Showing papers by "La Trobe University published in 2010"

Interventions for preventing falls in older people in nursing care facilities and hospitals

Abstract: Background Falls in nursing care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. Objectives To assess the effectiveness of interventions designed to reduce falls by older people in nursing care facilities and hospitals. Search methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2009); the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 2); MEDLINE, EMBASE, and CINAHL (all to November 2008); trial registers and reference lists of articles. Selection criteria Randomised controlled trials of interventions to reduce falls in older people in nursing care facilities or hospitals. Primary outcomes were rate of falls and risk of falling. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Data were pooled where appropriate. Main results We included 41 trials (25,422 participants). In nursing care facilities, the results from seven trials testing supervised exercise interventions were inconsistent. This was the case too for multifactorial interventions, which overall did not significantly reduce the rate of falls (rate ratio (RaR) 0.82, 95% CI 0.62 to 1.08; 7 trials, 2997 participants) or risk of falling (risk ratio (RR) 0.93, 95% CI 0.86 to 1.01; 8 trials, 3271 participants). A post hoc subgroup analysis, however, indicated that where provided by a multidisciplinary team, multifactorial interventions reduced the rate of falls (RaR 0.60, 95% CI 0.51 to 0.72; 4 trials, 1651 participants) and risk of falling (RR 0.85, 95% CI 0.77 to 0.95; 5 trials, 1925 participants). Vitamin D supplementation reduced the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; 4 trials, 4512 participants), but not risk of falling (RR 0.98, 95% CI 0.89 to 1.09; 5 trials, 5095 participants). In hospitals, multifactorial interventions reduced the rate of falls (RaR 0.69, 95% CI 0.49 to 0.96; 4 trials, 6478 participants) and risk of falling (RR 0.73, 95% CI 0.56 to 0.96; 3 trials, 4824 participants). Supervised exercise interventions showed a significant reduction in risk of falling (RR 0.44, 95% CI 0.20 to 0.97; 3 trials, 131 participants). Authors' conclusions There is evidence that multifactorial interventions reduce falls and risk of falling in hospitals and may do so in nursing care facilities. Vitamin D supplementation is effective in reducing the rate of falls in nursing care facilities. Exercise in subacute hospital settings appears effective but its effectiveness in nursing care facilities remains uncertain.

Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs

Abstract: Background Clinical pathways are structured multidisciplinary care plans used by health services to detail essential steps in the care of patients with a specific clinical problem. They aim to link evidence to practice and optimise clinical outcomes whilst maximising clinical efficiency. Objectives To assess the effect of clinical pathways on professional practice, patient outcomes, length of stay and hospital costs. Search methods We searched the Database of Abstracts of Reviews of Effectiveness (DARE), the Effective Practice and Organisation of Care (EPOC) Register, the Cochrane Central Register of Controlled Trials (CENTRAL) and bibliographic databases including MEDLINE, EMBASE, CINAHL, NHS EED and Global Health. We also searched the reference lists of relevant articles and contacted relevant professional organisations. Selection criteria Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series studies comparing stand alone clinical pathways with usual care as well as clinical pathways as part of a multifaceted intervention with usual care. Data collection and analysis Two review authors independently screened all titles to assess eligibility and methodological quality. Studies were grouped into those comparing clinical pathways with usual care and those comparing clinical pathways as part of a multifaceted intervention with usual care. Main results Twenty-seven studies involving 11,398 participants met the eligibility and study quality criteria for inclusion. Twenty studies compared stand alone clinical pathways with usual care. These studies indicated a reduction in in-hospital complications (odds ratio (OR) 0.58; 95% confidence interval (CI) 0.36 to 0.94) and improved documentation (OR 11.95: 95%CI 4.72 to 30.30). There was no evidence of differences in readmission to hospital or in-hospital mortality. Length of stay was the most commonly employed outcome measure with most studies reporting significant reductions. A decrease in hospital costs/ charges was also observed, ranging from WMD +261 US$ favouring usual care to WMD -4919 US$ favouring clinical pathways (in US$ dollar standardized to the year 2000). Considerable heterogeneity prevented meta-analysis of length of stay and hospital cost results. An assessment of whether lower hospital costs contributed to cost shifting to another health sector was not undertaken. Seven studies compared clinical pathways as part of a multifaceted intervention with usual care. No evidence of differences were found between intervention and control groups. Authors' conclusions Clinical pathways are associated with reduced in-hospital complications and improved documentation without negatively impacting on length of stay and hospital costs.

