Response shift, recall bias and their effect on measuring change in health-related quality of life amongst older hospital patients

Background: Assessments of change in subjective patient reported outcomes such as health-related quality of life (HRQoL) are a key component of many clinical and research evaluations. However, conventional longitudinal evaluation of change may not agree with patient perceived change if patients' understanding of the subjective construct under evaluation changes over time (response shift) or if patients' have inaccurate recollection (recall bias). This study examined whether older adults' perception of change is in agreement with conventional longitudinal evaluation of change in their HRQoL over the duration of their hospital stay. It also investigated this level of agreement after adjusting patient perceived change for recall bias that patients may have experienced. Methods: A prospective longitudinal cohort design nested within a larger randomised controlled trial was implemented. 103 hospitalised older adults participated in this investigation at a tertiary hospital facility. The EQ-5D utility and Visual Analogue Scale (VAS) scores were used to evaluate HRQoL. Participants completed EQ-5D reports as soon as they were medically stable (within three days of admission) then again immediately prior to discharge. Three methods of change score calculation were used (conventional change, patient perceived change and patient perceived change adjusted for recall bias). Agreement was primarily investigated using intraclass correlation coefficients (ICC) and limits of agreement. Results: Overall 101 (98%) participants completed both admission and discharge assessments. The mean (SD) age was 73.3 (11.2). The median (IQR) length of stay was 38 (20-60) days. For agreement between conventional longitudinal change and patient perceived change: ICCs were 0.34 and 0.40 for EQ-5D utility and VAS respectively. For agreement between conventional longitudinal change and patient perceived change adjusted for recall bias: ICCs were 0.98 and 0.90 respectively. Discrepancy between conventional longitudinal change and patient perceived change was considered clinically meaningful for 84 (83.2%) of participants, after adjusting for recall bias this reduced to 8 (7.9%). Conclusions: Agreement between conventional change and patient perceived change was not strong. A large proportion of this disagreement could be attributed to recall bias. To overcome the invalidating effect of response shift (on conventional change) and recall bias (on patient perceived change) a method of adjusting patient perceived change for recall bias has been described.

Evidence of disagreement between patient-perceived change and conventional longitudinal evaluation of change in health-related quality of life among older adults

Objective: To identify agreement levels between conventional longitudinal evaluation of change (post–pre) and patient-perceived change (post–then test) in health-related quality of life. Design: A prospective cohort investigation with two assessment points (baseline and six-month follow-up) was implemented. Setting: Community rehabilitation setting. Subjects: Frail older adults accessing community-based rehabilitation services. Intervention: Nil as part of this investigation. Main measures: Conventional longitudinal change in health-related quality of life was considered the difference between standard EQ-5D assessments completed at baseline and follow-up. To evaluate patient-perceived change a ‘then test’ was also completed at the follow-up assessment. This required participants to report (from their current perspective) how they believe their health-related quality of life was at baseline (using the EQ-5D). Patient-perceived change was considered the difference between ‘then test’ and standard follow-up EQ-5D assessments. Results: The mean (SD) age of participants was 78.8 (7.3). Of the 70 participants 62 (89%) of data sets were complete and included in analysis. Agreement between conventional (post–pre) and patient-perceived (post–then test) change was low to moderate (EQ-5D utility intraclass correlation coefficient (ICC)¼0.41, EQ-5D visual analogue scale (VAS) ICC¼0.21). Neither approach inferred greater change than the other (utility P¼0.925, VAS P¼0.506). Mean (95% confidence interval (CI)) conventional change in EQ-5D utility and VAS were 0.140 (0.045,0.236) and 8.8 (3.3,14.3) respectively, while patient-perceived change was 0.147 (0.055,0.238) and 6.4 (1.7,11.1) respectively. Conclusions: Substantial disagreement exists between conventional longitudinal evaluation of change in health-related quality of life and patient-perceived change in health-related quality of life (as measured using a then test) within individuals.

Physical function and health-related quality of life of older adults undergoing hospital rehabilitation : how strong is the association?

The purpose of this research is to report preliminary empirical evidence regarding the association between common physical performance measures and health-related quality of life (HRQoL) of hospitalized older adults recovering from illness and injury. Frequently, these patients do not return to premorbid levels of independence and physical ability. Rehabilitation for this population often focuses on improving physical functioning and mobility with the intention of maximizing their HRQoL for discharge and thereafter. For this reason, longitudinal use of physical performance measures as an indicator of improvement in physical functioning (and thus HRQoL) is common. Although this is a logical approach, there have been mixed results from previous investigations into the association between common measures of physical function and HRQoL amongst other adult patient populations.1,2 There has been no previous investigation reporting the association between HRQoL and a variety of common physical performance measures in hospitalized older adults.

