A systematic review of hepatitis C clinical practice guidelines: Benefits, limitations and harms

Background Hepatitis C (HCV) was described as a “viral time bomb” due to its prevalence and potential for causing serious, life-threatening complications. The Australian’s National Hepatitis C Strategy calls for a coordinated, evidence-based approach to testing, management, care and support of HCV. This review aimed to systematically and comparatively appraise existing international HCV clinical guidelines. Methods A systematic search of bibliographic databases and reference lists from selected papers were the source of data. Inclusion criteria were latest clinical guidelines as defined by Institute of Medicine, published in English, between January 2002 and November 2014. Quality of the guidelines was independently assessed using the iCAHE instrument. Results Twenty-eight international clinical practice guidelines were included. The majority of the international guidelines were based on the same primary studies however clinical recommendations on pre- and in-treatment assessments, choice of pharmaceuticals, and dosages and duration of the same pharmaceutical agents varied considerably. This diversity was beyond what would be considered reasonable practice context variations. Furthermore, there is limited guidance on post-treatment surveillance and care. Conclusions/implications There is a need for a harmonised international consensus on the clinical management of HCV. Key message A lack of consistency among international HCV clinical guidelines may impede effective and efficient patient care.

From maternity paper hand-held records to electronic health records: What do women tell us about their use?

The paper hand-held record (PHR) has been used extensively in general practice (GP) shared care management of pregnant women, and recently, the first Mater Shared Electronic Health Record (MSEHR) was introduced. The aim of this qualitative study was to examine women’s experiences using the records and the contribution of the records to integrate care. At the 36-week antenatal visit in a maternity tertiary centre clinic, women were identified as a user of either the PHR or the MSEHR and organised into Phase 1 and Phase 2 studies respectively. Fifteen women were interviewed in Phase 1 and 12 women in Phase 2. Semi-structured interviews were used for data collection, and analysed using qualitative content analysis. Four main themes were identified: (1) purpose of the record; (2) perceptions of the record; (3) content of the record, and; (4) sharing the record. Findings indicate that the PHR is a well-liked maternity tool. The findings also indicate there is under-usage of the MSEHR due to health-care providers failing to follow up and discuss the option of using the electronic health record option or if a woman has completed the log-in process. This paper adds to an already favourable body of knowledge about the use of the PHR. It is recommended that continued implementation of the MSEHR be undertaken to facilitate its use.

Caught in the act of collaboration: Students’ experiences of collective learning within a real-world design studio context

This study is an evaluation of design students’ perceptions of the benefits of collective learning in a real-world collaborative design studio. Third year students worked in inter-disciplinary teams representing architecture, interior design, landscape architecture, and industrial design. Responding to a real-world brief and in consultation with an industry partner client and early childhood education pre-service teachers, the teams were required to collectively propose a design response for a community-based child and family centre, on an iconic koala sanctuary site. Data were collected using several methods including a participatory action research method, through the form of a large analogue, collaborative jigsaw puzzle. Using a grounded theory methodology, qualitative data were thematically analysed to reveal six distinct aspects of collaboration, which positively impacted the students’ learning experience. The results of this study include recommendations for improving real world collaboration in the design studio in preparation for students’ transition into professional practice.

Problem solving in a 21st century mathematics curriculum

Research on problem solving in the mathematics curriculum has spanned many decades, yielding pendulum-like swings in recommendations on various issues. Ongoing debates concern the effectiveness of teaching general strategies and heuristics, the role of mathematical content (as the means versus the learning goal of problem solving), the role of context, and the proper emphasis on the social and affective dimensions of problem solving (e.g., Lesh & Zawojewski, 2007; Lester, 2013; Lester & Kehle, 2003; Schoenfeld, 1985, 2008; Silver, 1985). Various scholarly perspectives—including cognitive and behavioral science, neuroscience, the discipline of mathematics, educational philosophy, and sociocultural stances—have informed these debates, often generating divergent resolutions. Perhaps due to this uncertainty, educators’ efforts over the years to improve students’ mathematical problem-solving skills have had disappointing results. Qualitative and quantitative studies consistently reveal mathematics students’ struggles to solve problems more significant than routine exercises (OECD, 2014; Boaler, 2009)...

