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This article reports on a fictional case study focusing on a person with dementia with a history of wandering behaviour, who was admitted to a residential care setting for 2 weeks of respite care. Caring for people with behavioural and psychological symptoms of dementia is complex. It is imperative that gerontology nurses have a sound knowledge of dementia in order to provide person-centred, safe, integrated, high-quality and appropriate care. Furthermore, gerontology nurses are in a position to support people with dementia and their carers by undertaking a comprehensive assessment of the person's needs to advise on possible and appropriate solutions to enable ageing in place. Community care and support to enable people with dementia to remain in their own home is recommended. While previous research shows a small positive effect of respite care for carers of people with dementia, there is no current evidence showing the benefits or adverse effects of respite care for care recipients.

Integration of advanced technologies have revitalised treatment methods in the current clinical practice. In orthopaedic surgery, patient-specific implants have leveraged the design freedom offered by additive manufacturing (AM) exploiting the capabilities within powder bed fusion processes. Furthermore, generative design (GD), a design exploration tool based on the artificial intelligence, can integrate manufacturing constraints in the concept development phase, consequently bridging the gap between AM design and manufacturing. However, the reproducibility of implant prototypes are severely constrained due to uncomprehensive information on manufacturing and post processing techniques in the detailed design phase. This paper explores the manufacturing feasibility of novel GD concept plate designs for High Tibial Osteotomy (HTO), a joint preserving surgery for a patient diagnosed with osteoarthritis in the knee. A design for AM (DfAM) workflow for a generatively designed HTO plate is presented, including; detailed DfAM of GD concept designs, fabrication of plate prototypes using electron beam powder bed fusion (PBF-EB) of medical grade Ti-6Al-4 V, post processing and inspection. The study established PBF-EB as a suitable manufacturing method for the highly complex GD plate fixations, through evaluating the impact of manufacturing and post processing on the surface finish and geometrical precision of the plate design features.

Aim To investigate the impact of adenotonsillectomy (ADT) and adenoidectomy (AD) on child health and evaluated their post-operative complications. Methods We included all children aged

Aim: Acute otitis media (AOM) is the most common infectious disease for which antibiotics are prescribed; its management is costly and has the potential to increase the antimicrobial resistance of this infection. This study measured the levels of adherence to the clinical practice guidelines (CPGs) of AOM and otitis media with effusion (OME) management in Australian children. Methods: We searched for national and international CPGs relating to AOM and OME in children and created 37 indicators for assessment. We reviewed medical records for adherence to these indicators in 120 locations, across one inpatient and three ambulatory health-care settings. Our review sample was obtained from three Australian states that contain 60% of the nation's children. Results: We reviewed the records of 1063 children with one or more assessments of CPG adherence for otitis media. Of 22 indicators with sufficient data, estimated adherence ranged from 7.4 to 99.1%. Overuse of treatment, particularly overprescribing of antibiotics, was more common than underuse. A frequent lack of adherence with recommended care was observed for children aged between 1 and 2 years with AOM. Adherence varied by health-care setting, with emergency departments and inpatient settings more adherent to CPGs than general practices. Conclusions: Our assessment of a number of indicators in the common settings in which otitis media is treated found that guideline adherence varied widely between individual indicators. Internationally agreed standards for diagnosis and treatment, coupled with clinician education on the existence and content of CPGs and clinical decision support, are needed to improve the management of children presenting with AOM and OME Refereed/Peer-reviewed

Professional progression and skills development are the main expectations of mid-career managers when enrolling on an Executive MBA (EMBA), yet it can be personal development (PD) that turns out to be the unexpected benefit of management education. Joining a growing number of voices making a case for personal development and self-awareness in management education, and calling for schools to incorporate it in the curriculum, this paper advances the case for personal development as a core Executive MBA module. The paper sets out the holistic rationale and philosophic principles used to design and deliver a course underpinned by curiosity and self-reflection on an EMBA in the United Kingdom, and presents empirical findings from a survey conducted among 230 students and alumni. These suggest that the focus on reflective practice and integration of PD promotes a richer and deeper appreciation of the value of reflection for lasting and sometimes unexpected personal growth. In addition, the raising of awareness of self also brings awareness of others, and develops critical thinking in application of the MBA at work. The paper concludes with a discussion re-evaluating the subject of tacit knowledge in reflective practice.