Preparing quality teachers : making learning visible

Teacher quality is recognised as a lynchpin for education reforms internationally, and both Federal and State governments in Australia have turned their attention to teacher education institutions: the starting point for preparing quality teachers. Changes to policy and shifts in expectations impact on Faculties of Education, despite the fact that little is known about what makes a quality teacher preparation program effective. New accountability measures, mandated Professional Standards, and proposals to test all graduates before registration, mean that teacher preparation programs need capacity for flexibility and responsiveness. The risk is that undergraduate degree programs can become ‘patchwork quilts’ with traces of the old and new stitched together, sometimes at the expense of coherence and integrity. This paper provides a roadmap used by one large Faculty of Education in Queensland for reforming and reconceptualising the curriculum for a 4-year undergraduate program, in response to new demands from government and the professional bodies.

Measurement of the net environmental benefit of offsetting in Queensland

The process of offsetting land against unavoidable disturbance of development sites in Queensland will benefit from a method that allows the best possible selection to be made of alternative lands. With site selection now advocated through a combination of Regional Ecosystem and Land Capability classifications state-wide, a case study has determined methods of assessing the functional lift – that is, measures of net environmental gain – of such action. Outcomes with potentially high functional lift are determined, that offer promise not only for endangered ecosystems but also for managing adjacent conservation reserves.

Variability of input parameters related to pollutants build-up in stormwater quality modelling

The variability of input parameters is the most important source of overall model uncertainty. Therefore, an in-depth understanding of the variability is essential for uncertainty analysis of stormwater quality model outputs. This paper presents the outcomes of a research study which investigated the variability of pollutants build-up characteristics on road surfaces in residential, commercial and industrial land uses. It was found that build-up characteristics vary highly even within the same land use. Additionally, industrial land use showed relatively higher variability of maximum build-up, build-up rate and particle size distribution, whilst the commercial land use displayed a relatively higher variability of pollutant-solid ratio. Among the various build-up parameters analysed, D50 (volume-median-diameter) displayed the relatively highest variability for all three land uses.

An application of the CBBE model to assess brand loyalty for a long haul travel destination

In the past two decades there has been increasing interest in branding tourism destinations in an effort to meaningfully differentiate against a myriad of competing places that offer similar attractions and facilities. The academic literature relating to destination branding commenced only as recently as 1998, and there remains a dearth of empirical data that tests the effectiveness of brand campaigns, particularly in terms of enhancing destination loyalty. This paper reports the results of an investigation into destination brand loyalty for Australia as a long haul destination in a South American market. In spite of the high level of academic interest in the measurement of perceptions of destinations since the 1970s, few previous studies have examined perceptions held by South American consumers. Drawing on a model of consumer-based brand equity (CBBE), antecedents of destination brand loyalty was tested with data from a large Chilean sample of travelers, comprising a mix of previous visitors and non-visitors to Australia. Findings suggest that destination brand awareness, brand image, and brand value are positively related to brand loyalty for a long-haul destination. However, destination brand quality was not significantly related. The results also indicate that Australia is a more compelling destination brand for previous visitors compared to non-visitors.

Establishing a quality franchise relationship in Taiwan : Investigating relationships between relationship quality, loyalty and cooperation

Franchised convenience stores successfully operate throughout Taiwan, but the convenience store market is approaching saturation point. Creating a cooperative long-term franchising relationship between franchisors and franchisees is essential to maintain the proportion of convenience stores...

