University of the Sunshine Coast
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Early mobilisation of ventilated patients in the intensive care unit: A survey of critical care clinicians in an Australian tertiary hospital
No full textIntroduction: Mobilising mechanically ventilated patients is safe and beneficial and improves outcomes. However, early mobilisation is not widely practiced and barriers to its implementation still exist. Objective: The objective of this study was to assess clinician perceptions, knowledge, attitudes, and behaviours towards mobilising critically ill ventilated patients in the intensive care unit, as well as perceived barriers and facilitators towards mobilisation. Methods: A prospective questionnaire based on three existing questionnaires was administered to nurses, physicians, and physiotherapists from a single mixed medical/surgical intensive care unit in an Australian tertiary hospital. The 32-item questionnaire focused on knowledge, attitudes, behaviour, and perceived facilitators and barriers. Various response options were used, and data were analysed using descriptive statistics. Results: The overall response rate was 56.6% (82 of 145). Overall, clinicians' knowledge score was 4.1 (standard deviation = 1.4) out of a possible score of 6. Early mobilisation was not perceived as a top priority by 40.2% of participants. One important facilitator was that majority of the participants perceived early mobilisation was important. The most common perceived barriers to early mobilisation were medical instability, delirium, sedation, and limited staffing. Clinicians’ opinions varied on the timing and appropriateness for instituting early mobilisation. Conclusions: Clinicians had various levels of knowledge on early mobilisation as a therapy for critically ill patients. Most clinicians believed that early mobility was important and were willing to reduce sedation; however, several key barriers were identified which need to be addressed by using targeted interventions. This will reduce or close the gap between knowledge and practice
Pathways to Child Sexual Offending: Applying Ward and Siegert's Pathways Model on Offenders Convicted of Penetrative Offenses on Children
No full textAlthough research supports Ward and Siegert’s Pathways Model to child sexual offending, few studies have empirically validated it. The current study aimed to explore the applicability of the Pathways Model on offenders convicted of penetrative offenses on children. All available sentencing remarks across a 10-year period in one jurisdiction of Australia were analyzed (58 offenders). A multi-methods approach was used. Regarding descriptives, most offenders were male, late thirties, single, employed, completed grade 10, had previous sexual convictions, an extrafamilial relationship with the victim, pleaded guilty, and received a custodial sentence. Most victims were female, with an average age of 11. While the deductive thematic analysis captured Ward and Siegert’s Pathways, sub-groups emerged within the emotional dysregulation pathway: impulsivity, sexualized coping, and mental health. These findings are valuable for researchers and practitioners, with implications for tailored treatment and prevention due to enhanced understanding on the motives for child sexual offending
Transformative Learning: Developing Agency, Independence and Promoting a Strong Sense of Self in Teen Mothers
No full textAdolescents who become pregnant during their secondary education experience a range of challenges that intersect and limit their opportunities to complete schooling and take up university places. One approach to addressing this issue at an Australian regional university is through the Tertiary Preparation Pathway (TPP) which has been delivered within the Supporting Teenagers with Education, Mothering, and Mentoring (STEMM) program, since 2008. The STEMM program offers teen mothers an opportunity to continue or re-engage with education during and beyond pregnancy. Adopting an intersectionality lens, interviews with adolescent mothers identified three key elements underpinning the success of the TPP/STEMM program: recognising the educational aspirations of teen mothers, developing agency and independence and promoting a strong sense of self. This article aims to provide practical implications for educators wishing to establish or develop programs based on this transformative teaching
Ecological outcomes of agroforests and restoration 15 years after planting
No full textLarge‐scale forest restoration relies on approaches that are cost‐effective and economically attractive to farmers, and in this context agroforestry systems may be a valuable option. Here, we compared ecological outcomes among (1) 12–15 year old coffee agroforests established with several native shade trees, (2) 12–15 year old high‐diversity restoration plantations, and (3) reference, old‐growth forests, within a landscape restoration project in the Pontal do Paranapanema region, in the Atlantic Forest of southeastern Brazil. We compared the aboveground biomass, canopy cover, and abundance, richness and composition of trees, and the regenerating saplings in the three forest types. In addition, we investigated the landscape drivers of natural regeneration in the restoration plantations and coffee agroforests. Reference