Heat-Ready: heatwave awareness, preparedness and adaptive capacity in aged care facilities

AbstractThis study identifies the current policies and strategies Australian ACFs use to keep residents well, and highlights the barriers to heatwave adaptation and maintaining wellness in the residential aged during periods of extreme heat. As the Australian population ages, planning for the health effects of extreme heat in elderly residents is critical to ensure wellness in this population group is maintained.Aims were to: 1) investigate current heat-wave planning, policies, staff knowledge and heat prevention strategies and 2) identify barriers to adaptation and successful implementation of adequate heat-wave health care in ACFs in three Australian states (NSW, Queensland and South Australia).Residential ACFs were identified across three states using Department of Health and Ageing databases, white pages and internet searching. After removal of duplicates, 1,561 facilities were invited to participate in the study. Each participating facility was asked to provide informed consent and invited to select one administrative and one clinical staff member to participate in a 15 minute Computer Assisted Telephone Interview (CATI). Participants were asked about their knowledge of the effects of heat on the elderly and to detail current plans and policies which addressed residents’ health during heat-waves, and barriers to care during periods of extreme heat. Data was entered into a purpose-built database and analysed using Statistical Package for the Social Sciences (SPSS) Version 19.Two hundred and eighty seven (287) facilities (18%) participated in the telephone interview. The ACFs enrolled represented 20,928 Australian aged care residents.  Ninety percent of facilities had a current ACF emergency plan, although only 30% included heat-wave emergency planning. Heatwave policies were not routine in all ACFs in any state. Staff used a range of strategies to keep residents cool in extreme heat, although strategies were not consistent across all states or facilities. The issues raised in relation to clinical care in this group can be synthesised into four key messages; cooling, hydration, monitoring and emergency planning, which, at a practical level are essential to maintain the health of older people in very hot weather.Please cite this report as: Black, DA, Veitch, C, Wilson, LA, Hansen, A 2013 Heat-Ready: Heatwave awareness, preparedness and adaptive capacity in aged care facilities in three Australian states: New South Wales, Queensland and South Australia, National Climate Change Adaptation Research Facility, Gold Coast, 47 pp.AbstractThis study identifies the current policies and strategies Australian ACFs use to keep residents well, and highlights the barriers to heatwave adaptation and maintaining wellness in the residential aged during periods of extreme heat. As the Australian population ages, planning for the health effects of extreme heat in elderly residents is critical to ensure wellness in this population group is maintained.Aims were to: 1) investigate current heat-wave planning, policies, staff knowledge and heat prevention strategies and 2) identify barriers to adaptation and successful implementation of adequate heat-wave health care in ACFs in three Australian states (NSW, Queensland and South Australia).Residential ACFs were identified across three states using Department of Health and Ageing databases, white pages and internet searching. After removal of duplicates, 1,561 facilities were invited to participate in the study. Each participating facility was asked to provide informed consent and invited to select one administrative and one clinical staff member to participate in a 15 minute Computer Assisted Telephone Interview (CATI). Participants were asked about their knowledge of the effects of heat on the elderly and to detail current plans and policies which addressed residents’ health during heat-waves, and barriers to care during periods of extreme heat. Data was entered into a purpose-built database and analysed using Statistical Package for the Social Sciences (SPSS) Version 19.Two hundred and eighty seven (287) facilities (18%) participated in the telephone interview. The ACFs enrolled represented 20,928 Australian aged care residents.  Ninety percent of facilities had a current ACF emergency plan, although only 30% included heat-wave emergency planning. Heatwave policies were not routine in all ACFs in any state. Staff used a range of strategies to keep residents cool in extreme heat, although strategies were not consistent across all states or facilities. The issues raised in relation to clinical care in this group can be synthesised into four key messages; cooling, hydration, monitoring and emergency planning, which, at a practical level are essential to maintain the health of older people in very hot weather.&nbsp

Can the Center Hold? Grappling with the decline of a small-city downtown in Meridian, Mississippi

