An Examination of Community Awareness and Understanding of Patron Banning Provisions in Western Australia: Implications for Policy Development and Success.

Individuals who engage in problematic behaviours within Australian night-time entertainment precincts can be banned from entering certain locations. Bans are expected to deter recipients and the wider community from further inappropriate behaviours. The collective effect is intended to reduce crime and increase safety within entertainment precincts. This study examined public awareness and understanding of two patron banning mechanisms (police barring notices and prohibition orders) used across Western Australia (WA). An anonymous survey was completed by 1018 respondents, and interviews were conducted with 54 stakeholders. Survey participants had limited awareness of patron banning: 75% had not heard of police barring notices; 87% had not heard of prohibition orders. Knowledge was higher for individuals directly associated with a ban recipient. Stakeholders also perceived a low level of community awareness and understanding of patron banning. Patron banning may have some merit as a specific deterrent for recipients but, in WA, the lack of public knowledge means that the banning provisions may currently have limited effect as a general deterrent. Public awareness should be increased in order to optimise the direct and consequential effects of patron banning policy.

Romidepsin in peripheral and cutaneous T-cell lymphoma: mechanistic implications from clinical and correlative data.

Romidepsin is an epigenetic agent approved for the treatment of patients with cutaneous or peripheral T-cell lymphoma (CTCL and PTCL). Here we report data in all patients treated on the National Cancer Institute 1312 trial, demonstrating long-term disease control and the ability to retreat patients relapsing off-therapy. In all, 84 patients with CTCL and 47 with PTCL were enrolled. Responses occurred early, were clinically meaningful and of very long duration in some cases. Notably, patients with PTCL receiving romidepsin as third-line therapy or later had a comparable response rate (32%) of similar duration as the total population (38%). Eight patients had treatment breaks of 3.5 months to 10 years; in four of six patients, re-initiation of treatment led to clear benefit. Safety data show slightly greater haematological and constitutional toxicity in PTCL. cDNA microarray studies show unique individual gene expression profiles, minimal overlap between patients, and both induction and repression of gene expression that reversed within 24 h. These data argue against cell death occurring as a result of an epigenetics-mediated gene induction programme. Together this work supports the safety and activity of romidepsin in T-cell lymphoma, but suggests a complex mechanism of action.

Preparing NPs for primary care: unraveling complexity with unfolding cases.

Patients with comorbid mental and physical illnesses often present in the primary care setting. To explore the complexities of caring for these patients, a Behavioral Health Therapeutics course was developed and taught in the first semester of a Doctor of Nursing Practice program. This article describes the research, theories, and curricular innovations used in the online learning environment, which provide the foundation for the course and reflect the essential changes called for in the 2010 Carnegie report. Highlighted in this article is the unfolding case study method using Backward Design by Wiggins and McTighe in the planning phase, Zull's model for engaging the brain in the Implementation phase, and grading criteria created from Tanner's "Case for Cases: A Pedagogy for Developing Habits of Thought" in the evaluation phase.

Authentic Teaching to Promote Active Learning: Redesign of an Online RN to BSN Evidence-Based Practice Nursing Course.

BACKGROUND: Although an evidence-based practice course (EBP) is taught in most undergraduate nursing programs, timeworn teaching strategies of lecture, discussions, and narrative written assignments are typically used. PROBLEM: The current online EBP course in an RN-BSN program was initially developed with low level objectives and included busywork that did not provide students with an opportunity to apply the seven steps of the EBP process. APPROACH: Revision of the EBP course incorporated authentic teaching/learning methods, in which active learning was required since students actually worked through the seven steps of the EBP process; first through small group online discussions and then through individually crafted assignments. The project was not implemented since it was based on a realistic but fictitious clinical scenario that was used throughout the various steps. Each step began with all students working from the same information or data, which helped to focus on learning the EBP process itself. CONCLUSIONS: Students reported decreased stress by first working collaboratively in groups where they received support from faculty and classmates, then completing individual assignments. Faculty were in turn given support when giving feedback and grading assignments by using completed templates and reference lists that were provided for them. Students also demonstrated better preparation to develop and implement their own EBP projects in their capstone course.

A legal analysis of Australian criminal cases involving defendants with autism spectrum disorder charged with online sexual offending.

This paper examines how the symptomology of the small number of individuals with autism spectrum disorder (ASD) charged with online sexual offenses in Australia is established during legal arguments and conceived by the judiciary to impact legal liability and offending behavior. This study aims to provide empirical support for the proposition that judicial discourses regarding the connection between ASD and online sexual offending, including conduct related to child exploitation material (CEM), have little bearing on overall questions of criminal liability or the use of alternative penal dispositions. It does so by exploring a sample of nine recent Australian criminal cases, involving ten rulings, that examine how evidence of ASD is raised in legal arguments in ways that suggest a diagnosed condition may have contributed significantly to the alleged wrongdoing. We conclude by suggesting current Australian judicial practice requires more sensitivity to the impact of clinical factors associated with ASD in shaping alternative supervisory and non-custodial dispositions for individuals convicted of online sexual offenses.