Quantifying the state of populations and effects of disturbances at large spatio-temporal scales: The case of coral populations in the great barrier reef

This project was a step forward in applying statistical methods and models to provide new insights for more informed decision-making at large spatial scales. The model has been designed to address complicated effects of ecological processes that govern the state of populations and uncertainties inherent in large spatio-temporal datasets. Specifically, the thesis contributes to better understanding and management of the Great Barrier Reef.

Clinical factors associated with the humoral immune response to influenza vaccination in chronic obstructive pulmonary disease

Background and objective Individuals with chronic obstructive pulmonary disease (COPD) are at a high risk of developing significant complications from infection with the influenza virus. It is therefore vital to ensure that prophylaxis with the influenza vaccine is effective in COPD. The aim of this study was to assess the immunogenicity of the 2010 trivalent influenza vaccine in persons with COPD compared to healthy subjects without lung disease, and to examine clinical factors associated with the serological response to the vaccine. Methods In this observational study, 34 subjects (20 COPD, 14 healthy) received the 2010 influenza vaccine. Antibody titers at baseline and 28 days post-vaccination were measured using the hemagglutination inhibition assay (HAI) assay. Primary endpoints included seroconversion (≥4-fold increase in antibody titers from baseline) and the fold increase in antibody titer after vaccination. Results Persons with COPD mounted a significantly lower humoral immune response to the influenza vaccine compared to healthy participants. Seroconversion occurred in 90% of healthy participants, but only in 43% of COPD patients (P=0.036). Increasing age and previous influenza vaccination were associated with lower antibody responses. Antibody titers did not vary significantly with cigarette smoking, presence of other comorbid diseases, or COPD severity. Conclusion The humoral immune response to the 2010 influenza vaccine was lower in persons with COPD compared to non-COPD controls. The antibody response also declined with increasing age and in those with a history of prior vaccination.

Evaluation of immune responses to influenza vaccination in chronic obstructive pulmonary disease

Background: Given that viral infections are common triggers for exacerbations of Chronic Obstructive Pulmonary Disease (COPD), current clinical guidelines recommend that all patients receive annual influenza vaccinations. A detailed examination of the immune response to vaccination in COPD has not previously been undertaken, so this study aimed to compare immune responses to influenza vaccination between COPD patients and healthy subjects. Methods: Twenty one COPD patients and fourteen healthy subjects were recruited and cellular immune function was assessed pre- and post- vaccination with trivalent inactivated influenza vaccine. Results: One month after vaccination, H1N1 specific antibody titres were significantly lower in COPD patients than in healthy controls (p=0.02). Multivariate analysis demonstrated that post vaccination antibody titres were independently associated with COPD, but not with age or smoking status. Innate immune responses to the vaccine preparation did not differ between the two populations. Serum concentrations of IL-21, a cytokine that is important for B cell development and antibody synthesis, were also lower in COPD patients than in healthy subjects (p<0.01). In vitro functional differences were also observed, with fewer proliferating B cells expressing CD27 (p=0.04) and reduced T-cell IFN-γ synthesis (p<0.01) in COPD patients, relative to healthy subjects. Conclusions: In conclusion, COPD was associated with altered immune responses to influenza vaccination compared to healthy controls with reductions in both T-cell and B-cell function. These findings provide a foundation for future research aimed at optimising the effectiveness of influenza vaccination in COPD.

Does failed chronic wet cough response to antibiotics predict bronchiectasis?

Aim: To determine whether a child with chronic wet cough and poor response to at least 4 weeks of oral antibiotics is more likely to have bronchiectasis. Methods: All chest multi-detector computerised tomography (MDCT) scans at a single paediatric tertiary hospital from April 2010 to August 2012 were reviewed retrospectively so as to identify those ordered by respiratory physicians for assessment of children with a chronic wet cough. Information regarding age, sex, ethnicity, indication for imaging and the response to at least 4 weeks of antibiotics before having the scan were recorded from their charts. The data were analysed using simple and multiple logistic regression. Results: Of the 144 (87 males) eligible children, 106 (65 males, 30 Indigenous) aged 10–199 months had MDCT scan evidence of bronchiectasis. Antibiotic data were available for 129 children. Among the 105 children with persistent cough despite at least 4 weeks of antibiotics, 88 (83.8%) had bronchiectasis, while of the 24 children whose cough resolved after antibiotics, only six (25.0%) received this diagnosis (adjusted OR 20.9; 95% CI 5.36 to 81.8). Being Indigenous was also independently associated with radiographic evidence of bronchiectasis (adjusted OR 5.86; 95% CI 1.20 to 28.5). Conclusions: Further investigations including a MDCT scan should be considered in a child with a chronic wet cough that persists following 4 weeks of oral antibiotics. However, while reducing the likelihood of underlying bronchiectasis, responding well to a single prolonged course of antibiotics does not exclude this diagnosis completely.

