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Factors influencing decision-making in postoperative pain management of older people: a critical ethnography
No full textAim: The aim of this critical ethnography was to examine decision-making among nurses, doctors and older patients regarding postoperative pain management. Method: A critical ethnography was used to examine the interactions between clinicians and patients for its utility in uncovering the influence these interactions had on decision-making. Habermas' Theory of Communicative Action was used to provide a framework to the analysis and dual process theory was used in this study as the decision-making model. Nurses (n=21) and doctors (n=8) working on a general surgical ward in a large tertiary referral hospital were recruited. Patients over the age of 65 (n=6) were also recruited. One hundred and nine hours of ethnographic observations were undertaken on the study ward of the interactions between clinicians and patients and forty-five hours of interview transcripts (eight hours and forty minutes with patients, thirteen hours and five minutes with medical staff and twenty-three hours and fifteen minutes with nursing staff) were analysed. Findings: Emergent themes from the data were analysed to provide a comprehensive understanding of the complex nature of decision-making in pain management. The findings revealed an inherent connection between communication and decision-making, and the communicative interactions between patients, nurses and doctors revealed the central theme of the thesis, decision-making is a social transaction linguistically mediated. The clinicians created and maintained a culture on the study ward, through their clinical practice and language, that acknowledged the subjective nature of pain, normalised the pain experience for patients within the postoperative environment and encouraged participation and collaboration with patients. The subjective quality of pain introduced uncertainty into the clinical environment and clinicians developed communication techniques to diminish the impact this uncertainty had on their decision-making. The agents of decision-making—patients, nurses and doctors—constructed an understanding of postoperative pain through language, communicating with one another in a process Habermas referred to as communicative interaction. This linguistically mediated meaning of pain influenced the participants’ expression of pain, assessment of pain and their decision-making. Conclusion: The social aspects of decision-making play a crucial role in pain management. Decision-making is a product of the environment in which it occurs; the patient and the clinician interacting within the greater setting of the acute surgical ward, the acute hospital and society. The subjective nature of pain was recognised by the participants who communicated with one another to either enhance or hinder decision-making
Biological, behavioural and life history traits associated with range expansion of common mynas (Acridotheres tristis) in Australia
No full textInvasive species have been recognized as the second major threat to biodiversity just following habitat destruction. Biotic invasions science over recent decades has invested substantial research efforts in identifying the factors (e.g., biologic, ecologic, behavioural, genetic) that help predict invasiveness ability in order to anticipate and prevent future invasions. A range of studies have examined the multiple stages in the invasion process from transport to invasion. However, to date, less attention has been given to an important step of the invasion process: spread. In order to enhance the scientific knowledge about invasive species and the patterns and drivers of spread, this thesis aimed to study the common (Indian) myna’s (Acridotheres tristis) ongoing invasion in Australia with emphasis on NSW and QLD. This case study offers an exceptional opportunity and natural experiment for studying individuals at different stages of the invasion process simultaneously and in real time. I took advantage of this setting to investigate for the first time the potential differences in both morphological and behavioural traits in long-established (>40 years; also termed source) vs recently-established (<10 years; front) common myna populations (Chapters 1 and 2). Furthermore, I studied the interactions of common mynas with native avian species around nesting resources. I focused on interactions with an important cavity-nesting competitor, the eastern rosella (Platycercus eximius), and a non-cavity nesting, but highly aggressive, despotic and territorial native honeyeater, the noisy miner (Manorina melanocephala) (Chapters 3 and 4). In my final chapter, I undertook a large-scale analysis of common myna abundance and breeding success as a function of habitat and invasion stage across two Australian states (Queensland and New South Wales). I found differences in morphological, physiological