Land-use intensification reduces functional redundancy and response diversity in plant communities

Abstract: Ecosystem resilience depends on functional redundancy (the number of species contributing similarly to an ecosystem function) and response diversity (how functionally similar species respond differently to disturbance). Here, we explore how land-use change impacts these attributes in plant communities, using data from 18 land-use intensity gradients that represent five biomes and > 2800 species. We identify functional groups using multivariate analysis of plant traits which influence ecosystem processes. Functional redundancy is calculated as the species richness within each group, and response diversity as the multivariate within-group dispersion in response trait space, using traits that influence responses to disturbances. Meta-analysis across all datasets showed that land-use intensification significantly reduced both functional redundancy and response diversity, although specific relationships varied considerably among the different land-use gradients. These results indicate that intensified management of ecosystems for resource extraction can increase their vulnerability to future disturbances.

Performing Qualitative Cross-Cultural Research

Abstract: Cross-cultural research is rife with ethical and methodological challenges but, despite the increased demand for such research, discussions on 'culturally sensitive methodologies' are still largely neglected. Consequently, researchers often find themselves faced with difficulties but lack information on how to deal with them. This text provides an in-depth discussion on how to perform qualitative research in cross-cultural contexts with an emphasis on a more ethical, sensible and responsible approach. Pranee Liamputtong suggests culturally sensitive and appropriate research methods that would work well with cultural groups. She offers thought-provoking perspectives and diverse cultural examples which will be of value to both novice and experienced cross-cultural researchers. Throughout the volume there are references to the excellent work of many cross-cultural researchers who have paved the way in different social and cultural settings.

What does species richness tell us about functional trait diversity? Predictions and evidence for responses of species and functional trait diversity to land-use change

Abstract: In the conservation literature on land-use change, it is often assumed that land-use intensification drives species loss, driving a loss of functional trait diversity and ecosystem function. Modern research, however, does not support this cascade of loss for all natural systems. In this paper we explore the errors in this assumption and present a conceptual model taking a more mechanistic approach to the species-functional trait association in a context of land-use change. We provide empirical support for our model's predictions demonstrating that the association of species and functional trait diversity follows various trajectories in response to land-use change. The central premise of our model is that land-use change impacts upon processes of community assembly, not species per se. From the model, it is clear that community context (i.e. type of disturbance, species pool size) will affect the response trajectory of the relationship between species and functional trait diversity in communities undergoing land-use change. The maintenance of ecosystem function and of species diversity in the face of increasing land-use change are complementary goals. The use of a more ecologically realistic model of responses of species and functional traits will improve our ability to make wise management decisions to achieve both aims in specific at-risk systems.

What is a clinical pathway? Development of a definition to inform the debate

Abstract: Background Clinical pathways are tools used to guide evidence-based healthcare that have been implemented internationally since the 1980s. However, there is widespread lack of agreement on the impact of clinical pathways on hospital resources and patient outcomes. This can be partially attributed to the confusion for both researchers and healthcare workers regarding what constitutes a clinical pathway. This paper describes efforts made by a team of Cochrane Review authors to develop criteria to assist in the objective identification of clinical pathway studies from the literature.

The endoplasmic reticulum provides the membrane platform for biogenesis of the flavivirus replication complex.

Abstract: The cytoplasmic replication of positive-sense RNA viruses is associated with a dramatic rearrangement of host cellular membranes. These virus-induced changes result in the induction of vesicular structures that envelop the virus replication complex (RC). In this study, we have extended our previous observations on the intracellular location of West Nile virus strain Kunjin virus (WNV(KUN)) to show that the virus-induced recruitment of host proteins and membrane appears to occur at a pre-Golgi step. To visualize the WNV(KUN) replication complex, we performed three-dimensional (3D) modeling on tomograms from WNV(KUN) replicon-transfected cells. These analyses have provided a 3D representation of the replication complex, revealing the open access of the replication complex with the cytoplasm and the fluidity of the complex to the rough endoplasmic reticulum. In addition, we provide data that indicate that a majority of the viral RNA species housed within the RC is in a double-stranded RNA (dsRNA) form.

