A pre-clinical functional assessment of an acellular scaffold intended for the treatment of hard-to-heal wounds

Dermal wound healing is a biochemical and cellular process critical to life. While the majority of the population will only ever experience successful wound healing outcomes, some 1-3 % of those aged over 65 years will experience wound healing delay or perpetuation. These hard-to-heal wounds are comprised of degraded and dysfunctional extracellular matrix, yet the integrity of this structure is critical in the processes of normal wound healing. As such, extracellular matrix replacements have been devised that can replace dysfunctional extracellular matrix in hard-to-heal wounds with the aim of restoring normal wound healing processes. Here we evaluated a novel synthetic matrix protein for its ability to act as an acellular scaffold that can replace dysfunctional extracellular matrix. In this regard the synthetic protein demonstrated an ability to rapidly adsorb to the dermal surface, permit cell attachment and facilitate the cellular functions essential to wound healing. When applied to deep partial thickness wounds in a porcine animal model the matrix protein also demonstrated the ability to reduce wound duration. These data provide evidence that the synthetic matrix protein has the ability to function as an acellular scaffold for wound healing purposes.

Effectiveness of an acellular synthetic matrix in the treatment of hard-to-heal leg ulcers

Hard-to-heal leg ulcers are a major cause of morbidity in the elderly population. Despite improvements in wound care, some wounds will not heal and they present a significant challenge for patients and health care providers. A multi-centre cohort study was conducted to evaluate the effectiveness and safety of a synthetic, extracellular matrix protein as an adjunct to standard care in the treatment of hard-to-heal venous or mixed leg ulcers. Primary effectiveness criteria were (i) reduction in wound size evaluated by percentage change in wound area and (ii) healing assessed by number of patients healed by end of the 12 week study. Pain reduction was assessed as a secondary effectiveness criteria using VAS. A total of 45 patients completed the study and no difference was observed between cohorts for treatment frequency. Healing was achieved in 35·6% and wound size decreased in 93·3% of patients. Median wound area percentage reduction was 70·8%. Over 50% of patients reported pain on first visit and 87·0% of these reported no pain at the end of the study. Median time to first reporting of no pain was 14 days after treatment initiation. The authors consider the extracellular synthetic matrix protein an effective and safe adjunct to standard care in the treatment of hard-to-heal leg ulcers.

Molecular profiling of exudate from chronic ulcerated wounds

Non-healing wounds represent a significant burden to healthcare systems and societies worldwide. Current best practice treatments of chronic wounds can require patients to undergo extensive periods of therapy without any positive outcome. This consumes substantial healthcare resources and severely impacts patient quality of life. At present, there are no measures to predict a patient's response to best practice care. The hypothesis of this thesis was that biochemical markers could be found within the wound fluid of chronic ulcers and these markers could predict the healing outcome of an ulcer undergoing best practice care. Discovery phase proteomic and mass spectrometry techniques were utilised to determine novel proteins that correlated with the healing outcome of ulcers. These candidate biomarkers could be developed into simple dip-stick tools for use in clinical practice. This would aid clinicians in the choice of effective wound management strategies to address hard-to-heal wounds.

PROVIDING OPTIMUM WOUND HEALING CONDITIONS DURING THE PROLIFERATIVE STAGE USING KERRAFIBRE

Abstract : In order to analyze the role of a new structured fibrous dressing in the proliferative stage of chronic wound healing in hard to heal wounds, a case study was performed on a stagnant venous ulcer, which remained non-healed in the past 7 months. All chronicity factors that could affect wound healing were excluded, including biofilm (with the use of polihexanide+betaine, Prontosan range), and compression therapy was provided. The results were very interesting with healing achieved in 7 weeks of treatment. Most of times it is not easy to find/select a dressing to promote granulation and epithelisation, once ideal cleaning/debridement and bioburden control are achieved. Some dressings do not provide a good healing rate, lead to bioburden elevation during time and recurrence in the use of antimicrobials. Other options to promote proliferation are very expensive and need a secondary dressing. Treatment with kerrafibre showned to be very cost effective. Its is also implicit the important role of advanced wound care centers versus conventional care.This case study was originally presented as a poster at Wounds UK 2014 Conference, at Harrogate, England, United Kingdom.