forests had a higher abundance of trees and regenerating saplings, but had similar levels of species richness compared to coffee agroforests. High‐diversity agroforests and restoration plantations did not differ in tree abundance. However, compared to restoration plantations agroforests showed higher abundance and species richness of regenerating saplings, a higher proportion of animal‐dispersed species, and higher canopy cover. The abundance of regenerating saplings declined with increasing density of coffee plants, thus indicating a potential trade‐off between productivity and ecological benefits. High‐diversity coffee agroforests provide a cost‐effective and ecologically viable alternative to high‐diversity native tree plantations for large‐scale forest restoration within agricultural landscapes managed by local communities, and should be included as part of the portfolio of reforestation options used to promote the global agenda on forest and landscape restoration
Health practitioner knowledge and confidence in diagnosis and treatment of mental health issues in people with intellectual disabilities
No full textBackground: There is limited Australian research investigating health practitioner knowledge and/or confidence in the diagnosis and treatment of mental health disorders in people with intellectual disabilities (IDs). Method: Ninety-three health practitioners from four professional groups (primary health practitioners, psychologists, mental health practitioners, and alternative therapies) completed a 34-item online survey comprising questions designed to identify participant knowledge of disorders described in the Psychiatric Assessment Schedule for Adults with Developmental Disabilities and the Therapy Confidence Scale-Intellectual Disabilities. Results: Participants demonstrated low knowledge of symptomology and were “moderately confident” to “confident” working with people with IDs. Whilst professional group showed a significant main effect on confidence levels, post-hoc analysis did not detect significant differences between the individual professional groups. Conclusions: Australian participants demonstrated confidence, but low knowledge, in treating individuals with IDs. The development of training to address deficits in practitioner knowledge of symptomology, assessment, and assessment-based communication is recommended
Effect of the material's stiffness on stress-shielding in osseointegrated implants for boneanchored prostheses: a numerical analysis and initial benchmark data
No full textPurpose: This study attempted to establish the link between design of implants for boneanchored prostheses and stress-shielding, affecting the stability of the bone-implant coupling using numerical approach. The objectives were to share a numerical model capable to evaluate the long-term stability of implants and to use this model to extract datasets showing how shape and material stiffness of threaded, press-fit and modular press-fit implants affect stress-shielding intensity. Methods: We considered three designs: threaded, press-fit and modular press-fit. The effect of shape and material stiffness of each design on stress-shielding intensity was assessed using Young's modulus (10 GPa to 210 GPa). Furthermore, the impact of the diameter of percutaneous part (10 mm to 18 mm) and thickness of medullar part (5 mm to 1 mm) was investigated for the modular press-fit implant. Results: The threaded design generated 4% more bone mass loss at the distal femur but an overall loss of bone mass 5% lower to press-fit design. The influence of Young's modulus on bone mass changes was noticeable for modular press-fit implant, depending on diameter of percutaneous or medullary part. A 20 GPa change of stiffness caused a bone mass change from 0.65% up to 2.45% and 0.07% up to 0.32% for percutaneous parts with 18 mm and 10 mm diameter, respectively. Conclusions: Results suggested that threaded implant provides greater stability despite an increased bone loss at the distal femur. Altogether, this work provided an initial model that could be applied in subsequent studies on the long-term stability of current and upcoming implants
Applying AcciMap to test the common cause hypothesis using aviation near misses
No full textThe common cause hypothesis, as applied here, proposes that similar networks of influencing factors may contribute to both adverse outcomes and near misses. This hypothesis has not been evaluated using a systems-thinking perspective. The aims of this study are to evaluate whether networks of contributory and protective factors exist within aviation serious near miss reports and to determine if the common cause hypothesis is applicable in this context. Sixteen incident reports from French civil aviation crash investigation bureau were analysed using the AcciMap method. Contributory and protective factors, and relationships between both were identified via coding of the reports. The results indicate that considering protective factors support a richer picture of incidents and provide support for the common cause hypothesis as measured by similar mean factor volume and sociotechnical levels for both contributory and protective factors. However, the findings also show the direction of relationships among protective and contributory factors may be indicative of a difference among adverse outcomes, near misses, and normal work. Future research should consider how a network of relationships may impact on the common contributory and protective factors found in near misses
