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Presents a model that depicts the interplay of influences shaping the reallocation of authority over educational policy. The model is used as a framework for analyzing events in the United States, England, and Australia pertaining to educational governance, finance, and reform. (78 references) (MLF)

Discloses the critical need for research into the effects of educational governance structures on decision-making quality. Notes the recent shift to a more decentralized quasi-market orientation consistent with other trends associated with the information age. Presents a framework for allocating decision-making authority in three countries. Includes 100 references. (MLH)

The article reports on the result of randomized controlled trial comparing two self-help treatments for panic disorder and a control condition for their effects on panic disorder symptoms in Australia. Email support and cognitive-behavior therapy (CBT) self-help book are included in the Internet-based CBT program interventions. The findings suggest that CBT for panic disorder with reduced therapist contact is an effective treatment.

Background: Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation in the intensive care unit. The incidence, patient characteristics, and outcomes have not been described in a regional Australian setting., Objectives: Τhe primary objective was to establish the incidence of VAP in a regional intensive care unit using predetermined diagnostic criteria. The secondary objective was to compare the agreement between criteria-based and physician-based diagnostic processes. The tertiary objectives were to compare patient characteristics and clinical outcomes of cases with and without VAP., Methods: A retrospective clinical audit was performed of adult patients admitted to Rockhampton Intensive Care Unit, Australia, between 2013 and 2016. We included all patients ventilated for ≥72 h and not diagnosed with a pneumonia before or during the first 72 h of ventilation., Results: A total of 170 cases met the inclusion criteria. The incidence of VAP as per the criteria-based diagnosis was 27.3 cases per 1000 ventilator days (95% confidence interval [CI]: 18.4-36.2) and as per the physician-based diagnosis was 25.8 cases per 1000 ventilator days (95% CI: 17.1-34.4). There was a moderate chance-corrected agreement between the criteria- and physician-based diagnosis. Very obese cases (body mass index [BMI] ≥40) were nearly four times more likely to develop VAP than cases with normal BMI (BMI <30) (odds ratio: 3.664; 95% CI: 1.394-9.634; p = 0.008). After controlling for sex, BMI category, comorbidities, and Acute Physiology and Chronic Health Evaluation II scores, there was a trend (p = 0.283) for higher adjusted mortality rate for cases with VAP (10.1%, 95% CI: 4.8-21.5) than for those without VAP (6.1%, 95% CI: 3.0-12.4). Cases with VAP had a higher total hospital cost ($123,223 AUD vs $66,425 AUD, p < 0.001), than cases without VAP., Conclusions: This is the first study reporting incidence of VAP in an Australian regional intensive care unit setting. An increased length of stay and significantly higher hospital costs warrant research investigating reliable and valid clinical prediction rules to forecast those at risk of VAP., Competing Interests: Conflict of Interest There are no declarations of competing interest., (Copyright © 2021 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Youth depression is highly prevalent and is related to impairments in academic, social and behavioural functioning. Evidence-based treatments are available, but many young people do not respond or sufficiently recover with first-line options, and a significant proportion experience relapse. Consequently, there is clear scope to enhance intervention in this critical period of early-onset depression. Memory specificity training (MeST) is a low-intensity intervention for depression that targets reduced specificity when recalling memories of the past, a common cognitive vulnerability in depression. This randomised controlled trial will assess the efficacy of adding a computerised version of MeST (c-MeST) to usual care for youth depression., Methods/design: Young people aged 15-25 years with a major depressive episode (MDE) will be recruited and randomised to have immediate access to the seven session online c-MeST program in addition to usual care, or to usual care and wait-list for c-MeST. The primary outcomes will be diagnostic status of an MDE and self-reported depressive symptoms assessed at baseline, 1-, 3- and 6-month intervals. Autobiographical memory specificity and other variables thought to contribute to the maintenance of reduced memory specificity and depression will be assessed as mediators of change., Discussion: Online provision of c-MeST provides a simple, low-intensity option for targeting a cognitive vulnerability that predicts the persistence of depressive symptoms. If found to be efficacious as an adjunct to usual care for depressed youth, it could be suitable for broader roll-out, as c-MeST is highly accessible and implementation requires only minimal resources due to the online and automated nature of intervention., Trial Registration: Australian New Zealand Clinical Trials Registry, ACTRN12619000234112p. Registered on the 18 February 2019. All items from the WHO Trial Registration Data Set can be found within the protocol., Protocol Version: 1.0.