BackgroundIn order to determine the extent to which care delivered to children is appropriate (in line with evidence-based care and/or clinical practice guidelines (CPGs)) in Australia, we developed a set of clinical indicators for 21 common paediatric medical conditions for use across a range of primary, secondary and tertiary healthcare practice facilities.MethodsClinical indicators were extracted from recommendations found through systematic searches of national and international guidelines, and formatted with explicit criteria for inclusion, exclusion, time frame and setting. Experts reviewed the indicators using a multi-round modified Delphi process and collaborative online wiki to develop consensus on what constituted appropriate care.ResultsFrom 121 clinical practice guidelines, 1098 recommendations were used to draft 451 proposed appropriateness indicators. In total, 61 experts (n = 24 internal reviewers, n = 37 external reviewers) reviewed these indicators over 40 weeks. A final set of 234 indicators resulted, from which 597 indicator items were derived suitable for medical record audit. Most indicator items were geared towards capturing information about under-use in healthcare (n = 551, 92%) across emergency department (n = 457, 77%), hospital (n = 450, 75%) and general practice (n = 434, 73%) healthcare facilities, and based on consensus level recommendations (n = 451, 76%). The main reason for rejecting indicators was 'feasibility' (likely to be able to be used for determining compliance with 'appropriate care' from medical record audit).ConclusionA set of indicators was developed for the appropriateness of care for 21 paediatric conditions. We describe the processes (methods), provenance (origins and evolution of indicators) and products (indicator characteristics) of creating clinical indicators within the context of Australian healthcare settings. Developing consensus on clinical appropriateness indicators using a Delphi approach and collaborative online wiki has methodological utility. The final indicator set can be used by clinicians and organisations to measure and reflect on their own practice.

Background: Variable and poor care quality are important causes of preventable patient harm. Many patients receive less than recommended care, but the extent of the problem remains largely unknown. The CareTrack Kids (CTK) research programme sought to address this evidence gap by developing a set of indicators to measure the quality of care for common paediatric conditions. In this study, we focus on one clinical area, 'preventive care' for pre-school aged children. Our objectives were two-fold: (i) develop and validate preventive care quality indicators and (ii) apply them in general medical practice to measure adherence. Methods: Clinical experts (n = 6) developed indicator questions (IQs) from clinical practice guideline (CPG) recommendations using a multi-stage modified Delphi process, which were pilot tested in general practice. The medical records of Australian children (n = 976) from general practices (n = 80) in Queensland, New South Wales and South Australia identified as having a consultation for one of 17 CTK conditions of interest were retrospectively reviewed by trained paediatric nurses. Statistical analyses were performed to estimate percentage compliance and its 95% confidence intervals. Results: IQs (n = 43) and eight care 'bundles' were developed and validated. Care was delivered in line with the IQs in 43.3% of eligible healthcare encounters (95% CI 30.5-56.7). The bundles of care with the highest compliance were 'immunisation' (80.1%, 95% CI 65.7-90.4), 'anthropometric measurements' (52.7%, 95% CI 35.6-69.4) and 'nutrition assessments' (38.5%, 95% CI 24.3-54.3), and lowest for 'visual assessment' (17.9%, 95% CI 8.2-31.9), 'musculoskeletal examinations' (24.4%, 95% CI 13.1-39.1) and 'cardiovascular examinations' (30.9%, 95% CI 12.3-55.5). Conclusions: This study is the first known attempt to develop specific preventive care quality indicators and measure their delivery to Australian children in general practice. Our findings that preventive care is not reliably delivered to all Australian children and that there is substantial variation in adherence with the IQs provide a starting point for clinicians, researchers and policy makers when considering how the gap between recommended and actual care may be narrowed. The findings may also help inform the development of specific improvement interventions, incentives and national standards. Refereed/Peer-reviewed

Objective: The aims of this study were twofold: (1) to design and validate a set of clinical indicators of appropriate care for tonsillitis and (2) to measure the level of tonsillitis care that is in line with guideline recommendations in a sample of Australian children Study design: A set of tonsillitis care indicators was developed from available national and international guidelines and validated in 4 stages. This research used the same design as the CareTrack Kids study, which was described in detail elsewhere Setting: Samples of patient records from general practices, emergency departments, and hospital admissions were assessed Subjects and methods: Patient records of children aged 0 to 15 years were assessed for the presence of, and adherence to, the indicators for care delivered in 2012 and 2013 Results: Eleven indicators were developed. The records of 821 children (mean age, 5.0 years; SD, 4.0) with tonsillitis were screened. The reviewers conducted 2354 eligible indicator assessments across 1127 visits. Adherence to 6 indicators could be assessed and ranged from 14.3% to 73.2% (interquartile range 31.5% to 72.2%). Conclusion: Our main findings are consistent with the international literature: the treatment of many children who present with confirmed or suspected tonsillitis is inconsistent with current guidelines. Future research should consider how the indicators could be applied in a structured and automated manner to increase the reliability and efficiency of record reviews and help raise clinicians' awareness of appropriate tonsillitis management. Refereed/Peer-reviewed