A Synthesis of Sociotechnical Principles for System Design
No full textA set of Sociotechnical System (STS) Principles that aims to optimise both the social and the technical aspects of the work system have been derived from many STS design efforts and experiences. In particular, the sets of principles have been developed by Trist and Bamforth [35], Cherns [9, 10], Davis [14], Berniker [5], Clegg [11], Walker et al. [41], Read et al. [30] and Waterson and Eason [45]. The current paper reviewed and compared the aforementioned seventy years of mainstream sociotechnical principles for system design. The principles were identified from a systematic review, grouped by similarity, and synthesised into an updated set of principles for researchers and organisations to use and discuss. In the tradition of all previous sociotechnical principles, they seek to provide criteria for designing organisational structures, group work, work processes, design processes, technology and individual tasks. They are also used as criteria to evaluate a set of existing ergonomics methods. The fortunes of sociotechnical theory have ebbed and flowed over the past seventy years, but the value of sociotechnical principles has remained. They are now increasingly relevant to a host of distinctly 21st century problems, all of which share a common imperative to effectively integrate people and technology. A synthesis of existing sociotechnical principles is overdue
Different and diverse anaerobic microbiota were seen in women living with HIV with unsuppressed HIV viral load and in women with recurrent bacterial vaginosis: a cohort study
No full textObjective To compare the vaginal microbiota of women living with HIV (WLWH) with the vaginal microbiota of women with recurrent bacterial vaginosis (BV) and healthy women without HIV to determine if there are differences in the vaginal microbiome, what factors influence these differences, and to characterise HIV clinical parameters including viral load and CD4 count in relation to the vaginal microbiome. Design Observational cohort study. Setting Canada. Population Women aged 18–49 years who were premenopausal and not pregnant were recruited into three cohorts: healthy women, WLWH and women with recurrent BV. Methods Demographic and clinical data were collected via interviews and medical chart reviews. Vaginal swabs were collected for Gram-stain assessment and microbiome profiling using the cpn60 barcode sequence. Main outcome measures To compare overall community composition differences, we used compositional data analysis methods, hierarchical clustering and Kruskal–Wallis tests where appropriate. Results Clinical markers such as odour and abnormal discharge, but not irritation, were associated with higher microbial diversity. WLWH with unsuppressed HIV viral loads were more likely than other groups to have non-Gardnerella-dominated microbiomes. HIV was associated with higher vaginal microbial diversity and this was related to HIV viral load, with unsuppressed women demonstrating significantly higher relative abundance of Megasphaera genomosp. 1, Atopobium vaginae and Clostridiales sp. (all P < 0.05) compared with all other groups. Conclusions In WLWH, unsuppressed HIV viral loads were associated with a distinct dysbiotic profile consisting of very low levels of Lactobacillus and high levels of anaerobes
Key occupational stressors in the ED: An international comparison
No full textBackground: The ED Stressor Scale outlines 15 stressors that are of importance for ED staff. Limited research has identified how commonly such stressors occur, or whether such factors are perceived with similar importance across different hospitals. This study sought to examine the frequency or perceived severity of these 15 stressors using a multicentre cohort of emergency clinicians (nurses and physicians) in EDs in two countries (Australia and Sweden). Method: This was a cross-sectional survey of staff working in eight hospitals in Australia and Sweden. Data were collected between July 2016 and June 2017 (depending on local site approvals) via a printed survey incorporating the 15-item ED stressor scale. The median stress score for each item and the frequency of experiencing each event was reported. Results: Events causing most distress include heavy workload, death or sexual abuse of a child, inability to provide optimum care and workplace violence. Stressors reported most frequently include dealing with high acuity patients, heavy workload and crowding. Violence, workload, inability to provide optimal care, poor professional relations, poor professional development and dealing with high-acuity patients were reported more commonly by Australian staff. Swedish respondents reported more frequent exposure to mass casualty incidents, crisis management and administrative concerns. Conclusions: Workload, inability to provide optimal care, workplace violence and death or sexual abuse of a child were consistently reported as the most distressing events across sites. The frequency with which these occurred differed in Australia and Sweden, likely due to differences in the healthcare systems