Meridian, Mississippi, is a poster child for the Post-War Era decline of America\u27s downtowns. The center city has been in steady decline since the rise of automobile culture and the opening of Meridian’s first suburban mall in the 1970s. This study analyzes how a historic preservation ethic may better inform the economic development of a downtown with an emphasis on establishing best practices for other small American cities. In focusing on a small, southern city, this paper fortifies a weak area in the study of preservation best practices related to downtown revitalization, which has focused on larger cities outside the Mid-South region. It examines the preservation policies within Meridian\u27s 2004 Downtown Redevelopment Plan, 2009 Comprehensive Plan, and other official city planning documents. It gauges the importance placed on preservation in city planning, as well as to what degree preservation policies are actually carried out. Meridian\u27s revitalization efforts focus on large development projects devoted to entertainment and tourism: the restoration of the Grand Opera House, the upcoming redevelopment of an abandoned Art Deco office building into a hotel, and the construction of the MAEE, slated to open in 2017. This study examines the current success of these and other projects and gauges how successfully they encourage sustainable development of the downtown core. Specifically, the study will suggest how historic preservation, incremental development, and diverse services and functions can improve downtown revitalization efforts in Meridian and comparable cities

Self Vs. Society: The Essential Antagonism Between Society and the Individual In Adam Bede, The Mill on the Floss, and Daniel Deronda

This study focuses on the conflicts between society and the individual in three of George Eliot’s works: Adam Bede, The Mill on the Floss, and Daniel Deronda. This work analyzes the relationship between the individual and his or her society within these novels and uses its findings to illustrate the mechanism and goal of social evolution as it is depicted in these three works. Research was conducted by reading several primary and secondary texts. The primary texts included the three novels discussed, as well as many of Eliot’s non-fiction essays and Herbert Spencer’s essay The Social Organism, in order to place the novels within a larger discussion of the theory of social organicism. Secondary literary criticisms of George Eliot’s works were also consulted in order to place this study within the current discussion of social organicism as well as the individual’s place in society in George Eliot’s works. The research suggests that in these three novels George Eliot depicts social evolution as giving rise to the organic society in Herbert Spencer s sense as opposed to J. G. Herder’s sense. This study argues that in Adam Bede there is a fundamental and necessary conflict between society and the individual, that in The Mill on the Floss this conflict is revealed to be the very mechanism by which societies evolve, and that in Daniel Deronda George Eliot suggests that Spenserian organicism, in which the needs of the individual are valued above those of the a society, is the final goal of this social evolution

Sudden Unexpected Death in Infants (SUDI) and parental infant care: perspectives of general practitioners, nurses and parents living and working in the multicultural community of Western Sydney

For many years the major cause of infant mortality in NSW has been the result of Sudden Infant Death Syndrome (SIDS). Statistics show the area defined as 'Western Sydney' is no exception, and in 2002, a report prepared by the Epidemiology, Indicators, Evaluation and Research Unit (EIRE) in Western Sydney presented data indicating SIDS rates in the area were higher than the state average. In particular, two Local Government Areas (LGAs) had clusters of SIDS deaths. Previous Australian research identified a higher risk of SIDS and other causes of infant mortality in Aboriginal and Torres Strait Islander populations. The areas of Western Sydney where SIDS rates were higher than expected were home to Aboriginal, Torres Strait Islander and Pacific Island residents. The number of SIDS deaths in Aboriginal infants did not explain the higher than expected rate of SIDS in the areas under investigation. Studies undertaken in New Zealand and the Pacific Islands have identified higher than expected risk of SIDS in Maori and Pacific Island communities in those countries, although this has never been studied in Pacific Island residents living in Australia. The reasons for these communities exhibiting a higher than normal SIDS rate is not completely understood, but can be partially explained by behavioural practices which are known to impact adversely on the risk of SIDS. This study sought to investigate the level of knowledge concerning the prevention of sudden and unexpected death in infants (SUDI) in three key groups of infant caregivers: general practitioners, nurses and parents living or working in the area geographically defined by Sydney West Area Health Service (WSAHS). In addition, the study sought to identify any variation in knowledge of SIDS reduction strategies in the three groups under study, and to investigate factors influencing knowledge and practice in these participants. The study findings were then used as a basis on which to develop strategies and recommendations to enhance the delivery of safe sleeping messages through the health care system. Using a combination of qualitative and quantitative methods, this cross-sectional study highlights a number of issues around infant care practices and the major influences on new parents living in a multicultural community. Results of the study showed there is a large variation in knowledge around safe sleeping practices (including SIDS reduction strategies) in all the groups studied. Although educational campaigns are conducted regularly, many general practitioners and parents are confused about the key SIDS reduction messages and still place infants in sleeping positions considered unsafe. While nurses and midwives were aware of the SIDS reduction strategies, they still occasionally used infant sleeping positions considered unsafe. General practitioners born overseas in a country where English is not the first language were less likely to be familiar with safe sleeping messages, including SIDS reduction strategies. Families from a Culturally and Linguistically Diverse (CALD) background were less likely to have seen SIDS information in their own language than families who spoke English, and as a result were more likely to use traditional methods of infant care, including co-sleeping with siblings and parents and side or tummy sleeping. CALD parents were more likely to rely on herbal remedies and friends and family for assistance, than English speaking parents who accessed health professionals as the first point of call when infants were unwell. The study identified a relatively recent practice, which until reported in this study, has not been documented in the literature. The practice of draping infant prams with blankets originated from the Cancer Council of Australia guidelines which recommend covering a pram with a light muslin wrap to protect infants’ skin from the sun. It appears parents have misinterpreted this message and are covering infant prams with blankets to encourage sleep, even when sun exposure is not an issue. Research suggests that poor air quality around the head of an infant may affect an infant’s arousal response. While no research has been conducted on the air quality around an infants head when covered by a heavy blanket in a pram, it is possible based on research into air quality around infants, that that this practice may increase the risk of sudden and unexpected death in an infant. In conclusion, this study found that multiple changes to the SIDS reduction messages since the initial ‘Reduce the Risks’ Campaign have led to confusion about ways of preventing SIDS in GPs, nurses and parents in Western Sydney. The study makes seven recommendations aimed at improving knowledge of safe sleeping practices in these groups, and optimizing health outcomes for infants using a collaborative approach to service delivery and future initiatives