Predicting language outcomes at 4 years of age: findings from Early Language in Victoria Study

Abstract: OBJECTIVE: To quantify the contributions of child, family, and environmental predictors to language ability at 4 years. METHODS: A longitudinal study was performed with a sample of 1910 infants recruited at 8 months in Melbourne, Australia. Predictors were child gender, prematurity, birth weight and order, multiple birth, socioeconomic status, maternal mental health, vocabulary, education, and age at child9s birth, non–English-speaking background, and family history of speech/language difficulties. Outcomes were Clinical Evaluation of Language Fundamentals-Preschool, language scores, low language status (scores >1.25 SDs below the mean), and specific language impairment (SLI) (scores >1.25 SDs below the mean for children with normal nonverbal performance). RESULTS: A total of 1596 children provided outcome data. Twelve baseline predictors explained 18.9% and 20.9% of the variation in receptive and expressive scores, respectively, increasing to 23.6% and 30.4% with the addition of late talking status at age 2. A total of 20.6% of children (324 of 1573 children) met the criteria for low language status and 17.2% (251 of 1462 children) for SLI. Family history of speech/language problems and low maternal education levels and socioeconomic status predicted adverse language outcomes. The combined predictors discriminated only moderately between children with and without low language levels or SLIs (area under the curve: 0.72–0.76); this improved with the addition of late talking status (area under the curve: 0.78–0.84). CONCLUSIONS: Measures of social disadvantage helped explain more variation in outcomes at 4 years than at 2 years, but ability to predict low language status and SLI status remained limited.

Longing to belong : social inclusion and wellbeing among youth with refugee backgrounds in the first three years in Melbourne, Australia

Abstract: For young people with refugee backgrounds, establishing a sense of belonging to their family and community, and to their country of resettlement is essential for wellbeing. This paper describes the psychosocial factors associated with subjective health and wellbeing outcomes among a cohort of 97 refugee youth (aged 11-19) during their first three years in Melbourne, Australia. The findings reported here are drawn from the Good Starts Study, a longitudinal investigation of settlement and wellbeing among refugee youth conducted between 2004 and 2008. The overall aim of Good Starts was to identify the psychosocial factors that assist youth with refugee backgrounds in making a good start in their new country. A particular focus was on key transitions: from pre-arrival to Australia, from the language school to mainstream school, and from mainstream school to higher education or to the workforce. Good Starts used a mix of both method and theory from anthropology and social epidemiology. Using standardized measures of wellbeing and generalised estimating equations to model the predictors of wellbeing over time, this paper reports that key factors strongly associated with wellbeing outcomes are those that can be described as indicators of belonging e the most important being subjective social status in the broader Australian community, perceived discrimination and bullying. We argue that settlement specific policies and programs can ultimately be effective if embedded within a broader socially inclusive society - one that offers real opportunities for youth with refugee backgrounds to flourish.

Molecular mechanisms of late apoptotic/necrotic cell clearance.

Abstract: Phagocytosis serves as one of the key processes involved in development, maintenance of tissue homeostasis, as well as in eliminating pathogens from an organism. Under normal physiological conditions, dying cells (e.g., apoptotic and necrotic cells) and pathogens (e.g., bacteria and fungi) are rapidly detected and removed by professional phagocytes such as macrophages and dendritic cells (DCs). In most cases, specific receptors and opsonins are used by phagocytes to recognize and bind their target cells, which can trigger the intracellular signalling events required for phagocytosis. Depending on the type of target cell, phagocytes may also release both immunomodulatory molecules and growth factors to orchestrate a subsequent immune response and wound healing process. In recent years, evidence is growing that opsonins and receptors involved in the removal of pathogens can also aid the disposal of dying cells at all stages of cell death, in particular plasma membrane-damaged cells such as late apoptotic and necrotic cells. This review provides an overview of the molecular mechanisms and the immunological outcomes of late apoptotic/necrotic cell removal and highlights the striking similarities between late apoptotic/necrotic cell and pathogen clearance.