Burnout and work engagement in occupational therapists

Introduction Work engagement, characterized by vigour, dedication, and absorption, is often perceived as the opposite of burnout. Occupational therapists with burnout feel exhausted and disengaged from their work. This study aims to investigate demographic and work-related psychosocial factors associated with burnout and work engagement. Method A cross-sectional postal survey of 951 occupational therapists was conducted. Findings Two models representing factors associated with burnout (F(15,871) = 28.01, p < .001) and work engagement (F(10,852) = 16.15, p < .001) accounted for 32.54% and 15.93% of the variance respectively. Burnout and work engagement were inversely associated (χ2(n = 941) = 55.16, p < .001). Conclusion Factors associated with burnout and work engagement were identified. The variables associated with burnout included: low psychological detachment from work during out-of-work hours, low income satisfaction, perceived work overload, difficulty saying ‘no’, < 10 years' experience, low frequency of having a ‘belly laugh’, and not having children. High levels of work engagement were reported by therapists with the following: low psychological detachment from work, high income satisfaction, postgraduate qualifications, > 40 hours work/week, high frequency of having a ‘belly laugh’, and having children. Understanding the factors associated with burnout and work engagement provides prerequisite information to inform strategies aimed at building healthy workforces.

A framework for evaluating the impact of obesity prevention strategies on socioeconomic inequalities in weight

We developed a theoretical framework to organize obesity prevention interventions by their likely impact on the socioeconomic gradient of weight. The degree to which an intervention involves individual agency versus structural change influences socioeconomic inequalities in weight. Agentic interventions, such as standalone social marketing, increase socioeconomic inequalities. Structural interventions, such as food procurement policies and restrictions on unhealthy foods in schools, show equal or greater benefit for lower socioeconomic groups. Many obesity prevention interventions belong to the agento–structural types of interventions, and account for the environment in which health behaviors occur, but they require a level of individual agency for behavioral change, including workplace design to encourage exercise and fiscal regulation of unhealthy foods or beverages. Obesity prevention interventions differ in their effectiveness across socioeconomic groups. Limiting further increases in socioeconomic inequalities in obesity requires implementation of structural interventions. Further empirical evaluation, especially of agento–structural type interventions, remains crucial.

General practitioners learning qualitative research: A case study of postgraduate education

Background Qualitative research is increasingly being recognised as a vital aspect of primary healthcare research. Teaching and learning how to conduct qualitative research is especially important for general practitioners and other clinicians in the professional educational setting. This article examines a case study of postgraduate professional education in qualitative research for clinicians, for the purpose of enabling a robust discussion around teaching and learning in medicine and the health sciences. Method A series of three workshops was delivered for primary healthcare academics. The workshops were evaluated using a quantitative survey and qualitative free-text responses to enable descriptive analyses. Results Participants found qualitative philosophy and theory the most difficult areas to engage with, and learning qualitative coding and analysis was considered the easiest to learn. Discussion Key elements for successful teaching were identified, including the use of adult learning principles, the value of an experienced facilitator and an awareness of the impact of clinical subcultures on learning.

Rethinking Culture and Diversity in Early Childhood Preservice Teacher Education: Looking at Teaching and Learning Through an Interdisciplinary Lens