Determinants of Childhood Morbidity and the Role of Malnutrition: Evidence from Indonesia

Studies that have attempted to examine the impact of early childhood malnutrition on acute illness have failed to adequately establish the causal link from malnutrition to acute illness. The empirical challenge arises because household behavioral decisions that influence investment in a child's nutrition and growth are very likely correlated with other household decisions that affect a child's incidence of illness. These include decisions to invest in hygiene and sanitation or a mother's knowledge and use of appropriate feeding practices. There may also be unobserved risk factors, such as genetic endowments, which introduce correlation between one of the regressors - nutritional status - and the error term in a disease production equation. In this dissertation, I test two basic hypotheses: (1) chronic undernutrition in early childhood, as measured by stunting in children under five, increases the probability of contemporaneous acute illness; and (2) there is a significant effect of early childhood malnutrition on the probability of developing acute illness later in childhood. I estimate a model that predicts the incidence of febrile, diarrheal and respiratory disease, diseases which combined account for the greatest total burden of morbidity and mortality in children in developing countries. I focus my research on contemporaneous and longer-term acute illness outcomes in children under five for three reasons. First, substantial research has shown that children are at greatest risk of malnutrition in the early years of life, particularly before age two (Victora et al. 2008; Ruel et al 2008). In this period, children are no longer exclusively breastfeed and they have high nutritional requirements because they are growing quickly. Second, the burden of infectious disease is disproportionately borne by children under five due to their relatively immature immune systems and their dependence on caregivers to use appropriate feeding and hygiene practices to avoid infection (Martorell 1999; Martorell and Habicht 1986). Third, since most of the literature on the long-term consequences for human capital formation focuses on conditions in early childhood, by placing this research question in the same context, it can be more clearly seen as contributing to the broader literature on human capital formation. I employ instrumental variables to allow identification of the impact of early childhood malnutrition on acute illness. I use a panel dataset from three waves of the Indonesian Family Life Survey (IFLS) to address the measurement challenges that arise due to the unobservable household factors that influence both the likelihood of early childhood malnutrition and acute illness, and the synergistic nature of malnutrition and infection. My results show a strong and statistically significant contemporaneous effect of malnutrition on the likelihood of acute illness. I find that children under five who are stunted are 16 percent more likely than children who are not stunted to report symptoms of acute illness. I find that the impact of malnutrition on the likelihood of acute illness remains positive and significant four years into the future. Children who were stunted in 1993 are still 5 percent more likely than non-stunted children to experience acute illness in 1997. While I find this impact of early childhood stunting on future illness outcomes dissipates seven years later, I present suggestive evidence that this may reflect the fact that many of the children in my sample who were stunted in 1993 are in fact no longer stunted by 2000. Overall, these results suggest that efforts at reducing early childhood malnutrition can lead not only to immediate health benefits in terms of lower rates of infectious disease, but also lead to better health outcomes in the future. Many international organizations and bilateral donors are prioritizing improvements in early childhood nutrition with the goal of improving long-term human capital outcomes (World Bank 2002; USAID 2008). The most important implication of my results is that improvements in early childhood nutrition and reducing the burden of disease are complementary objectives; improved early childhood nutrition will facilitate meeting the Millennium Development Goal of reducing the burden of disease. Further, to the extent improvements in pre-school nutritional status reduce either the incidence of acute illness, the severity of acute illness episodes, or both, such improvements may have indirect benefits. These include reducing school absenteeism which likely will enhance the acquisition of knowledge at school and lead to higher school completion rates among children in developing countrie