Wavefront aberrations and the depth of focus of the human eye

The depth of focus (DOF) can be defined as the variation in image distance of a lens or an optical system which can be tolerated without incurring an objectionable lack of sharpness of focus. The DOF of the human eye serves a mechanism of blur tolerance. As long as the target image remains within the depth of focus in the image space, the eye will still perceive the image as being clear. A large DOF is especially important for presbyopic patients with partial or complete loss of accommodation (presbyopia), since this helps them to obtain an acceptable retinal image when viewing a target moving through a range of near to intermediate distances. The aim of this research was to investigate the DOF of the human eye and its association with the natural wavefront aberrations, and how higher order aberrations (HOAs) can be used to expand the DOF, in particular by inducing spherical aberrations ( 0 4 Z and 0 6 Z ). The depth of focus of the human eye can be measured using a variety of subjective and objective methods. Subjective measurements based on a Badal optical system have been widely adopted, through which the retinal image size can be kept constant. In such measurements, the subject.s tested eye is normally cyclopleged. Objective methods without the need of cycloplegia are also used, where the eye.s accommodative response is continuously monitored. Generally, the DOF measured by subjective methods are slightly larger than those measured objectively. In recent years, methods have also been developed to estimate DOF from retinal image quality metrics (IQMs) derived from the ocular wavefront aberrations. In such methods, the DOF is defined as the range of defocus error that degrades the retinal image quality calculated from the IQMs to a certain level of the possible maximum value. In this study, the effect of different amounts of HOAs on the DOF was theoretically evaluated by modelling and comparing the DOF of subjects from four different clinical groups, including young emmetropes (20 subjects), young myopes (19 subjects), presbyopes (32 subjects) and keratoconics (35 subjects). A novel IQM-based through-focus algorithm was developed to theoretically predict the DOF of subjects with their natural HOAs. Additional primary spherical aberration ( 0 4 Z ) was also induced in the wavefronts of myopes and presbyopes to simulate the effect of myopic refractive correction (e.g. LASIK) and presbyopic correction (e.g. progressive power IOL) on the subject.s DOF. Larger amounts of HOAs were found to lead to greater values of predicted DOF. The introduction of primary spherical aberration was found to provide moderate increase of DOF while slightly deteriorating the image quality at the same time. The predicted DOF was also affected by the IQMs and the threshold level adopted. We then investigated the influence of the chosen threshold level of the IQMs on the predicted DOF, and how it relates to the subjectively measured DOF. The subjective DOF was measured in a group of 17 normal subjects, and we used through-focus visual Strehl ratio based on optical transfer function (VSOTF) derived from their wavefront aberrations as the IQM to estimate the DOF. The results allowed comparison of the subjective DOF with the estimated DOF and determination of a threshold level for DOF estimation. Significant correlation was found between the subject.s estimated threshold level for the estimated DOF and HOA RMS (Pearson.s r=0.88, p<0.001). The linear correlation can be used to estimate the threshold level for each individual subject, subsequently leading to a method for estimating individual.s DOF from a single measurement of their wavefront aberrations. A subsequent study was conducted to investigate the DOF of keratoconic subjects. Significant increases of the level of HOAs, including spherical aberration, coma and trefoil, can be observed in keratoconic eyes. This population of subjects provides an opportunity to study the influence of these HOAs on DOF. It was also expected that the asymmetric aberrations (coma and trefoil) in the keratoconic eye could interact with defocus to cause regional blur of the target. A dual-Badal-channel optical system with a star-pattern target was used to measure the subjective DOF in 10 keratoconic eyes and compared to those from a group of 10 normal subjects. The DOF measured in keratoconic eyes was significantly larger than that in normal eyes. However there was not a strong correlation between the large amount of HOA RMS and DOF in keratoconic eyes. Among all HOA terms, spherical aberration was found to be the only HOA that helped to significantly increase the DOF in the studied keratoconic subjects. Through the first three studies, a comprehensive understanding of DOF and its association to the HOAs in the human eye had been achieved. An adaptive optics system was then designed and constructed. The system was capable of measuring and altering the wavefront aberrations in the subject.s eye and measuring the resulting DOF under the influence of different combination of HOAs. Using the AO system, we investigated the concept of extending the DOF through optimized combinations of 0 4 Z and 0 6 Z . Systematic introduction of a targeted amount of both 0 4 Z and 0 6 Z was found to significantly improve the DOF of healthy subjects. The use of wavefront combinations of 0 4 Z and 0 6 Z with opposite signs can further expand the DOF, rather than using 0 4 Z or 0 6 Z alone. The optimal wavefront combinations to expand the DOF were estimated using the ratio of increase in DOF and loss of retinal image quality defined by VSOTF. In the experiment, the optimal combinations of 0 4 Z and 0 6 Z were found to provide a better balance of DOF expansion and relatively smaller decreases in VA. Therefore, the optimal combinations of 0 4 Z and 0 6 Z provides a more efficient method to expand the DOF rather than 0 4 Z or 0 6 Z alone. This PhD research has shown that there is a positive correlation between the DOF and the eye.s wavefront aberrations. More aberrated eyes generally have a larger DOF. The association of DOF and the natural HOAs in normal subjects can be quantified, which allows the estimation of DOF directly from the ocular wavefront aberration. Among the Zernike HOA terms, spherical aberrations ( 0 4 Z and 0 6 Z ) were found to improve the DOF. Certain combinations of 0 4 Z and 0 6 Z provide a more effective method to expand DOF than using 0 4 Z or 0 6 Z alone, and this could be useful in the optimal design of presbyopic optical corrections such as multifocal contact lenses, intraocular lenses and laser corneal surgeries.

