The development of a component to improve the loading safety of bone-anchored prostheses

Use of socket prostheses Currently, for individuals with limb loss, the conventional method of attaching a prosthetic limb relies on a socket that fits over the residual limb. However, there are a number of issues concerning the use of a socket (e.g., blisters, irritation, and discomfort) that result in dissatisfaction with socket prostheses, and these lead ultimately a significant decrease in quality of life. Bone-anchored prosthesis Alternatively, the concept of attaching artificial limbs directly to the skeletal system has been developed (bone anchored prostheses), as it alleviates many of the issues surrounding the conventional socket interface.Bone anchored prostheses rely on two critical components: the implant, and the percutaneous abutment or adapter, which forms the connection for the external prosthetic system (Figure 1). To date, an implant that screws into the long bone of the residual limb has been the most common intervention. However, more recently, press-fit implants have been introduced and their use is increasing. Several other devices are currently at various stages of development, particularly in Europe and the United States. Benefits of bone-anchored prostheses Several key studies have demonstrated that bone-anchored prostheses have major clinical benefits when compared to socket prostheses (e.g., quality of life, prosthetic use, body image, hip range of motion, sitting comfort, ease of donning and doffing, osseoperception (proprioception), walking ability) and acceptable safety, in terms of implant stability and infection. Additionally, this method of attachment allows amputees to participate in a wide range of daily activities for a substantially longer duration. Overall, the system has demonstrated a significant enhancement to quality of life. Challenges of direct skeletal attachment However, due to the direct skeletal attachment, serious injury and damage can occur through excessive loading events such as during a fall (e.g., component damage, peri-prosthetic fracture, hip dislocation, and femoral head fracture). These incidents are costly (e.g., replacement of components) and could require further surgical interventions. Currently, these risks are limiting the acceptance of bone-anchored technology and the substantial improvement to quality of life that this treatment offers. An in-depth investigation into these risks highlighted a clear need to re-design and improve the componentry in the system (Figure 2), to improve the overall safety during excessive loading events. Aim and purposes The ultimate aim of this doctoral research is to improve the loading safety of bone-anchored prostheses, to reduce the incidence of injury and damage through the design of load restricting components, enabling individuals fitted with the system to partake in everyday activities, with increased security and self-assurance. The safety component will be designed to release or ‘fail’ external to the limb, in a way that protects the internal bone-implant interface, thus removing the need for restorative surgery and potential damage to the bone. This requires detailed knowledge of the loads typically experienced by the limb and an understanding of potential overload situations that might occur. Hence, a comprehensive review of the loading literature surrounding bone anchored prostheses will be conducted as part of this project, with the potential for additional experimental studies of the loads during normal activities to fill in gaps in the literature. This information will be pivotal in determining the specifications for the properties of the safety component, and the bone-implant system. The project will follow the Stanford Biodesign process for the development of the safety component.

Enabling people to ‘see what they can be’… The Community Aspirations Program (CAP-ED)

The Community Aspirations Program in Education (CAP-ED) was delivered by CQUniversity’s Office of Indigenous Engagement to increase Aboriginal and Torres Strait Islander student participation in higher education. CAP-ED was developed through scoping studies of six individual communities within the CQuniversity footprint, including a designated Aboriginal and Torres Strait Islander community and rural and regional communities. The scoping process included developing community profiles and extensive consultation with Traditional Owners, Elders, community members and key stakeholders. This process proved to be an essential component of CAP-ED’s success, resulting in Indigenous participation in the program’s networking lunches, through to the delivery of information and workshop sessions. Moreover, it witnessed engagement with people in communities as partners in the program’s delivery and co-presenters in workshops and other events. The CAP-ED workshops focus on identity, culture, aspirations and assist participants to see that they have the potential to participate in higher education. The other essential components of the program’s success have included enabling people to ‘see what they can be’, offering opportunities for people to ask questions, voice honest concerns, and build confidence. The flexibility of delivery was paramount in accommodating the varying needs of each community and the differences in cultural protocols and community approaches, while the face to face engagement between knowledgeable and skilled staff and community members proved to be vital. Over the life of the project, CAP-ED has developed into a broad based strategy that has successfully matched community needs and university based responses through the process of community engagement.