Aims: Currently minimal research has quantified physical requirement differences in match-play between youth and senior Australian football players. The aim of the current research was to describe and compare the movement profiles and energy cost of youth, sub-elite and elite senior Australian football match-play., Methods: Fifty-seven Australian footballers playing in an elite senior 20, sub-elite senior 16 and elite youth competition 21 participated in this study. Distance, speed based indices and metabolic power measures recording via Global Positioning System (GPS) devices were compared across three competition tiers. Kicks and handballs were collected via a commercial statistics provider (Champion Data) and compared across the competition tiers., Results: Youth players recorded less field time (elite: ES = 1.37/sub-elite: ES = 1.68), total distance (elite: ES = 1.64 /sub-elite: ES = 1.55) and high speed running (elite: ES = 0.90/sub-elite: ES = 0.26) compared to the elite and sub-elite players. The average energy cost of elite (ES = 2.19) and sub-elite (ES = 1.58) match-play was significantly higher that youth match-play., Conclusions: A progressive increase regarding physical demands was evident across AF competition tiers. The findings suggest that sub-elite match-play can provide a viable pathway for youth players to develop physical capacity and technical skills before transitioning to elite senior match-play., Competing Interests: The authors have declared that no competing interests exist.

Purpose: This study compared the movement demands of players competing in matches from the elite Australian and European rugby league competitions., Methods: Global positioning system devices were used to measure 192 performances of forwards, adjustables, and outside backs during National Rugby League (NRL; n = 88) and European Super League (SL; n = 104) matches. Total and relative distances covered overall and at low (0-3.5 m/s), moderate (3.6-5 m/s), and high (>5 m/s) speeds were measured alongside changes in movement variables across the early, middle, and late phases of the season., Results: The relative distance covered in SL matches (95.8 ± 18.6 m/min) was significantly greater (P < .05) than in NRL matches (90.2 ± 8.3 m/min). Relative low-speed activity (70.3 ± 4.9 m/min vs 75.5 ± 18.9 m/min) and moderate-speed running (12.5 ± 3.3 m m/min vs 14.2 ± 3.8 m/min) were highest (P < .05) in the SL matches, and relative high-speed distance was greater (P < .05) during NRL matches (7.8 ± 2.1 m/min vs 6.1 ± 1.7 m/min)., Conclusions: NRL players have better maintenance of high-speed running between the first and second halves of matches and perform less low- and moderate-speed activity, indicating that the NRL provides a higher standard of rugby league competition than the SL.

Purpose: It is uncertain whether smoking has an independent dose-related adverse effect on mortality in critically ill patients. This study assessed whether the intensity of smoking history, measured in pack-years, has a dose-related effect on mortality in critically ill patients., Methods: In this multicentre cohort study data were collected from six tertiary intensive care units (ICU) in Australia and New Zealand., Results: Of the 8,962 patients considered in the study, data on patients' smoking status and smoking history were available from 5,063 and 2,865 patients, respectively. Male gender, and chronic respiratory, liver and cardiovascular diseases were over-represented among smokers compared to non-smokers. Smokers had a higher risk of requiring mechanical ventilation and dying in hospital than non-smokers (10.7% vs. 6.7%, p=0.001), particularly after emergency admission. Smokers also had a longer ICU stay than non-smokers (mean 3.2 days, interquartile range 0.8-3.2 vs. 2.8 days, interquartile range 0.8-2.9; p=0.024). After adjusting for age, gender, elective surgical admission, severity of acute illness, and severe chronic illnesses, the intensity of smoking history remained significantly associated with the risk of dying in hospital. This was in a relatively linear fashion (odds ratio 1.08 per 10 pack-years increment, 95% confidence interval 1.02-1.15; p=0.02). Further grouping of smokers into active smokers and ex-smokers, or including patients with unknown smoking status in the sensitivity analyses did not change the association between the intensity of smoking history and mortality., Conclusions: Smoking has a dose-related adverse effect on mortality of critically ill patients after adjusting for other confounders., (© Copyright jointly held by Springer and ESICM 2011)

Background: The Better Outcomes in Mental Health Care (BOMHC) initiative encourages general practitioners to use electronic mental health resources (EMHRs) during consultation with patients requiring psychological assistance. However, there is little data on GPs' acceptance and use of EMHRs., Method: Semistructured interviews were conducted with 27 GPs to determine their attitude toward EMHRs, and their use during consultation with patients., Results: Few GPs reported frequently using EMHRs in consultation. Identified barriers to use included lack of familiarity with information technology, and insufficient knowledge of available resources. Identified advantages of electronic resources included high patient acceptance, time efficiency, and improved quality of information., Discussion: General practitioners recognise several advantages of utilising electronic resources for managing patients with mental illness. However, GPs are not sufficiently familiar with electronic resources to use them effectively. This could be overcome by education.

An 18-item questionnaire assessing attitudes toward AIDS and homosexuality was administered to 420 Australian tertiary students. The predictive power of attitudes toward homosexuality, empathy toward AIDS sufferers, knowledge about AIDS, church attendance, age, and sex was tested using independent and stepwise multiple-regression analyses. In the stepwise analysis attitudes toward homosexuality and empathy toward AIDS sufferers were the major contributors to fear about AIDS. Church attendance and age improved the over-all prediction significantly, but only slightly. In the independent analysis all variables, except church attendance, were significant predictors. Educational programmes on AIDS should address the relationship between homosexuality and fear of AIDS.