topological. Analyses presented in a recent double-issue of Theory, Culture & Society are used to demonstrate the utility of topology for education. In particular, the article explains education's topological character through examining the global convergence of education policy, testing and the discursive ranking of systems, schools and individuals in the promise of reforming education through the proliferation of regimes of testing at local and global levels that constitute a new form of governance through data. In this conceptualisation of global education policy changes in the form and nature of testing combine with it the emergence of global policy network to change the nature of the local (national, regional, school and classroom) forces that operate through the ‘system’. While these forces change, they work through a discursivity that produces disciplinary effects, but in a different way. This new–old disciplinarity, or ‘database effect’, is here represented through a topological approach because of its utility for conceiving education in an increasingly networked world.

Education policy-making and time

This paper examines the global policy convergence toward high-stakes testing in schools and the use of test results to ‘steer at a distance’, particularly as it applies to policy-makers’ promise to improve teacher quality. Using Deleuze’s three syntheses of time in the context of the Australian policy blueprint Quality Education, this paper argues that using test scores to discipline teaching repeats the past habit of policy-making as continuing the problem of the unaccountable teacher. This results in local policy-making enfolding test scores in a pure past where the teacher-as-problem is resolved through the use of data from testing to deliver accountability and transparency. This use of the database returns a digitised form of inspection that is a repetition of the habit of teacher-as-problem. While dystopian possibilities are available through the database, in what Deleuze refers to as a control society, for us the challenge is to consider policy-making as a step into an unknown future, to engage with producing policy that is not grounded on the unconscious interiority of solving the teacher problem, but of imagining new ways of conceiving the relationship between policy-making and teaching.

That’s Not For Our Kids: The strange death of philosophy and ethics in a low socioeconomic secondary school

This article reflects on the successes and failures of a new Philosophy and Ethics course in a low socioeconomic context in Perth, Western Australia, with the eventual demise of the subject in the school at the end of 2010. We frame this reflection within Deleuzian notions of geophilosophy to advocate for a Philosophy and Ethics that is informed by nomadic thought, as this offers a critical freedom for students to transform themselves and their society and suggests practical ways both of overcoming the prejudices which led to its demise and of student reluctance to engage in open discussion in class. We consider the demise of the course a ‘missed opportunity’ because it had so much potential to be transformative of student subjectivities in schools.

The logics of good teaching in an audit culture: A Deleuzian analysis

This article examines the attempted reform of education within an emerging audit culture in Australia that has led to the implementation of a high-stakes testing regime known as NAPLAN. NAPLAN represents a machine of auditing, which creates and accounts for data that are used to measure, amongst other things, good teaching. In particular, we address the logics of a policy intervention that aims to improve the quality of education through returning ‘good teaching’. Using Deleuze’s concepts of series, events, copies and simulacra, we suggest that an attempt to return past commonsense logics of ‘good teaching’ as a result of NAPLAN is not possible. In an audit culture as exemplified by NAPLAN, ‘good teaching’ is being reconceptualized through those practices and becomes unrecognizable. Whilst policy claims to improved equity and quality are admirable, this article suggests that the simulacral change to logics of good teaching may actualize something very different.

Alternate destinies for survey items destined for the island of misfit toys: An analysis of teachers' perceptions of NAPLAN

This is a methodological paper describing when and how manifest items dropped from a latent construct measurement model (e.g., factor analysis) can be retained for additional analysis. Presented are protocols for assessment for retention in the measurement model, evaluation of dropped items as potential items separate from the latent construct, and post hoc analyses that can be conducted using all retained (manifest or latent) variables. The protocols are then applied to data relating to the impact of the NAPLAN test. The variables examined are teachers’ achievement goal orientations and teachers’ perceptions of the impact of the test on curriculum and pedagogy. It is suggested that five attributes be considered before retaining dropped manifest items for additional analyses. (1) Items can be retained when employed in service of an established or hypothesized theoretical model. (2) Items should only be retained if sufficient variance is present in the data set. (3) Items can be retained when they provide a rational segregation of the data set into subsamples (e.g., a consensus measure). (4) The value of retaining items can be assessed using latent class analysis or latent mean analysis. (5) Items should be retained only when post hoc analyses with these items produced significant and substantive results. These suggested exploratory strategies are presented so that other researchers using survey instruments might explore their data in similar and more innovative ways. Finally, suggestions for future use are provided.