Forensic trace DNA: a review

Abstract: DNA analysis is frequently used to acquire information from biological material to aid enquiries associated with criminal offences, disaster victim identification and missing persons investigations. As the relevance and value of DNA profiling to forensic investigations has increased, so too has the desire to generate this information from smaller amounts of DNA. Trace DNA samples may be defined as any sample which falls below recommended thresholds at any stage of the analysis, from sample detection through to profile interpretation, and can not be defined by a precise picogram amount. Here we review aspects associated with the collection, DNA extraction, amplification, profiling and interpretation of trace DNA samples. Contamination and transfer issues are also briefly discussed within the context of trace DNA analysis. Whilst several methodological changes have facilitated profiling from trace samples in recent years it is also clear that many opportunities exist for further improvements.

Reducing Overconfidence in the Interval Judgments of Experts.

Abstract: Elicitation of expert opinion is important for risk analysis when only limited data are available. Expert opinion is often elicited in the form of subjective confidence intervals; however, these are prone to substantial overconfidence. We investigated the influence of elicitation question format, in particular the number of steps in the elicitation procedure. In a 3-point elicitation procedure, an expert is asked for a lower limit, upper limit, and best guess, the two limits creating an interval of some assigned confidence level (e.g., 80%). In our 4-step interval elicitation procedure, experts were also asked for a realistic lower limit, upper limit, and best guess, but no confidence level was assigned; the fourth step was to rate their anticipated confidence in the interval produced. In our three studies, experts made interval predictions of rates of infectious diseases (Study 1, n = 21 and Study 2, n = 24: epidemiologists and public health experts), or marine invertebrate populations (Study 3, n = 34: ecologists and biologists). We combined the results from our studies using meta-analysis, which found average overconfidence of 11.9%, 95% CI [3.5, 20.3] (a hit rate of 68.1% for 80% intervals)-a substantial decrease in overconfidence compared with previous studies. Studies 2 and 3 suggest that the 4-step procedure is more likely to reduce overconfidence than the 3-point procedure (Cohen's d = 0.61, [0.04, 1.18]).

Meta‐Analysis of Homework Effects in Cognitive and Behavioral Therapy: A Replication and Extension

Abstract: [Clin Psychol Sci Prac 17: 144–156, 2010] Kazantzis, Deane, and Ronan (2000) estimated the effect size (ES) for homework’s causal effects on outcome, but did not (a) estimate ES for “control” therapy conditions, (b) incorporate data from correlational studies, or (c) test for outliers. The present analysis (46 studies, N = 1,072) replicated and extended Kazantzis and colleagues’ review and obtained a pre–posttreatment ES of d = 0.63 for control conditions, and a larger d = 1.08 for therapy conditions with homework. A pooled ES of d = 0.48 favoring homework was obtained when the analysis was restricted to controlled studies contrasting the same therapy. No evidence was found for outlier or publication bias effects. Results supported the conclusion that homework assignments enhance therapy outcomes.

Stock Return Predictability and the Adaptive Markets Hypothesis: Evidence from Century Long U.S. Data

Abstract: We study return predictability of the Dow Jones Industrial Average indices from 1900 to 2009. We find strong evidence that time-varying return predictability is driven by changing market conditions, consistent with the implications of the adaptive markets hypothesis. During market crashes, no return predictability is observed, but an extreme degree of uncertainty is associated with return predictability. During fundamental economic or political crises, stock returns have been highly predictable with a moderate degree of uncertainty. During economic bubbles, return predictability and its uncertainty have been smaller than normal times.