Helping doctoral students teach: Transitioning to early career academia through cognitive apprenticeship

Doctoral training is strongly focused on honing research skills at the expense of developing teaching competency. As a result, emerging academics are unprepared for the pedagogical requirements of their early-career academic roles. Employing an action research approach, this study investigates the effectiveness of a competency-based teaching development intervention that aims to improve the teaching self-efficacy of doctoral candidates. To conduct this research, we apply the theoretical framework of Cognitive Apprenticeship Theory, a theory of social learning that requires learners to participate in a community of inquiry. Participants report significantly higher levels of teaching self-efficacy and a stronger sense of connectedness to the wider academic community.

The cost-effectiveness of the MobileMums intervention to increase physical activity among mothers with young children: A Markov model informed by a randomised controlled trial

Objectives: To determine the cost-effectiveness of the MobileMums intervention. MobileMums is a 12-week programme which assists mothers with young children to be more physically active, primarily through the use of personalised SMS text-messages. Design: A cost-effectiveness analysis using a Markov model to estimate and compare the costs and consequences of MobileMums and usual care. Setting: This study considers the cost-effectiveness of MobileMums in Queensland, Australia. Participants: A hypothetical cohort of over 36 000 women with a child under 1 year old is considered. These women are expected to be eligible and willing to participate in the intervention in Queensland, Australia. Data sources: The model was informed by the effectiveness results from a 9-month two-arm community-based randomised controlled trial undertaken in 2011 and registered retrospectively with the Australian Clinical Trials Registry (ACTRN12611000481976). Baseline characteristics for the model cohort, treatment effects and resource utilisation were all informed by this trial. Main outcome measures: The incremental cost per quality-adjusted life year (QALY) of MobileMums compared with usual care. Results: The intervention is estimated to lead to an increase of 131 QALYs for an additional cost to the health system of 1.1 million Australian dollars (AUD). The expected incremental cost-effectiveness ratio for MobileMums is 8608 AUD per QALY gained. MobileMums has a 98% probability of being cost-effective at a cost-effectiveness threshold of 64 000 AUD. Varying modelling assumptions has little effect on this result. Conclusions: At a cost-effectiveness threshold of 64 000 AUD, MobileMums would likely be a cost-effective use of healthcare resources in Queensland, Australia. Trial registration number: Australian Clinical Trials Registry; ACTRN12611000481976.

Access To Justice In The ASEAN The Key Role Of UNCITRAL

UNCITRAL’s operation as a subsidiary of the UN General Assembly, tasked to unify and harmonise international trade law is a necessary and indispensable element of the UN’s mandate to maintain international peace and security. Strong legal frameworks which are compatible with those of international trading partners often accompany accelerated growth in economic capacity and stability. Over time, access to markets and resultant growth in economic and human development creates a disincentive for instability as incomes and standards of living rise. Human and economic development, facilitated by a modernised and just legal framework that is available to the broadest range of recipients goes hand in hand with the maintenance of domestic and regional peace, particularly in regions such as the ASEAN , one of the fastest growing in the world covering approximately 30% of global population and with a number of strong global economic neighbours including Japan, Korea, China (to the north), Australia (to the south) and Singapore (to the west). In an increasingly interconnected world, the ability of government, enterprise and individuals to participate in the global supply chain offers opportunities for economic growth and development. Over its almost 50 years of operations, UNCITRAL has produced a range of important texts that are designed to underpin world trade. A key implicit assumption underpinning the development of UNCITRAL texts is that the texts, once adopted can and will be applied in adopting states.

Patient perspectives of factors contributing to inadequate dietary intake in acute care patients in hospital

Up to 30% of acute care patients consume less than half of the food provided in hospital. Inadequate dietary intake can have adverse clinical outcomes, including a higher risk of in-hospital mortality. This study aimed to investigate the reasons for poor intake among acute care patients in hospital. Patients with an observed intake of ≤50% of the food provided at lunch were approached to participate in the study. Thirty-two patients participated in semi-structured interviews over a three week period, to provide their perspective of food and mealtimes in hospital and discuss the reasons and factors influencing inadequate intake. Responses were coded and analysed thematically using the framework method. Patients reported both individual and organisational factors contribute to their inadequate intake. Half the patients reported the size of the meals were too large, with some patients reporting that large meal sizes puts them off their food and reduced their intake. ‘Not important to eat all the food provided’, and ‘do not need to eat much food in hospital’ were common attitudes among the patients. Half the patients reported that nurses did not observe their intake and were not concerned if all the food was not eaten. Identifying the reasons for poor intake can assist with the development of suitable interventions to improve dietary intake and reduce the risk of adverse clinical outcomes. Further investigation of suitable interventions to reduce portion sizes and improve both staff and patient perceptions of the importance of food in hospital is recommended.