The good student: Subjectivities, power and schooling

Schools are places where student subjectivities are negotiated and contested in a variety of spaces. This paper argues that schools organise the possibilities for student subjectivities through a set of discourses that construct idealised notions of the good student. Whilst some discourses occur across educational sites, in practice these sets of discourses construct a unique vision of the good student in each specific school site. This vision is articulated in a variety of ways in each school, however, the result is that each student is enmeshed within a complex nexus of power relations that they can contest, negotiate or accept. Most of the time, students engage in a swirling set of subjectivities that encompasses these possibilities in various ways at various times. This paper problematises commonsense notions of the good student at one school site. One intent is to give voice to the lived experience of students who find themselves the site of these technologies of power. These technologies construct a set of commonsense expectations of schools - amongst which is the desire to produce the good student. Another is to use a Foucaultean analysis that rejects the good/bad binary that underpins many commonsense understandings of what students should be.

Global business services: Increasing specialization and integration of the world economy as drivers of economic growth

Purpose The purpose of this paper is to explore the contribution of global business services to improved productivity and economic growth of the world economy, which has gone largely unnoticed in service research. Design/methodology/approach The authors draw on macroeconomic data and industry reports, and link them to the non-ownership-concept in service research and theories of the firm. Findings Business services explain a large share of the growth of the global service economy. The fast growth of business services coincides with shifts from domestic production towards global outsourcing of services. A new wave of global business services are traded across borders and have emerged as important drivers of growth in the world’s service sector. Research limitations/implications This paper advances the understanding of non-ownership services in an increasingly global and specialized post-industrial economy. The paper makes a conceptual contribution supported by descriptive data, but without empirical testing. Originality/value The authors integrate the non-ownership concept and three related economic theories of the firm to explain the role of global business services in driving business performance and the international transformation of service economies.

Key determinants of real estate service quality among renters and buyers

Purpose The purpose of this study is to compare quality perceptions of virtual servicescapes and physical service encounters among buyers and renters of real estate. Design/methodology/approach Qualitative data from a sample of 27 professionals engaged in higher education in the USA are gathered by recorded interview before being transcribed and imported into MAXQDA 2007 software for analytical coding. Findings Particular differences are found to exist between renters and buyers with regard to specific service attributes – for example, description of properties and type of visuals during the pre‐purchase stage, knowledge/experience and honest behavior of realtors during the service encounter stage and a continuous relationship with the realtor in the post‐encounter stage. Research limitations/implications Generalization of the results is limited because the study utilizes data from only one industry (real estate) and from only one demographic segment (professionals in higher education). Practical implications Real‐estate firms need to pay attention to both the training of agents and the design and content of their websites. Originality/value This paper contributes to knowledge regarding virtual servicescapes in professional services.

Associations between individual socioeconomic position, neighbourhood disadvantage, and transport mode: Baseline results from the HABITAT multilevel study

Background Understanding how different socioeconomic indicators are associated with transport modes provide insight into which interventions might contribute to reducing socioeconomic inequalities in health. The purpose of this study was to examine associations between neighbourhood-level socioeconomic disadvantage, individual-level socioeconomic position (SEP) and usual transport mode. Methods This investigation included 11,036 residents from 200 neighbourhoods in Brisbane, Australia. Respondents self-reported their usual transport mode (car or motorbike, public transport, walking or cycling). Indicators for individual-level SEP were education, occupation, and household income; and neighbourhood disadvantage was measured using a census-derived index. Data were analysed using multilevel multinomial logistic regression. High SEP respondents and residents of the most advantaged neighbourhoods who used a private motor vehicle as their usual form of transport was the reference category. Results Compared with driving a motor vehicle, the odds of using public transport were higher for white collar employees (OR1.68, 95%CrI 1.41-2.01), members of lower income households (OR 1.71 95%CrI 1.25-2.30), and residents of more disadvantaged neighbourhoods (OR 1.93, 95%CrI 1.46-2.54); and lower for respondents with a certificate-level education (OR 0.60, 95%CrI 0.49-0.74) and blue collar workers (OR 0.63, 95%CrI 0.50-0.81). The odds of walking for transport were higher for the least educated (OR 1.58, 95%CrI 1.18-2.11), those not in the labour force (OR 1.94, 95%CrI 1.38-2.72), members of lower income households (OR 2.10, 95%CrI 1.23-3.64), and residents of more disadvantaged neighbourhoods (OR 2.73, 95%CrI 1.46-5.24). The odds of cycling were lower among less educated groups (OR 0.31, 95% CrI 0.19-0.48). Conclusion The relationships between socioeconomic characteristics and transport modes are complex, and provide challenges for those attempting to encourage active forms of transportation. Further work is required exploring the individual- and neighbourhood-level mechanisms behind transport mode choice, and what factors might influence individuals from different socioeconomic backgrounds to change to more active transport modes.