The Enigma of Lone Wolf Terrorism: An Assessment

Abstract: Lone wolf terrorism remains an ambiguous and enigmatic phenomenon. The boundaries of lone wolf terrorism are fuzzy and arbitrary. This article aims to define and analyze the main features and patterns of lone wolf terrorism in fifteen countries. Lone wolf terrorism is shown to be more prevalent in the United States than in the other countries under study. The cross-national analysis suggests that in the United States lone wolf terrorism has increased markedly during the past three decades; a similar increase does not appear to have occurred in the other countries under study. The numbers of casualties resulting from lone wolf terrorism have been relatively limited, and there is no evidence that the lethality of lone wolf terrorism is on the increase. The rates of psychological disturbance and social ineptitude are found to be relatively high among lone wolf terrorists. Lone wolf terrorists tend to create their own ideologies that combine personal frustrations and aversion with broader political, social, or religious aims. In this process, many lone wolf terrorists draw on the communities of belief and ideologies of validation generated and transmitted by extremist movements.

Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy (UPDATE)

Abstract: Background Cerebral palsy (CP) is a central nervous system deficit resulting from a non-progressive lesion in the developing brain. Although the brain lesions are static, the movement disorders that arise are not unchanging and are characterised by atypical muscle tone, posture and movement (Rang 1990). The spastic motor type is the most common form of CP and its conventional therapeutic management may include splinting/casting, passive stretching, facilitation of posture and movement, spasticity-reducing medication and surgery. More recently, health care professionals have begun to use botulinum toxin A (BtA) as an adjunct to interventions in an attempt to reduce muscle tone and spasticity to improve function Objectives To assess the effectiveness of intramuscular BtA injections as an adjunct to managing the upper limb in children with spastic CP. Search strategy We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003), MEDLINE (1966 to March Week 3 2004), EMBASE (1980 to 2003 Week 16) and CINAHL (1982 to Week 3 March 2004). Selection criteria All randomised controlled trials (RCTs) comparing intramuscular BtA injections into any muscle group of the upper limb with placebo, no treatment or other interventions. Data collection and analysis Two authors using standardised forms extracted the data independently. Each trial was assessed for internal validity with differences resolved by discussion. Data was extracted and entered into RevMan 4.2.3. Main results Two trials met the inclusion criteria, each having short-term follow up, a small number of subjects and using a single set of injections. The study by Corry 1997 compared BtA with an injection of normal saline and found promising results in elbow extension, elbow and wrist muscle tone. At three months, encouraging results for wrist muscle tone and grasp and release were noted. The trial reported median change, range of changes and the difference in these measures between groups. The study by Fehlings 2000 compared BtA with no intervention. When data were analysed no treatment effect was found for quality of upper limb function, passive range of motion, muscle tone, grip strength or self-care ability. Reviewers' conclusions This systematic review has not found sufficient evidence to support or refute the use of intramuscular injections of BtA as an adjunct to managing the upper limb in children with spastic cerebral palsy. Only one of the two identified RCTs reported some promising results in support of reduced muscle tone following BtA injections. Further research incorporating larger sample sizes, rigorous methodology, measurement of upper limb function and functional outcomes is essential.

International Student Security

Abstract: More than three million students globally are on the move each year, crossing borders for their tertiary education. Many travel from Asia and Africa to English speaking countries, led by the United States, including the UK, Australia and New Zealand where students pay tuition fees at commercial rates and prop up an education export sector that has become lucrative for the provider nations. But the 'no frills' commercial form of tertiary education, designed to minimise costs and maximise revenues, leaves many international students inadequately protected and less than satisfied. International Student Security draws on a close study of international students in Australia, and exposes opportunity, difficulty, danger and courage on a massive scale in the global student market. It works through many unresolved issues confronting students and their families, including personal safety, language proficiency, finances, sub-standard housing, loneliness and racism.

Self‐determined blended learning: a case study of blended learning design

Abstract: Higher education has been actively encouraged to find more effective and flexible delivery models to provide all students with access to quality learning experiences yet also meet institutional imperatives for efficiency and accountability. Blended learning, commonly defined as an integration of traditional face‐to‐face and online approaches to instruction (Garrison & Kanuka, 2004; Graham, 2006; Macdonald, 2008), is now proposed as one solution that addresses both student learning and higher education organisational needs. Successful blended learning, however, is more than a simple integration of information and communication technologies with face‐to‐face approaches. This paper proposes, describes and evaluates a pedagogical approach to blended learning focused on learners and learning. First, we interrogate the literature related to blended learning to show how various constructions of blended learning may be driven by teacher‐centric or learner‐centric conceptions. Next, planning a learner‐centric blen...