AVX-470, an Orally Delivered Anti-Tumour Necrosis Factor Antibody for Treatment of Active Ulcerative Colitis: Results of a First-in-Human Trial.

BACKGROUND AND AIMS: AVX-470 is an oral, polyclonal bovine-derived anti-tumour necrosis factor (TNF) antibody in development for treatment of inflammatory bowel disease (IBD). AVX-470 neutralizes TNF locally in the gastrointestinal tract, minimizing systemic exposure. This was a double-blind, placebo-controlled, first-in-human trial designed to assess the safety, pharmacokinetics, immunogenicity and preliminary efficacy of 4 weeks of AVX-470 in patients with active ulcerative colitis (UC). METHODS: Thirty-seven patients with active UC were randomized and 36 received AVX-470 (0.2, 1.6 or 3.5g/day) or placebo over 4 weeks. Endoscopic activity was assessed by colonoscopy pre- and post-treatment. The primary endpoint was safety. Secondary endpoints included pharmacokinetics and immunogenicity. Clinical and endoscopic response and remission were assessed as exploratory endpoints. RESULTS: Thirty-three (92%) patients completed treatment and follow-up. The incidence of adverse events was similar across treatment groups and no allergic reactions or opportunistic infections were reported. AVX-470 therapy did not induce human anti-bovine antibodies (HABA). Bovine immunoglobulin (Ig) with TNF binding capacity was detected in stool, while bovine Ig levels in serum were low. Across all AVX-470 doses, 25.9% of patients achieved clinical response compared with 11.1% on placebo, with greatest improvements in the 3.5g/day group associated with proximal colon endoscopic improvement and reductions in serum CRP and IL-6. CONCLUSIONS: AVX-470 was safe and well tolerated in this first-in-human trial in UC, with efficacy trends for clinical, endoscopic and biomarker endpoints in the highest dose group (3.5g/day). Results suggest benefit of an orally delivered locally active agent in moderate to severe UC. CLINICAL TRIAL REGISTRATION NUMBER: This trial was registered with Clinicaltrials.gov as study NCT01759056 and with EudraCT as study 2012-004859-27.

Teaching dual-process diagnostic reasoning to doctor of nursing practice students: problem-based learning and the illness script.

Accelerating the development of diagnostic reasoning skills for nurse practitioner students is high on the wish list of many faculty. The purpose of this article is to describe how the teaching strategy of problem-based learning (PBL) that drills the hypothetico-deductive or analytic reasoning process when combined with an assignment that fosters pattern recognition (a nonanalytic process) teaches and reinforces the dual process of diagnostic reasoning. In an online Doctor of Nursing Practice program, four PBL cases that start with the same symptom unfold over 2 weeks. These four cases follow different paths as they unfold leading to different diagnoses. Culminating each PBL case, a unique assignment called an illness script was developed to foster the development of pattern recognition. When combined with hypothetico-deductive reasoning drilled during the PBL case, students experience the dual process approach to diagnostic reasoning used by clinicians.

Polymyalgia rheumatica and giant cell arteritis: an in-depth look at diagnosis and treatment.

PURPOSE: To provide an in-depth synthesis of the literature on polymyalgia rheumatic (PMR) and giant cell arteritis (GCA) that will assist the primary care nurse practitioner (NP) in recognizing the variety of symptom presentations, accurately evaluating laboratory data, developing a plan of care that includes current treatment guidelines, and adroitly managing patients for improved outcomes. DATA SOURCES: A thorough search of the literature was conducted including MEDLINE, CIHAHL, and PubMed encompassing the decades from the 1970s to the present. CONCLUSIONS: Because of the varied and vague symptom presentations of PMR and GCA, primary healthcare providers often misdiagnose these pathologies, delaying treatment and relief of suffering. Textbooks descriptions often omit supplemental content necessary to understand the intricacies of the presenting symptoms, diagnostic tests needed for work-up, and specific treatment for these overlapping pathologies. IMPLICATIONS FOR PRACTICE: Because PMR and GCA often present in the primary care setting, NPs must maintain a high index of suspicion when a patient over 60 years of age presents with vague complaints such as headache, weakness, anorexia, and malaise. Arriving at an accurate diagnosis in a timely fashion will lead to appropriate treatment and minimize patient suffering.