IMPORTANCE The quality of routine care for children is rarely assessed, and then usually in single settings or for single clinical conditions. OBJECTIVE To estimate the quality of health care for children in Australia in inpatient and ambulatory health care settings. DESIGN, SETTING, AND PARTICIPANTS Multistage stratified sample with medical record review to assess adherence with quality indicators extracted from clinical practice guidelines for 17 common, high-burden clinical conditions (noncommunicable [n = 5], mental health [n = 4] , acute infection [n = 7], and injury [n = 1] ), such as asthma, attention-deficit/hyperactivity disorder, tonsillitis, and head injury. For these 17 conditions, 479 quality indicators were identified, with the number varying by condition, ranging from 9 for eczema to 54 for head injury. Four hundred medical records were targeted for sampling for each of 15 conditions while 267 records were targeted for anxiety and 133 for depression. Within each selected medical record, all visits for the 17 targeted conditions were identified, and separate quality assessments made for each. Care was evaluated for 6689 children 15 years of age and younger who had 15 240 visits to emergency departments, for inpatient admissions, or to pediatricians and general practitioners in selected urban and rural locations in 3 Australian states. These visits generated 160 202 quality indicator assessments. EXPOSURES Quality indicators were identified through a systematic search of local and international guidelines. Individual indicators were extracted from guidelines and assessed using a 2-stage Delphi process. MAIN OUTCOMES AND MEASURES Quality of care for each clinical condition and overall. RESULTS Of 6689 children with surveyed medical records, 53.6% were aged 0 to 4 years and 55.5% were male. Adherence to quality of care indicators was estimated at 59.8% (95% CI, 57.5%-62.0%; n = 160 202) across the 17 conditions, ranging from a high of 88.8% (95% CI, 83.0%-93.1%; n = 2638) for autism to a low of 43.5% (95% CI, 36.8%-50.4%; n = 2354) for tonsillitis. The mean adherence by condition category was estimated as 60.5% (95% CI, 57.2%-63.8%; n = 41 265) for noncommunicable conditions (range, 52.8%-75.8%); 82.4% (95% CI, 79.0%-85.5%; n = 14 622) for mental health conditions (range, 71.5%-88.8%); 56.3% (95% CI, 53.2%-59.4%; n = 94 037) for acute infections (range, 43.5%-69.8%); and 78.3% (95% CI, 75.1%-81.2%; n = 10 278) for injury. CONCLUSIONS AND RELEVANCE Among a sample of children receiving care in Australia in 2012-2013, the overall prevalence of adherence to quality of care indicators for important conditions was not high. For many of these conditions, the quality of care may be inadequate. Refereed/Peer-reviewed

Securitization has been recognized as an important form of funding for the Australian financial system. Reflecting recovery from the financial crisis, the Australian securitization market had an active year in terms of new issuance in 2014. The large majority of transactions were in Australian dollars, reflecting good domestic demand and a preparedness by some international investors to invest in AUD. The Aussie residential mortgage-backed securities (RMBS) market has been performing well, reflecting a strong credit culture in Australia, regulatory underpinning of underwriting standards, and the full-recourse nature of Australian mortgages. Sponsors of RMBS in Australia are typically the ongoing servicers of the mortgage assets, which provides implicit “skin in the game” where the lender/servicer has a direct economic interest in the performance of the securitized mortgages. The securitization industry is hoping that the banking regulator, the Australian Prudential Regulatory Authority (ARPA), will allow banks to use master trust structures and also to use date-based calls to issue bullet and scheduled amortization notes to international investors in non-AUD denominations with the objective of expanding the investor base and bringing global investors back to the Australian securitization market. The regulator is also looking to simplify securitization. The direction is for structures primarily to have just two credit tranches and to avoid resecuritizations and synthetic securitizations.

This paper proposes a limitation to epistemological claims to theory building prevalent in critical realist research. While accepting the basic ontological and epistemological positions of the perspective as developed by Roy Bhaskar, it is argued that application in social science has relied on sociological concepts to explain the underlying generative mechanisms, and that in many cases this has been subject to the effects of an anthropocentric constraint. A novel contribution to critical realist research comes from the work and ideas of Gregory Bateson. This is in service of two central goals of critical realism, namely an abductive route to theory building and a commitment to interdisciplinarity. Five aspects of Bateson’s epistemology are introduced: (1) difference, (2) logical levels of abstraction, (3) recursive causal loops, (4) the logic of metaphor, and (5) Bateson’s theory of mind. The comparison between Bateson and Bhaskar’s ideas is seen as a form of double description, illustrative of the point being raised. The paper concludes with an appeal to critical realists to start exploring the writing and outlook of Bateson himself.