Regional resilience: Pre-service teacher preparation to teach in the bush

This paper reports on the outcomes of a two year ALTC Competitive Research and Development Project that aimed to "Develop Strategies at the Pre-Service Level to Address Critical Teacher Attraction and Retention Issues in Australian Rural, Regional and Remote Schools". As well as developing a ‘training framework’ and teaching guides to increase the capacity and credibility of four universities to prepare educators who might venture out of the metropolitan area to teach, data were gathered from pre-service and graduate teachers to analyse regional resilience. It was found that there was a strong likelihood to participate in a regional practicum and stay in a non-metropolitan community once they graduated from university if they had a positive attitude to regional Western Australia either through a family connection or previous experience. Recommendations from this study emphasise the importance of having pre-service students participate in positive regional experiences early in their university study.

An object-centred approach to encourage online participation in the context of behaviour change

Online groups rely on contributions from their members to flourish, but in the context of behaviour change individuals are typically reluctant to participate actively before they have changed successfully. We took inspiration from CSCW research on objects to address this problem by shifting the focus of online participation from the exchange of personal experiences to more incidental interactions mediated by objects that offer support for change. In this article we describe how we designed, deployed and studied a smartphone application that uses different objects, called distractions and tips, to facilitate social interaction amongst people trying to quit smoking. A field study with 18 smokers revealed different forms of interaction: purely instrumental interactions with the objects, subtle engagement with other users through receptive and covert interactions, as well as explicit interaction with other users through disclosure and mutual support. The distraction objects offered a stepping-stone into interaction, whereas the tips encouraged interaction with the people behind the objects. This understanding of interaction through objects complements existing frameworks of online participation and adds to the current discourse on object-centred sociality. Furthermore, it provides an alternative approach to the design of online support groups, which offers the users enhanced control about the information they share with other users. We conclude by discussing how researchers and practitioners can apply the ideas of interaction around objects to other domains where individuals may have a simultaneous desire and reluctance to interact.

Structuring time and questioning to achieve tactical awareness in games lessons

Background: A paradigm shift in educational policy to create problem solvers and critical thinkers produced the games concept approach (GCA) in Singapore's Revised Syllabus for Physical Education (1999). A pilot study (2001) conducted on 11 primary school student teachers (STs) using this approach identified time management and questioning as two of the major challenges faced by novice teachers. Purpose: To examine the GCA from three perspectives: structure—lesson form in terms of teacher-time and pupil-time; product—how STs used those time fractions; and process—the nature of their questioning (type, timing, and target). Participants and setting: Forty-nine STs from three different PETE cohorts (two-year diploma, four-year degree, two-year post-graduate diploma) volunteered to participate in the study conducted during the penultimate week of their final practicum in public primary and secondary schools. Intervention: Based on the findings of the pilot study, PETE increased the emphasis on GCA content specific knowledge and pedagogical procedures. To further support STs learning to actualise the GCA, authentic micro-teaching experiences that were closely monitored by faculty were provided in schools nearby. Research design: This is a descriptive study of time-management and questioning strategies implemented by STs on practicum. Each lesson was segmented into a number of sub-categories of teacher-time (organisation, demonstration and closure) and pupil-time (practice time and game time). Questions were categorised as knowledge, technical, tactical or affective. Data collection: Each ST was video-taped teaching a GCA lesson towards the end of their final practicum. The STs individually determined the timing of the data collection and the lesson to be observed. Data analysis: Each lesson was segmented into a number of sub-categories of both teacher- and pupil-time. Duration recording using Noldus software (Observer 4.0) segmented the time management of different lesson components. Questioning was coded in terms of type, timing and target. Separate MANOVAs were used to measure the difference between programmes and levels (primary and secondary) in relation to time-management procedures and questioning strategies. Findings: No differences emerged between the programmes or levels in their time-management or questioning strategies. Using the GCA, STs generated more pupil time (53%) than teacher time (47%). STs at the primary level provided more technical practice, and those in secondary schools more small-sided game play. Most questions (58%) were asked during play or practice but were substantially low-order involving knowledge or recall (76%) and only 6.7% were open-ended or divergent and capable of developing tactical awareness. Conclusions: Although STs are delivering more pupil time (practice and game) than teacher-time, the lesson structure requires further fine-tuning to extend the practice task beyond technical drills. Many questions are being asked to generate knowledge about games but lack sufficient quality to enhance critical thinking and tactical awareness, as the GCA intends.