and behavioural traits of common mynas at different invasion stages and across regions. On the front of the invasion, common mynas exhibited longer beaks, better health and a higher level of neophobia. My study of the native vs. invasive bird species revealed that contrary to common believe, common mynas in NSW did not display substantial aggression towards native parrots. In contrast, the native noisy miner exhibited high levels of aggressiveness towards common mynas. Moreover, I discovered that mynas in NSW were more abundant in urban areas than in suburban areas, whereas in QLD, mynas were equally abundant across the two environments. Finally, I found evidence that common mynas first colonise urban habitats during their range expansion. Using my thesis findings, I propose a model whereby common mynas are expanding their distribution across Eastern NSW by moving out of the urban core of coastal cities, while also by moving away from the highly urbanized NSW coastal strip towards more rural, smaller, inland townships. I propose that movement may be underpinned by a mechanism of spatial sorting by individual variation in habitat preferences, which allows mynas to spread across a spatially heterogeneous environments. This is likely be facilitated by diet preferences for natural foods, high neophobia and aggression from a despotic native bird, the noisy miner. Overall, key differences were found between source and front populations along the invasion gradient in behavioural and morphological traits, suggesting that introduced species can provide an excellent case study for examining dynamic invasion processes in real time
Effects of education and income on cardiovascular outcomes: a systematic review and meta-analysis
No full textObjective: Previous studies have reported discrepancy effects of education and income on cardiovascular diseases. This systematic review and meta-analysis was therefore conducted which aimed to summarize effects of education and income on cardiovascular diseases. Methods: Studies were identified from Medline and Scopus until July 2016. Cohorts were eligible if they assessed associations between education/income and cardiovascular diseases, had at least one outcome including coronary artery diseases, cardiovascular events, strokes and cardiovascular deaths. A multivariate meta-analysis was applied to pool risk effects of these social determinants. Results: Among 72 included cohorts, 39, 19, and 14 were studied in Europe, USA, and Asia. Pooled risk ratios of low and medium versus high education were 1.36 (95% confidence interval: 1.11-1.66) and 1.21 (1.06-1.40) for coronary artery diseases, 1.50 (1.17-1.92) and 1.27 (1.09-1.48) for cardiovascular events, 1.23 (1.06-1.43) and 1.17 (1.01-1.35) for strokes, and 1.39 (1.26-1.54) and 1.21 (1.12-1.30) for cardiovascular deaths. The effects of education on all cardiovascular diseases were still present in US and Europe settings, except in Asia this was present only for cardiovascular deaths. Effects of low and medium income versus high on these corresponding cardiovascular diseases were 1.49 (1.16-1.91) and 1.27 (1.10-1.47) for coronary artery diseases, 1.17 (0.96-1.44) and 1.05 (0.98-1.13) for cardiovascular events, 1.30 (0.99-1.72) and 1.24 (1.00-1.53) for strokes, and 1.76 (1.45-2.14) and 1.34 (1.17-1.54) for cardiovascular deaths. Conclusion: Social determinants are risk factors of cardiovascular diseases in developed countries, although high heterogeneity in pooling. Data in Asia countries are still needed to update pooling
An exploration of factors associated with student attrition and success in enabling programs
No full textUniversity-based enabling programs (EPs) provide a tertiary pathway for up to twenty percent of undergraduate enrolments at Australian universities. Attrition from these programs and the resulting costs to students, universities and society at large is an important issue deserving research attention. This research project aimed to investigate the factors that impacted the attrition of students from EPs and compared their experience with those students who successfully completed an EP. The study used a qualitative methodology involving individual participant interviews with students who participated in EPs at the University of Newcastle, NSW, Australia. The qualitative interviews supported existing research into the complexity of student attrition. The dominant themes emerging from the data broadly reflected the four factors identified in the existing literature; time pressures, personal circumstances, use of support services and level of student engagement. The use of qualitative interviews provided insight into the operation of these factors and assisted in developing pragmatic actions that could be taken to reduce attrition. The paper concludes that any attempts to reduce attrition in EPs must focus on developing more personal interventions with students as early as possible, aimed at addressing time management, providing more flexible study options, facilitating evening and mature age support and addressing self confidence. These implications lend further understanding to the reasons behind attrition and retention in EPs