The role and significance of securitization in Australia’s financial system is that it provides an element of competition and choice for consumers, particularly home loan borrowers, which defrays to a degree the dominant market presence of the four major banks. The strength of Australia’s prime residential mortgage-backed securities (RMBS) market is underpinned by conservative products, full recourse to the borrower, and non-deductibility of mortgage interest. Current challenges for the Australian securitization market include rebuilding the sustainable base of global investors it had before the financial crisis and changes to the credit rating agencies’ rating criteria. Optimism stems from the central bank’s acceptance of RMBS as security for its secured liquidity facility under Basel III provisions and increased domestic funds’ allocations toward domestic fixed-income securities.

Scanning infrared thermography systems have the potential to analyze materials and parts, quickly, accurately, and at a reduced cost compared to other systems. Scanning infrared thermography uses Fourier’s law of conductive heat transfer to detect both material and geometric anomalies in a particular sample. The current system has been developed to create an easy to operate physical system and an interface utilizing commercial software packages. New hardware components have been designed to work in concert with specially developed analytical models to treat surfaces with changing emissivity and uniformly finished surfaces like those used in traditional infrared scanning systems. The system has been successful at detecting defects on coated surfaces where cracks were oriented parallel to the heating element and at sub-optimal angles. In addition, new experimentation has shown the new camera shroud and LabView program to be successful at removing reflected radiation from variable emissivity, diffuse surfaces. However, the system has only been marginally successful at removing artifacts of reflected radiation from thermographic images of surfaces that show a high degree of specularity, making temperature correction and crack detection difficult. In these cases, coatings have shown to be a potential solution to eliminate specular effects and allow for continued use of the developed system.

Background & Aims Patients with functional gastrointestinal disorders treated with tricyclic antidepressants sometimes report nongastrointestinal symptoms; it is unclear whether these are drug side effects or reflect a behavioral tendency to report symptoms. We evaluated whether symptoms reported before treatment with a tricyclic antidepressant (desipramine) increased in number or worsened in severity after 2 weeks of treatment and assessed the baseline factors that predispose patients to report symptoms. Methods Female patients in a multicenter National Institutes of Health trial for functional bowel disorders completed a 15-item symptom questionnaire at baseline (before randomization), 2 weeks after they were given desipramine (n = 81) or placebo (n = 40), and at study completion (12 weeks). Patients were asked about the severity and frequency of 15 symptoms. Results were analyzed from 57 patients given desipramine who completed the questionnaires. Results Symptoms reported as side effects to have occurred more frequently and also worsened at week 2 in the group given desipramine included dizziness, dry mouth/thirstiness, lightheadedness, jittery feelings/tremors, and flushing. Symptoms that did not change in severity or showed improvement at week 2 in the group given desipramine included morning tiredness, nausea, blurred vision, headaches, appetite reduction, and trouble sleeping. Psychologic distress but not desipramine blood level correlated with symptom reporting. Conclusions Most symptoms often attributed to side effects of desipramine were present before treatment; only a few, related to anticholinergic effects, worsened 2 weeks after treatment, suggesting that most so-called side effects were not associated specifically with desipramine use. Such symptoms might instead be associated with psychologic distress.

Background: Supracricoid partial laryngectomy (SCPL) is an alternative to total laryngectomy (TL) for selected glottic and supraglottic carcinomas but its role in the setting of radiation failure is unclear. The aim of the present study was to present a series of patients with laryngeal cancer undergoing salvage surgery for local recurrence and examine the morbidity associated with this intervention. Methods: A retrospective review of 111 patients presenting with laryngeal cancer between 1997 and 2002 was performed. A total of 21 patients with recurrent disease following radiation therapy were identified, of which salvage surgery was performed in 18 patients. Minimum follow up of survivors was 22 months. Results: The 5-year cumulative local control and disease-specific survival was 76% and 85%, respectively. Surgical salvage consisted of TL in 12 patients and SCPL in six. The mortality and major morbidity rates for TL were 0% and 33%, and for SCPL they were 33% and 50%, respectively. Median length of hospital stay was similar in both groups (21 and 19 days). No patient undergoing SCPL developed recurrent disease at a median follow up of 19 months. Conclusions: Supracricoid partial laryngectomy is an oncologically sound alternative to TL as salvage for radiation failure. The operative morbidity and potential for mortality is high in this setting.

A novel series of Akt/PKB inhibitors derived from a screening lead (1) has been prepared. The novel trans-3,4′-bispyridinylethylenes described herein are potent inhibitors of Akt/PKB with IC50 values in the low double-digit nanomolar range against Akt1. Compound 2q shows excellent selectivity against distinct families of kinases such as tyrosine kinases and CAMK, and displays poor to modest selectivity against closely related kinases in the AGC and CMGC families. The cellular activities including inhibition of cell growth and phosphorylation of downstream target GSK3 are also described. The X-ray structure of compound 2q complexed with PKA in the ATP binding site was determined.