Seeing Music Theory: Graduate Music Theory for the Visually Impaired Music Student

Visually impaired individuals often encounter obstacles when seeking to become financially independent and obtain marketable skills. An increase in technology has allowed visually impaired persons, who desire to further their musical skills, the capability to seek further education. However, there is a lack of curriculum, especially in higher education, for teaching music theory skills to visually impaired individuals. Because a foundational knowledge of music is developed through music theory, it is essential that music educators at higher education institutions are prepared and equipped to properly and adequately teach and prepare visually impaired individuals for the music industry. By building on the research and pedagogical suggestions of music educators, this study will suggest sustainable, proven pedagogical methods to help equip both educators and visually impaired students. The Curriculum Project will provide a framework to teach a graduate level music theory course specifically designed to meet the unique needs of visually impaired music students

A Case Study of a Worksite Wellness Program that Incorporates Physical Activity

The purpose of this study was to expand the body of knowledge of organizational wellness programs through the exploration of improving the rate of physical activity by providing the incentives of time and choice. The results of this study may help broaden how organizations view wellness and inspire greater creativity in developing a program that is effective and economical. This study explored the impacts of time and choice on participation in physical activity and the effects of engaging in regular physical activity on presenteeism. Participants engaged in physical activity as part of their regular work schedule for a fourmonth period. Data were collected through interviews and survey instruments. Results indicate that providing time may influence participation in physical activity and contribute towards maintaining or improving the health of employees. Results also support studies in behavior change, which suggest that the success of an organization’s wellness program may be strengthened with strong leadership involvement and support. The outcome of this study warrants application to a larger population and for a longer duration to validate results and possibly strengthen the outcome in other areas of behavior change and presenteeism

Sudden Unexpected Death in Infants (SUDI) and parental infant care: perspectives of general practitioners, nurses and parents living and working in the multicultural community of Western Sydney

For many years the major cause of infant mortality in NSW has been the result of Sudden Infant Death Syndrome (SIDS). Statistics show the area defined as 'Western Sydney' is no exception, and in 2002, a report prepared by the Epidemiology, Indicators, Evaluation and Research Unit (EIRE) in Western Sydney presented data indicating SIDS rates in the area were higher than the state average. In particular, two Local Government Areas (LGAs) had clusters of SIDS deaths. Previous Australian research identified a higher risk of SIDS and other causes of infant mortality in Aboriginal and Torres Strait Islander populations. The areas of Western Sydney where SIDS rates were higher than expected were home to Aboriginal, Torres Strait Islander and Pacific Island residents. The number of SIDS deaths in Aboriginal infants did not explain the higher than expected rate of SIDS in the areas under investigation. Studies undertaken in New Zealand and the Pacific Islands have identified higher than expected risk of SIDS in Maori and Pacific Island communities in those countries, although this has never been studied in Pacific Island residents living in Australia. The reasons for these communities exhibiting a higher than normal SIDS rate is not completely understood, but can be partially explained by behavioural practices which are known to impact adversely on the risk of SIDS. This study sought to investigate the level of knowledge concerning the prevention of sudden and unexpected death in infants (SUDI) in three key groups of infant caregivers: general practitioners, nurses and parents living or working in the area geographically defined by Sydney West Area Health Service (WSAHS). In addition, the study sought to identify any variation in knowledge of SIDS reduction strategies in the three groups under study, and to investigate factors influencing knowledge and practice in these participants. The study findings were then used as a basis on which to develop strategies and recommendations to enhance the delivery of safe sleeping messages through the health care system. Using a combination of qualitative and quantitative methods, this cross-sectional study highlights a number of issues around infant care practices and the major influences on new parents living in a multicultural community. Results of the study showed there is a large variation in knowledge around safe sleeping practices (including SIDS reduction strategies) in all the groups studied. Although educational campaigns are conducted regularly, many general practitioners and parents are confused about the key SIDS reduction messages and still place infants in sleeping positions considered unsafe. While nurses and midwives were aware of the SIDS reduction strategies, they still occasionally used infant sleeping positions considered unsafe. General practitioners born overseas in a country where English is not the first language were less likely to be familiar with safe sleeping messages, including SIDS reduction strategies. Families from a Culturally and Linguistically Diverse (CALD) background were less likely to have seen SIDS information in their own language than families who spoke English, and as a result were more likely to use traditional methods of infant care, including co-sleeping with siblings and parents and side or tummy sleeping. CALD parents were more likely to rely on herbal remedies and friends and family for assistance, than English speaking parents who accessed health professionals as the first point of call when infants were unwell. The study identified a relatively recent practice, which until reported in this study, has not been documented in the literature. The practice of draping infant prams with blankets originated from the Cancer Council of Australia guidelines which recommend covering a pram with a light muslin wrap to protect infants’ skin from the sun. It appears parents have misinterpreted this message and are covering infant prams with blankets to encourage sleep, even when sun exposure is not an issue. Research suggests that poor air quality around the head of an infant may affect an infant’s arousal response. While no research has been conducted on the air quality around an infants head when covered by a heavy blanket in a pram, it is possible based on research into air quality around infants, that that this practice may increase the risk of sudden and unexpected death in an infant. In conclusion, this study found that multiple changes to the SIDS reduction messages since the initial ‘Reduce the Risks’ Campaign have led to confusion about ways of preventing SIDS in GPs, nurses and parents in Western Sydney. The study makes seven recommendations aimed at improving knowledge of safe sleeping practices in these groups, and optimizing health outcomes for infants using a collaborative approach to service delivery and future initiatives