A three species model to simulate application of hyperbaric oxygen therapy to chronic wounds

Chronic wounds are a significant socioeconomic problem for governments worldwide. Approximately 15% of people who suffer from diabetes will experience a lower-limb ulcer at some stage of their lives, and 24% of these wounds will ultimately result in amputation of the lower limb. Hyperbaric Oxygen Therapy (HBOT) has been shown to aid the healing of chronic wounds; however, the causal reasons for the improved healing remain unclear and hence current HBOT protocols remain empirical. Here we develop a three-species mathematical model of wound healing that is used to simulate the application of hyperbaric oxygen therapy in the treatment of wounds. Based on our modelling, we predict that intermittent HBOT will assist chronic wound healing while normobaric oxygen is ineffective in treating such wounds. Furthermore, treatment should continue until healing is complete, and HBOT will not stimulate healing under all circumstances, leading us to conclude that finding the right protocol for an individual patient is crucial if HBOT is to be effective. We provide constraints that depend on the model parameters for the range of HBOT protocols that will stimulate healing. More specifically, we predict that patients with a poor arterial supply of oxygen, high consumption of oxygen by the wound tissue, chronically hypoxic wounds, and/or a dysfunctional endothelial cell response to oxygen are at risk of nonresponsiveness to HBOT. The work of this paper can, in some way, highlight which patients are most likely to respond well to HBOT (for example, those with a good arterial supply), and thus has the potential to assist in improving both the success rate and hence the costeffectiveness of this therapy.

Addressing quality teaching in hard to staff settings : the Exceptional Teachers for Disadvantaged Schools Project

This Exceptional Teachers for Disadvantaged Schools (ETDS) project sets out to design a new model of Australian teacher education responding to recent demands for quality education in low SES and disadvantaged schools. The project moves teacher education from the ‘missionary’ (Larabee, 2010) or deficit (Comber and Kamler 2004; Flessa, 2007) approaches, towards a focus on notions of quality and academic excellence. Rice (2008, p.1) argues for a need to place more of the “very best teachers into the most challenging schools”, yet the problem is not merely one of training more teachers, for disadvantaged schools already receive disproportionate numbers of beginning teachers (Connell, 1994; Vickers & Ferfolja, 2006). Rather, Grossman and Loeb (2010, p. 245) argue the problem centers on the common practice of “[p]lacing the least experienced teachers with the most needy students”. This paper reports on the first year trial of the project. The ETDS project is at present, the only mainstream Australian teacher education model that targets cohorts of academically high achieving pre-service teachers with the overt aim of preparing graduates of the program to teach in disadvantaged schools. At the end of its first year, the ETDS program graduated 20 new teachers, each of whom had over the previous 18 months engaged with a specialized curriculum and carefully monitored/scaffolded practicum placements in disadvantaged schools around Brisbane, Australia.

Hanging out is hard to do : Methodology in non-avatar environments

Ethnography is now a well-established research methodology for virtual environments, and the vast majority of accounts have one aspect in common, whether textual or graphic environments – that of the embodied avatar. In this article, I first discuss the applicability of such a methodology to non-avatar environments such as Eve Online, considering where the methodology works and the issues that arise in its implementation – particularly for the consideration of sub-communities within the virtual environment. Second, I consider what alternative means exist for getting at the information that is obtained through an ethnographic study of the virtual environment. To that end, I consider the practical and ethical implications of utilizing existing accounts, the importance of the meta-game discourse, including those sources outside of the control of the environment developer, and finally the utility in combining personal observations with accounts of other ethnographers, both within and between environments.

Drugs, labels and (p)ill-fitting boxes : ADHD and children who are hard to teach

In offering a critical review of the problem we call “ADHD” this paper progresses in three stages. The first two parts juxtapose the dominant voices emanating from the literature in medicine and psychology, highlighting some interdependency between these otherwise competing interest groups. In part three, the nature of the relationship between these groups and the institution of the school is considered, as is the role that the school may play in the psycho-pathologisation of fidgety, distractible, active children who prove hard to teach. In so doing, the author provides an insight as to why the problem we call “ADHD” has achieved celebrity status in Australia and what the effects of that may be for children who come to be described in these ways.

Beef production and the environment : is it really 'hard to be green when you are in the red'?