Parent, partner, co-parent or partnership? The need for clarity as family systems thinking takes hold in the quest to motivate behavioural change
No full textResearch is increasingly pointing to the importance of extending the focus of childhood obesity intervention to include fathers, fathering figures, and other members of a child’s primary parenting network. Advances in communication technology are now making it possible to achieve this aim, within current resources, using modalities such text messaging, web-based resources and apps that extend intervention to parents not in attendance at face to face interactions. However, published research is often unclear as to which parent/s they targeted or engaged with, whether interventions planned to influence behaviours and capabilities across family systems, and how this can be achieved. As childhood obesity research employing information technology to engage with family systems takes hold it is becoming important for researchers clearly describe who they engage with, what they hope to achieve with them, and the pathways of influence that they aim to activate. This paper integrates extant knowledge on family systems thinking, parenting efficacy, co-parenting, and family intervention with the way parents are represented and reported in childhood obesity research. The paper concludes with recommendations on terminology that can be used to describe parents and parenting figures in future studies
Polymer solvation in choline chloride deep eutectic solvents modulated by the hydrogen bond donor
No full textCholine chloride (ChCl) Deep Eutectic Solvents (DESs) are a relatively new class of ionic fluid physicochemically similar to ionic liquids. Their properties, combined with their hydrogen bond - rich bulk nanostructures make them attractive alternatives as molecular solvents for a range of applications. Nevertheless, the solvation structure of molecular and polymer solvents in choline chloride DES remains largely uncharacterised due to the complexity of the DES nanostructure itself. We present a systematic quantum chemical investigation of the solvation structure of poly(ethylene glycol) (PEO) in DES formed by ChCl and urea, ethylene glycol and glycerol hydrogen bond donors. Trends in the solvation structure of PEO correlate with the density of the DES hydrogen bond network, and the extent to which this network can be perturbed by the polymer solute. We show that both of these factors are modulated by the type of hydrogen bond donor itself. Notably, PEO disrupts the urea – choline hydrogen bond network. This disruption leads to a more highly structured solvation environment for the polymer, which is forced into a relatively constrained, coiled morphology. By contrast, the disruption to the hydrogen bond networks in the ethylene glycol and glycerol DES are less significant, leading to a less constrained environment
Lawyer approaches to court-connected mediation: a new case study
No full textThis thesis examines the attitudes and behaviours of lawyers in response to court-connected mediation. Lawyers, as the first point of contact for legal services consumers finding themselves in conflict, are said to operate as "gate-keepers" or decision makers in determining the most appropriate response to their clients' needs. Failure to recognize the benefits of mediation can result in lost opportunities for more sensible, more durable and less expensive dispute resolution options. This qualitative study found that, whilst lawyers are generally amenable to mediation, their use of it is circumscribed by a poor understanding of the processes and entrenched legal professional culture. Despite the development of court-connected mediation in NSW over the part thirty years, there remains a reluctance on the part of lawyers to embrace it fully as a viable dispute resolution option. This reluctance, grounded in a cultural and educational context of adversarial legalism, results in resort to competitive and positional bargaining behaviours which are more in keeping with the process driven framework of the traditional justice system. Lawyers were reluctant to encourage or even permit disputant participation in the mediation narrative and there is uncertainty around the limits of mediation confidentiality. There was also a reluctance by lawyers to permit non-legal material to be introduced to the mediation narrative which in turn limits the opportunities of the disputants to understand other parties' interests, acknowledge their own contribution to the dispute and to reach consensus about positive solutions. The thesis also considers the legal education framework in the context of better understanding how lawyers' views about mediation are shaped and formed. It concludes that the 2016 reforms to the Civil Procedure element of the core subjects for study by law students are inadequate to prepare lawyers for practice in the twenty first century and that a disproportionate level of attention is still being directed to the role of adjudicatory determination of disputes. The thesis recommends further research into the role of the courts in referring cases to mediation and clarification of the laws relating to confidentiality and admissibility in respect of court-connected mediation