Transcriptomic analysis of midbrain and individual hindbrain rhombomeres in the chick embryo

The anteroposterior compartments of the developing hindbrain (rhombomeres [r]) are normally patterned by the combinatorial action of distinct Hox genes. Using Affymetrix GeneChips to define the repertoire of genes regulated in each rhombomere, we have performed a systematic survey of the transcriptional status of individual segments of the developing chick hindbrain (r1-5) at a key stage of early development (HH11) and identified hundreds of previously un-described genes expressed in this region. For comparative purposes, we have also included the adjacent region of the embryonic midbrain (m) in our dataset. In summary, six different embryonic brain regions (m, r1, r2, r3, r4 & r5) are represented by biological duplicates to give a raw dataset comprised of 12 individual Affymetrix GeneChip Cel and CHP files. These data give an opportunity to assess the genome-wide complexity of gene expression during patterning of the chick developing midbrain and hindbrain, and may be relevant to extending our understanding of the genes regulated by Hox family transcription factors

Educator Professional Development as Rhetorical Situation

Teacher effectiveness is recognized as the most prominent in-school influencer of student learning, and professional development (PD) of in-service educators is seen as vital to improving teachers’ effectiveness throughout their careers. Professional development is often studied atheoretically and with a linear view in which PD providers deliver instruction and teachers receive and apply that instruction as it was delivered to them. By casting them as passive, blank-slate receivers and automatic appliers of the PD, this view obscures the complexities of teachers’ role in PD. Examining educator PD through the lens of rhetoric, and viewing the PD experience as a rhetorical situation, allows us to tease apart the highly connected ecology of roles and text(s) present within any PD situation. Understanding more about the roles teachers take in PD–as PD provider or receiver, and as rhetorical audience and rhetor–opens up opportunities for engaging educators fully in their own and one another’s development. This collective case study of four educators used interviews and collection and analysis of PD-related Twitter activity in order to discover how the participants embrace, resist, and shift between the roles of PD receiver and provider and the roles of rhetorical audience and rhetor. The resulting study demonstrates that rhetoric acts as a rich lens for bringing to light the ways educators bring their own expertise and experiences to PD activities, make a number of complex choices within those activities for both their own enrichment and the enrichment of others involved, and embrace methods of PD, such as using social media platforms, that give them full access to all roles. The conclusion of this dissertation offers three tools for use by readers: 1) the rhetorical lens constructed in this project and used to view PD as a rhetorical situation; 2) a set of recommendations for educators who wish to seek PD using social media, including both composition methods to try and mindsets for shifting between the rhetorical roles available through social media; and 3) a set of recommendations for those offering PD to educators, with an emphasis on accounting for the complexities of their roles as learners with their own expertise, as audience members with an audience’s inherent power, and as potential rhetors when given access to the role