Mutation of the mitochondrial tyrosyl-tRNA synthetase gene, YARS2, causes myopathy, lactic acidosis, and sideroblastic anemia--MLASA syndrome.

Abstract: Mitochondrial respiratory chain disorders are a heterogeneous group of disorders in which the underlying genetic defect is often unknown. We have identified a pathogenic mutation (c.156C>G [p.F52L]) in YARS2, located at chromosome 12p11.21, by using genome-wide SNP-based homozygosity analysis of a family with affected members displaying myopathy, lactic acidosis, and sideroblastic anemia (MLASA). We subsequently identified the same mutation in another unrelated MLASA patient. The YARS2 gene product, mitochondrial tyrosyl-tRNA synthetase (YARS2), was present at lower levels in skeletal muscle whereas fibroblasts were relatively normal. Complex I, III, and IV were dysfunctional as indicated by enzyme analysis, immunoblotting, and immunohistochemistry. A mitochondrial protein-synthesis assay showed reduced levels of respiratory chain subunits in myotubes generated from patient cell lines. A tRNA aminoacylation assay revealed that mutant YARS2 was still active; however, enzyme kinetics were abnormal compared to the wild-type protein. We propose that the reduced aminoacylation activity of mutant YARS2 enzyme leads to decreased mitochondrial protein synthesis, resulting in mitochondrial respiratory chain dysfunction. MLASA has previously been associated with PUS1 mutations; hence, the YARS2 mutation reported here is an alternative cause of MLASA.

Writing themselves in 3: The third national study on the sexual health and wellbeing of same sex attracted and gender questioning young people

Abstract: Executive Summary Introduction This is the third of the Writing Themselves In national reports which have been conducted six years apart since 1998. In 2010, a total of 3134 same sex attracted and gender questioning (SSAGQ) young people participated in Writing Themselves In 3 (WTi3), almost double the number in 2004 and more than four times that of 1998. The participants, who were aged between 14 and 21 years, came from all states and territories of Australia, from remote (2%), rural (18%) and urban (67%) areas and from a range of culturally and linguistically diverse (CALD) backgrounds. There were more young women (57%) than young men (41%) and a smaller group (3%) who were gender questioning (GQ). Sexual feelings In 2010, the complex interaction of sexual attraction, identity and behaviour was even more evident than in previous studies. Most young men were exclusively same sex attracted but half of the young women were attracted to both sexes and less than one third exclusively to the same sex. More than a third of young people realized their sexual difference before puberty and there were few gender differences in age of first realization. More young people felt positive about their same sex attraction than in 2004. As in 2004, young people who felt bad about their sexuality used homophobic beliefs to describe their reasons whereas those who felt good used resistant, affirming explanations. Sexual identity Most young men identified as gay/homosexual. Young women were more likely to identify as bisexual. Young women chose a greater range of identity terms to describe their sexuality.

Maternal feeding practices, child eating behaviour and body mass index in preschool-aged children: a prospective analysis

Abstract: Previous research has found associations between parental feeding practices and children's eating behaviour and weight status. Prospective research is needed to elucidate these relationships. One hundred and fifty-six mothers of 2- to 4-year-old children completed questionnaires including measures of maternal feeding practices (pressure to eat, restriction, monitoring and modelling of healthy eating), child eating behaviour (food responsiveness, food fussiness and interest in food), and mother reported child height and weight. The questionnaire was repeated 12 months later. Regression analyses were used to find longitudinal associations between maternal feeding practices, child eating behaviour and child body mass index (BMI). Modelling of healthy eating predicted lower child food fussiness and higher interest in food one year later, and pressure to eat predicted lower child interest in food. Restriction did not predict changes in child eating behaviour. Maternal feeding practices did not prospectively predict child food responsiveness or child BMI. Maternal feeding practices appear to influence young children's eating behaviour but not weight status in the short term.