Interpreting regional frequencies from synchronized phasor measurement in multi-area power systems

In this paper a new approach is proposed for interpreting of regional frequencies in multi machine power systems. The method uses generator aggregation and system reduction based on coherent generators in each area. The reduced system structure is able to be identified and a kalman estimator is designed for the reduced system to estimate the inter-area modes using the synchronized phasor measurement data. The proposed method is tested on a six machine, three area test system and the obtained results show the estimation of inter-area oscillations in the system with a high accuracy.

Pedometry methods for assessing free-living youth

The purpose of this review is to integrate and summarize specific measurement topics (instrument and metric choice, validity, reliability, how many and what types of days, reactivity, and data treatment) appropriate to the study of youth physical activity. Research quality pedometers are necessary to aid interpretation of steps per day collected in a range of young populations under a variety of circumstances. Steps per day is the most appropriate metric choice, but steps per minute can be used to interpret time-in-intensity in specifically delimited time periods (e.g., physical education class). Reported intraclass correlations (ICC) have ranged from .65 over 2 days (although higher values also have been reported for 2 days) to .87 over 8 days (although higher values have been reported for fewer days). Reported ICCs are lower on weekend days (.59) versus weekdays (.75) and lower over vacation days (.69) versus school days (.74). There is no objective evidence of reactivity at this time. Data treatment includes (a) identifying and addressing missing values, (b) identifying outliers and reducing data appropriately if necessary, and (c) transforming the data as required in preparation for inferential analysis. As more pedometry studies in young populations are published, these preliminary methodological recommendations should be modified and refined.

Evaluating the influences of stakeholder management on construction project quality

The issue of ensuring that construction projects achieve high quality outcomes continues to be an important consideration for key project stakeholders. Although a lot of quality practices have been done within the industry, establishment and achievement of reasonable levels of quality in construction projects continues to be a problem. While some studies into the introduction and development of quality practices and stakeholder management in the construction industry have been undertaken separately, no major studies have so far been completed that examine in depth how quality management practices that specifically address stakeholders’ perspectives of quality can be utilised to contribute to the ultimate constructed quality of projects. This paper encompasses and summarizes a review of the literature related to previous research undertaken on quality within the industry, focuses on the benefits and shortcomings, together with examining the concept of integrating stakeholder perspectives of project quality for improvement of outcomes throughout the project lifecycle. Findings discussed in this paper reveal a pressing need for investigation, development and testing of a framework to facilitate better implementation of quality management practices and thus achievement of better quality outcomes within the construction industry. The framework will incorporate and integrate the views of stakeholders on what constitutes final project quality to be utilised in developing better quality management planning and systems aimed ultimately at achieving better project quality delivery.

Machine learning techniques to improve software quality

A significant proportion of the cost of software development is due to software testing and maintenance. This is in part the result of the inevitable imperfections due to human error, lack of quality during the design and coding of software, and the increasing need to reduce faults to improve customer satisfaction in a competitive marketplace. Given the cost and importance of removing errors improvements in fault detection and removal can be of significant benefit. The earlier in the development process faults can be found, the less it costs to correct them and the less likely other faults are to develop. This research aims to make the testing process more efficient and effective by identifying those software modules most likely to contain faults, allowing testing efforts to be carefully targeted. This is done with the use of machine learning algorithms which use examples of fault prone and not fault prone modules to develop predictive models of quality. In order to learn the numerical mapping between module and classification, a module is represented in terms of software metrics. A difficulty in this sort of problem is sourcing software engineering data of adequate quality. In this work, data is obtained from two sources, the NASA Metrics Data Program, and the open source Eclipse project. Feature selection before learning is applied, and in this area a number of different feature selection methods are applied to find which work best. Two machine learning algorithms are applied to the data - Naive Bayes and the Support Vector Machine - and predictive results are compared to those of previous efforts and found to be superior on selected data sets and comparable on others. In addition, a new classification method is proposed, Rank Sum, in which a ranking abstraction is laid over bin densities for each class, and a classification is determined based on the sum of ranks over features. A novel extension of this method is also described based on an observed polarising of points by class when rank sum is applied to training data to convert it into 2D rank sum space. SVM is applied to this transformed data to produce models the parameters of which can be set according to trade-off curves to obtain a particular performance trade-off.