The statement. 'it is hard to be green when you are in the red' is commonly used by primary producers to explain the necessity of placing a greater emphasis on financial survival rather than longer term environmental sustainability. The subject of environmental sustainability on pastoral properties was explored during face-to:face interviews with cattle grazers in the Fitzroy Basin area of Central Queensland. Findings from the study suggest that while economic factors are important, they are not the only determinant in whether a landholder priorities environmental sustainability, Rather. social factors such as knowledge claims. beliefs, attitudes. values, peer pressure and social sanctioning, constructed and enacted within the productivist paradigm of primary production. play a crucial role in how landholders manage their natural assets. This suggests that the edict that 'It is hard to be green when you are in the red' is inaccurate and does not explain why conservation-focused pastoral management is not yet occurring on a large scale.

How the royal commission can help Toowoomba to heal — again

In 2008 Toowoomba was rocked by a second paedophilia scandal in seven years. Local journalist Amanda Gearing says, maybe this time, the royal commission can help put the city back together.

Truckies and workplace health promotion: Targeting a hard-to-reach group

- Introduction Research identifies truck drivers as being at high risk of chronic disease. For most truck drivers their workplace is their vehicle. Truck drivers’ health is impacted by the limitations of this unique working environment, including reduced opportunities for physical activity and the intake of healthy foods. Workplaces are widely recognised as effective platforms for health promotion. However, the effectiveness of traditional and contemporary health promotion interventions in truck drivers’ novel workplace is unknown. - Methods This project worked with six transport industry workplaces in Queensland, Australia over a two-year period. Researchers used Participatory Action Research (PAR) processes to engage truck drivers and workplace managers in the implementation and evaluation of six workplace health promotion interventions. These interventions were designed to support truck drivers to increase their physical activity and access to healthy foods at work. They included traditional health promotion interventions such as a free fruit initiative, a ten thousand steps challenge, personal health messages and workplace posters, and a contemporary social media intervention. Participants were engaged via focus groups, interviews and mixed-methods surveys. - Results The project achieved positive changes in truck drivers’ health knowledge and health behaviours, particularly related to nutrition. There were positive changes in truck drivers’ self-reported health rating, body mass index (BMI) and readiness to make health-related lifestyle changes. There were also positive changes in truck drivers reporting their workplace as a key source of health information. These changes were underpinned by a positive shift in the culture of participating workplaces. Truck drivers’ perceptions of their workplace valuing, encouraging, modelling and facilitating healthy nutrition and physical activity behaviours improved. PAR processes enabled researchers to develop relationships with workplace managers, contextualise interventions and deliver rigorous outcomes. Despite the novelty of truck drivers’ mobile workplace, traditional health promotion interventions were more effective than contemporary ones. - Conclusion In this workplace health promotion project targeting a ‘hard-to-reach’ group of truck drivers, a combination of well-designed traditional workplace interventions and the PAR process resulted in positive health outcomes.

Truckies and health promotion: A “hard-to-reach” group without a “proper” workplace.

This literature review was undertaken to inform a settings based health promotion research project, conducted by a public health research team at the Queensland University of Technology (QUT). The aim of this project is to identify how transport workplaces can support their truck drivers to access healthy food options and increase physical activity. Truck drivers in Australia are at increased risk of numerous chronic diseases, in part due to the restrictions placed upon them by the environment in which they work. Barriers to good health through adequate nutrition and physical activity are the result of a complex interaction between government regulations, corporate policies, the built environment and individual factors. Few interventions target this population in a meaningful and sustainable way, though evidence exists for interventions which can be translated into truck drivers working environment.

The Economics of "Why is it so hard to save a threatened Language?"

We study the language choice behavior of bilingual speakers in modern societies, such as the Basque Country, Ireland andWales. These countries have two o cial languages:A, spoken by all, and B, spoken by a minority. We think of the bilinguals in those societies as a population playing repeatedly a Bayesian game in which, they must choose strategically the language, A or B, that might be used in the interaction. The choice has to be made under imperfect information about the linguistic type of the interlocutors. We take the Nash equilibrium of the language use game as a model for real life language choice behavior. It is shown that the predictions made with this model t very well the data about the actual use, contained in the censuses, of Basque, Irish and Welsh languages. Then the question posed by Fishman (2001),which appears in the title, is answered as follows: it is hard, mainly, because bilingual speakers have reached an equilibrium which is evolutionary stable. This means that to solve fast and in a re ex manner their frequent language coordination problem, bilinguals have developed linguistic conventions based chie y on the strategy 'Use the same language as your interlocutor', which weakens the actual use of B.1