Early Childhood Education (ECE) has a long history of building foundations for children to achieve their full potential, enabling parents to participate in the economy while children are cared for, addressing poverty and disadvantage, and building individual, community and societal resources. In so doing, ECE has developed a set of cultural practices and ways of knowing that shape the field and the people who work within it. ECE, consequently, is frequently described as unique and special (Moss, 2006; Penn, 2011). This works to define and distinguish the field while, simultaneously, insulating it from other contexts, professions, and ideas. Recognising this dualism illuminates some of the risks and challenges of operating in an insular and isolated fashion. In the 21st century, there are new challenges for children, families and societies to which ECE must respond if it is to continue to be relevant. One major issue is how ECE contributes to transition towards more sustainable ways of living. Addressing this contemporary social problem is one from which Early Childhood teacher education has been largely absent (Davis & Elliott, 2014), despite the well recognised but often ignored role of education in contributing to sustainability. Because of its complexity, sustainability is sometimes referred to as a ‘wicked problem’ (Rittel & Webber, 1973; Australian Public Service Commission, 2007) requiring alternatives to ‘business as usual’ problem solving approaches. In this chapter, we propose that addressing such problems alongside disciplines other than Education enables the Early Childhood profession to have its eyes opened to new ways of thinking about our work, potentially liberating us from the limitations of our “unique” and idiosyncratic professional cultures. In our chapter, we focus on understandings of culture and diversity, looking to broaden these by exploring the different ‘cultures’ of the specialist fields of ECE and Design (in this project, we worked with students studying Architecture, Industrial Design, Landscape Architecture and Interior Design). We define culture not as it is typically represented, i.e. in relation to ideas and customs of particular ethnic and language groups, but to the ideas and practices of people working in different disciplines and professions. We assert that different specialisms have their own ‘cultural’ practices. Further, we propose that this kind of theoretical work helps us to reconsider ways in which ECE might be reframed and broadened to meet new challenges such as sustainability and as yet unknown future challenges and possibilities. We explore these matters by turning to preservice Early Childhood teacher education (in Australia) as a context in which traditional views of culture and diversity might be reconstructed. We are looking to push our specialist knowledge boundaries and to extend both preservice teachers and academics beyond their comfort zones by engaging in innovative interdisciplinary learning and teaching. We describe a case study of preservice Early Childhood teachers and designers working in collaborative teams, intersecting with a ‘real-world’ business partner. The joint learning task was the design of an early learning centre based on sustainable design principles and in which early Education for Sustainability (EfS) would be embedded Data were collected via focus group and individual interviews with students in ECE and Design. Our findings suggest that interdisciplinary teaching and learning holds considerable potential in dismantling taken-for-granted cultural practices, such that professional roles and identities might be reimagined and reconfigured. We conclude the chapter with provocations challenging the ways in which culture and diversity in the field of ECE might be reconsidered within teacher education.

How to choose a healthy, eco-friendly childcare centre

The early years have been recognized as a “natural starting point” for education for sustainability. ECEfS is a newly emerging area and Australian educators, teacher educators, and researchers are leaders in this field. Indeed, there is a growing list of exemplary kindergartens, child care centres, preschools, and preps across the country engaged in EfS focusing on a range of topics that include, for example, water education, reducing energy use, recycling, growing gardens, and cleaning up parks and creeks. Some centres focus more on the social dimensions of sustainability – strengthening Indigenous communities, working with the elderly, supporting the unemployed, fostering gender equality in their communities, being more socially inclusive. There is mounting evidence that early lessons in sustainability help reshape adult sustainability actions in homes, schools and communities.

Students' responses to the RACQ docudrama program

Young people are over-represented in road crashes and school-based education programs, including the RACQ Docudrama program, represent initiatives aimed at improving road safety among this high-risk group. The aim of the study was to apply an extended Theory of Planned Behaviour framework to understand more about the extent to which the program influenced individuals‟ intentions to speak up to a driver engaging in risky behaviours (e.g., speeding). Senior high school students (N=260) from 5 Queensland schools completed a survey in class. The study included a Control group (n = 86) who responded to the survey prior to completing the Docudrama program and an Intervention group comprising an Intervention-Immediate (n=100) and an Intervention-Delayed group (n = 74) who completed the survey after having participated in the program either on the day or up to a week later, respectively. Overall, the findings provided support for the beneficial effects of the program. Some of the study’s key findings included: (i) Intervention group participants consistently reported significantly stronger intentions to speak up than participants in the control group; (ii) among the significant predictors of intentions, a notable finding was that the more individuals anticipated feeling regretful for not having spoken up to a risky driver, the stronger their intentions were to speak up, and; (iii) the level of fear reported by students significantly decreased and was lowest at the conclusion of the program, following facilitated group discussion. The implications of the results for future research, program development and practice are discussed.

Accountability of insurers under s 54: Striking the balance between commerciality and consumer protection

Section 54 of the Insurance Contracts Act 1984 (Cth) continues to occupy a prominent position in insurance-related litigation. This section which imposes a concept of causation, or prejudice to the insurer, to restrict an insurer’s reliance upon contractual terms to avoid liability for particular claims, is often before the courts. This note focuses upon the recent High Court of Australia decision in Maxwell v Highway Hauliers Pty Ltd [2014] HCA 33.