Assessment of motivation to control alcohol use: The motivational thought frequency and state motivation scales for alcohol control

Introduction The Elaborated Intrusion Theory of Desire holds that desires for functional and dysfunctional goals share a common form. Both are embodied cognitive events, characterised by affective intensity and frequency. Accordingly, we developed scales to measure motivational cognitions for functional goals (Motivational Thought Frequency, MTF; State Motivation, SM), based on the existing Craving Experience Questionnaire (CEQ). When applied to increasing exercise, MTF and SM showed the same three-factor structure as the CEQ (Intensity, Imagery, Availability). The current study tested the internal structure and concurrent validity of the MTF and SM Scales when applied to control of alcohol consumption (MTF-A; SM-A). Methods Participants (N = 417) were adult tertiary students, staff or community members who had recently engaged in high-risk drinking or were currently trying to control alcohol consumption. They completed an online survey comprising the MTF-A, SM-A, Alcohol Use Disorders Identification Test (AUDIT), Readiness to Change Questionnaire (RCQ) and demographics. Results Confirmatory Factor Analysis gave acceptable fit for the MTF-A, but required the loss of one SM-A item, and was improved by intercorrelations of error terms. Higher scores were associated with more severe problems on the AUDIT and with higher Contemplation and Action scores on the RCQ. Conclusions The MTF-A and SM-A show potential as measures of motivation to control drinking. Future research will examine their predictive validity and sensitivity to change. The scales' application to both increasing functional and decreasing dysfunctional behaviours is consistent with EI Theory's contention that both goal types operate in similar ways.

Experiments on homogeneous nucleation and physicochemical properties related to atmospheric new particle formation

Aerosol particles play a role in the earth ecosystem and affect human health. A significant pathway of producing aerosol particles in the atmosphere is new particle formation, where condensable vapours nucleate and these newly formed clusters grow by condensation and coagulation. However, this phenomenon is still not fully understood. This thesis brings an insight to new particle formation from an experimental point of view. Laboratory experiments were conducted both on the nucleation process and physicochemical properties related to new particle formation. Nucleation rate measurements are used to test nucleation theories. These theories, in turn, are used to predict nucleation rates in atmospheric conditions. However, the nucleation rate measurements have proven quite difficult to conduct, as different devices can yield nucleation rates with differences of several orders of magnitude for the same substances. In this thesis, work has been done to have a greater understanding in nucleation measurements, especially those conducted in a laminar flow diffusion chamber. Systematic studies of nucleation were also made for future verification of nucleation theories. Surface tensions and densities of substances related to atmospheric new particle formation were measured. Ternary sulphuric acid + ammonia + water is a proposed candidate to participate in atmospheric nucleation. Surface tensions of an alternative candidate to nucleate in boreal forest areas, sulphuric acid + dimethylamine + water, were also measured. Binary compounds, consisting of organic acids + water are possible candidates to participate in the early growth of freshly nucleated particles. All the measured surface tensions and densities were fitted with equations, thermodynamically consistent if possible, to be easily applied to atmospheric model calculations of nucleation and subsequent evolution of particle size.

What influences the timing of the introduction of solid food to infants?