Discovery & effective use of quality association rules in multi-level datasets

In today’s electronic world vast amounts of knowledge is stored within many datasets and databases. Often the default format of this data means that the knowledge within is not immediately accessible, but rather has to be mined and extracted. This requires automated tools and they need to be effective and efficient. Association rule mining is one approach to obtaining knowledge stored with datasets / databases which includes frequent patterns and association rules between the items / attributes of a dataset with varying levels of strength. However, this is also association rule mining’s downside; the number of rules that can be found is usually very big. In order to effectively use the association rules (and the knowledge within) the number of rules needs to be kept manageable, thus it is necessary to have a method to reduce the number of association rules. However, we do not want to lose knowledge through this process. Thus the idea of non-redundant association rule mining was born. A second issue with association rule mining is determining which ones are interesting. The standard approach has been to use support and confidence. But they have their limitations. Approaches which use information about the dataset’s structure to measure association rules are limited, but could yield useful association rules if tapped. Finally, while it is important to be able to get interesting association rules from a dataset in a manageable size, it is equally as important to be able to apply them in a practical way, where the knowledge they contain can be taken advantage of. Association rules show items / attributes that appear together frequently. Recommendation systems also look at patterns and items / attributes that occur together frequently in order to make a recommendation to a person. It should therefore be possible to bring the two together. In this thesis we look at these three issues and propose approaches to help. For discovering non-redundant rules we propose enhanced approaches to rule mining in multi-level datasets that will allow hierarchically redundant association rules to be identified and removed, without information loss. When it comes to discovering interesting association rules based on the dataset’s structure we propose three measures for use in multi-level datasets. Lastly, we propose and demonstrate an approach that allows for association rules to be practically and effectively used in a recommender system, while at the same time improving the recommender system’s performance. This especially becomes evident when looking at the user cold-start problem for a recommender system. In fact our proposal helps to solve this serious problem facing recommender systems.

Conceptualising use for information systems (IS) success

This thesis conceptualises Use for IS (Information Systems) success. While Use in this study describes the extent to which an IS is incorporated into the user’s processes or tasks, success of an IS is the measure of the degree to which the person using the system is better off. For IS success, the conceptualisation of Use offers new perspectives on describing and measuring Use. We test the philosophies of the conceptualisation using empirical evidence in an Enterprise Systems (ES) context. Results from the empirical analysis contribute insights to the existing body of knowledge on the role of Use and demonstrate Use as an important factor and measure of IS success. System Use is a central theme in IS research. For instance, Use is regarded as an important dimension of IS success. Despite its recognition, the Use dimension of IS success reportedly suffers from an all too simplistic definition, misconception, poor specification of its complex nature, and an inadequacy of measurement approaches (Bokhari 2005; DeLone and McLean 2003; Zigurs 1993). Given the above, Burton-Jones and Straub (2006) urge scholars to revisit the concept of system Use, consider a stronger theoretical treatment, and submit the construct to further validation in its intended nomological net. On those considerations, this study re-conceptualises Use for IS success. The new conceptualisation adopts a work-process system-centric lens and draws upon the characteristics of modern system types, key user groups and their information needs, and the incorporation of IS in work processes. With these characteristics, the definition of Use and how it may be measured is systematically established. Use is conceptualised as a second-order measurement construct determined by three sub-dimensions: attitude of its users, depth, and amount of Use. The construct is positioned in a modified IS success research model, in an attempt to demonstrate its central role in determining IS success in an ES setting. A two-stage mixed-methods research design—incorporating a sequential explanatory strategy—was adopted to collect empirical data and to test the research model. The first empirical investigation involved an experiment and a survey of ES end users at a leading tertiary education institute in Australia. The second, a qualitative investigation, involved a series of interviews with real-world operational managers in large Indian private-sector companies to canvass their day-to-day experiences with ES. The research strategy adopted has a stronger quantitative leaning. The survey analysis results demonstrate the aptness of Use as an antecedent and a consequence of IS success, and furthermore, as a mediator between the quality of IS and the impacts of IS on individuals. Qualitative data analysis on the other hand, is used to derive a framework for classifying the diversity of ES Use behaviour. The qualitative results establish that workers Use IS in their context to orientate, negotiate, or innovate. The implications are twofold. For research, this study contributes to cumulative IS success knowledge an approach for defining, contextualising, measuring, and validating Use. For practice, research findings not only provide insights for educators when incorporating ES for higher education, but also demonstrate how operational managers incorporate ES into their work practices. Research findings leave the way open for future, larger-scale research into how industry practitioners interact with an ES to complete their work in varied organisational environments.