A lanthanide-based magnetic nanosensor as an erasable and visible platform for multi-color point-of-care detection of multiple targets and the potential application by smartphone
No full textThe sensitive, selective and point-of-care detection of dipicolinic acid (DPA) is of great significance for the prevention of the anthrax virus and the containment of bioterrorism. In this work, a multi-color fluorescent nanoprobe composed of lanthanides and magnetic nanoparticles (Fe3O4@CePO4:Tb-EDTA-Eu) has been designed, in which the portion of Fe3O4@CePO4:Tb can be used as the internal stable signal of green fluorescence, while the EDTA-Eu part can be used as the sensitive reaction signal for monitoring DPA. Upon the addition of DPA, the red fluorescence of Eu3+ ions is significantly enhanced, while the fluorescent color of the nanoprobes can change from green to red (such as yellow-green, orange-yellow and orange-red), achieving visual multi-color fluorescent detection even by the naked eye. By using the magnetic separation method, the composites can be easily purified for point-of-care testing. More importantly, the nanoprobe fixed test pieces enable real-time analysis of DPA by using an easy-to-access color-scanning application on a smartphone. Furthermore, the fluorescence intensity can be quenched by the addition of Cu2+, which leads to a rewritable nanosensor and can be used in the detection of cysteine (Cys) with high sensitivity. With the addition of Cys, this erasable nano detection platform can also display the original multi-color visual point-of-care detection. With further optimization, this new type of multi-color fluorescent assay is promising in point-of-care clinics for multi-target diagnostics
Evaluation of hyperacute infarct volume using ASPECTS and brain CT perfusion core volume
No full textObjective: To compare the accuracy of Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and CT perfusion to detect established infarction in acute anterior circulation stroke. Methods: We performed an observational study in 59 acute anterior circulation ischemic stroke patients who underwent brain noncontrast CT, CT perfusion, and MRI within 100 minutes from CT imaging. ASPECTS scores were calculated by 4 blinded vascular neurologists. The accuracy of ASPECTS and CT perfusion core volume to detect an acute MRI diffusion lesion of ≥70 mL was evaluated using receiver operating characteristics analysis and optimum cutoff values were calculated using Youden J. Results: Median ASPECTS score was 8 (interquartile range [IQR] 5-9). Median CT perfusion core volume was 22 mL (IQR 10.4-71.9). Median MRI diffusion lesion volume was 24.5 mL (IQR 10-63.9). No significant difference was found between the accuracy of CT perfusion and ASPECTS (c statistic 0.95 vs 0.87, p value for difference = 0.17). The optimum ASPECTS cutoff score to detect a diffusion-weighted imaging lesion ≥70 mL was < 7 (sensitivity 0.74, specificity 0.86, Youden J = 0.60) and the optimum CT perfusion core volume cutoff was ≥50 mL (sensitivity 0.86, specificity 0.97, Youden J = 0.84). The CT perfusion core lesion covered a median of 100% (IQR 86%-100%) of the acute MRI lesion volume (Pearson R = 0.88; R² = 0.77). Conclusions: We found no significant difference between the accuracy of CT perfusion and ASPECTS to predict hyperacute MRI lesion volume in ischemic stroke
Numeracy across the curriculum: a pathway to critical thinking
No full textThis writing seeks to identify and explore the ways in which mathematical competencies, skills and conceptual understandings underpin all the discipline areas across the mainstream primary school curriculum as numeracy competencies. It considers how these numeracy capacities can be investigated and acknowledged in each of the major areas of disciplinary study and how these foundational, embedded numeracy components can facilitate the development of critical thinking skills that are subject dominated but generic in nature. A framework is presented to illustrate the ways in which sound logic and the development of skills in various types of reasoning supports the intuitive compulsion of students to investigate diverse perspectives, assess these in relation to problem solving and decision making and evaluate their subsequent proposals in a critical manner. In this way, opportunities are provided in diverse contexts for the development of two essential skills for 21st century success: numeracy competencies and critical thinking skills