The aim of the present study was to assess the factors which may influence the timing of the introduction of solid food to infants. The design was a prospective cohort study by interview and postal questionnaire. Primiparous women (n 541) aged between 16 and 40 years were approached in the Forth Park Maternity Hospital, Fife, Scotland. Of these, 526 women agreed to participate and seventy-eight were used as subjects in the pilot study. At 12 weeks we interviewed 338 women of the study sample. The postal questionnaire was returned by 286 of 448 volunteers. At 12 weeks 133 of 338 mothers said that they had introduced solids. Those that said that they had introduced solids early (<12 weeks) were compared with those who had introduced solids late (>12 weeks) by bivariate and multiple regression analysis. Psychosocial factors influencing the decision were measured with the main outcome measure being the time of introduction of solid food. The early introduction of solids was found to be associated with: the opinions of the infant's maternal grandmother; living in a deprived area; personal disagreement with the advice to wait until the baby was 4 months; lack of encouragement from friends to wait until the baby was 4 months; being in receipt of free samples of manufactured food. Answers to open-ended questions indicated that the early introduction appeared to be influenced by the mothers’ perceptions of the baby's needs. Some of the factors influencing a woman's decision to introduce solids are amenable to change, and these could be targeted in educational interventions.

The Right to Participation of Minorities and Irish Travellers

The idea of participation is becoming increasingly important in international human rights law and recent political and constitutional theory. There is an emerging international law right of minorities to participate in public life. There are many problems though with putting this right into practice. It is not enough to offer formal opportunities for representation or even to facilitate more participatory processes. This article explores how participation is more easily proclaimed than practised by examining the position of one ethnic minority, Travellers, in a liberal democracy, Ireland. While there are many formal opportunities for participation, these do not necessarily result in effective participation on a basis of equality, and may still result in decisions which fail to consider the Traveller culture and identity. Travellers still suffer from an imbalance of power in these arrangements. There are hopeful avenues to pursue in improving participation, the role of civil society and the use of a dialogue between non-governmental organisations and international organisations to put pressure on a national government, including special representation to offset the disadvantages of traditional representative democracy and emphasising the role of special parliamentary bodies; and the need to address the politics of recognition so as to strengthen the hand of disadvantaged groups such as Travellers.

The journey to concordance for patients with hypertension: a qualitative study in primary care

Objective: We aimed to explore, using qualitative methods, the perspectives of patients with hypertension on issues relating to concordance in prescribing.

Method: This study took place in NHS general practices in Northern Ireland. A purposeful sample of patients who had been prescribed anti-hypertensive medication for at least one year were invited to participate in focus groups or semi-structured interviews; data were analysed using constant comparison.

Main outcome measures: The perspectives of patients with hypertension on issues relating to concordance in prescribing.

Results: Twenty-five individuals participated in five focus groups; two participated in semi-structured interviews. Participants felt they could make valuable contributions to consultations regarding their management. They were prepared to negotiate with GPs regarding their medication, but most deferred to their doctor’s advice, perceiving doctors’ attitudes and time constraints as barriers to their greater involvement in concordant decision-making. They had concerns about taking anti-hypertensive drugs, were aware of lifestyle influences on hypertension and reported using personal strategies to facilitate adherence and reduce the need to take medication.

Conclusions: Participants indicated a willingness to be?involved in concordance in prescribing anti- hypertensive medication but needed health professionals to address their concerns and confusion about the nature of hypertension. These findings suggest that there is a need for doctors and other healthcare professionals with responsibility for prescribing to develop skills specifically to explore the beliefs and views underlying an individual’s medication use. Such skills may need to be developed through specific training programmes at both undergraduate and postgraduate level.

Extension of general practice training from three to four years: experiences of a vocational training programme in Southern Ireland

The aim of this study was to evaluate the experiences of trainees taking part in an extended (four-year) general practice training programme introduced in the South Eastern region of the Republic of Ireland to replace the previous traditional (three-year) programme. In a qualitative design, eight homogeneous focus groups were held to determine the value of the additional year of training. The first cohort of trainees was interviewed towards the start and at the end of their fourth year. Trainees finishing the following year were also interviewed, as were graduates from the final three-year programme. GP trainers and the four members of the programme directing team comprised two further independent focus groups. Trainees reported that the integration of hospital posts and general practice attachments over the four years was particularly beneficial. The exposure to a variety of different general practices and the opportunity to take part in specialty clinics were considered extremely useful. The fourth year of training was felt to be less pressurised than previous years. Professional and personal development was enhanced; improved readiness to practise and confidence were noted. Perceived disadvantages of extended training included a lack of acknowledgment for doctors in their fourth year and excessive emphasis placed on research during the final year of training. The addition of an extra year of vocational training improves professional and personal development and changes the learning experience for doctors. Doctors felt more confident and ready to enter independent practice at the end of the fourth year of training.