Development of patient-specific computer simulation tools for endoscopic scoliosis surgery

Endoscopic approaches for anterior correction of idiopathic scoliosis are a relatively new surgical technique. This paper describes the development of patient-specific finite element modelling techniques to investigate the biomechanics of single rod anterior scoliosis correction. Spinal geometry is obtained from pre-operative CT scans and material properties for osteo-ligamentous spinal tissues are based on existing literature. The techniques being developed will allow pre-surgical prediction of stresses, forces and deformations in spinal tissues, rods and screws under post-operative physiological loads.

Application of data mining techniques in the prediction of coronary artery disease : use of anaesthesia time-series and patient risk factor data

The high morbidity and mortality associated with atherosclerotic coronary vascular disease (CVD) and its complications are being lessened by the increased knowledge of risk factors, effective preventative measures and proven therapeutic interventions. However, significant CVD morbidity remains and sudden cardiac death continues to be a presenting feature for some subsequently diagnosed with CVD. Coronary vascular disease is also the leading cause of anaesthesia related complications. Stress electrocardiography/exercise testing is predictive of 10 year risk of CVD events and the cardiovascular variables used to score this test are monitored peri-operatively. Similar physiological time-series datasets are being subjected to data mining methods for the prediction of medical diagnoses and outcomes. This study aims to find predictors of CVD using anaesthesia time-series data and patient risk factor data. Several pre-processing and predictive data mining methods are applied to this data. Physiological time-series data related to anaesthetic procedures are subjected to pre-processing methods for removal of outliers, calculation of moving averages as well as data summarisation and data abstraction methods. Feature selection methods of both wrapper and filter types are applied to derived physiological time-series variable sets alone and to the same variables combined with risk factor variables. The ability of these methods to identify subsets of highly correlated but non-redundant variables is assessed. The major dataset is derived from the entire anaesthesia population and subsets of this population are considered to be at increased anaesthesia risk based on their need for more intensive monitoring (invasive haemodynamic monitoring and additional ECG leads). Because of the unbalanced class distribution in the data, majority class under-sampling and Kappa statistic together with misclassification rate and area under the ROC curve (AUC) are used for evaluation of models generated using different prediction algorithms. The performance based on models derived from feature reduced datasets reveal the filter method, Cfs subset evaluation, to be most consistently effective although Consistency derived subsets tended to slightly increased accuracy but markedly increased complexity. The use of misclassification rate (MR) for model performance evaluation is influenced by class distribution. This could be eliminated by consideration of the AUC or Kappa statistic as well by evaluation of subsets with under-sampled majority class. The noise and outlier removal pre-processing methods produced models with MR ranging from 10.69 to 12.62 with the lowest value being for data from which both outliers and noise were removed (MR 10.69). For the raw time-series dataset, MR is 12.34. Feature selection results in reduction in MR to 9.8 to 10.16 with time segmented summary data (dataset F) MR being 9.8 and raw time-series summary data (dataset A) being 9.92. However, for all time-series only based datasets, the complexity is high. For most pre-processing methods, Cfs could identify a subset of correlated and non-redundant variables from the time-series alone datasets but models derived from these subsets are of one leaf only. MR values are consistent with class distribution in the subset folds evaluated in the n-cross validation method. For models based on Cfs selected time-series derived and risk factor (RF) variables, the MR ranges from 8.83 to 10.36 with dataset RF_A (raw time-series data and RF) being 8.85 and dataset RF_F (time segmented time-series variables and RF) being 9.09. The models based on counts of outliers and counts of data points outside normal range (Dataset RF_E) and derived variables based on time series transformed using Symbolic Aggregate Approximation (SAX) with associated time-series pattern cluster membership (Dataset RF_ G) perform the least well with MR of 10.25 and 10.36 respectively. For coronary vascular disease prediction, nearest neighbour (NNge) and the support vector machine based method, SMO, have the highest MR of 10.1 and 10.28 while logistic regression (LR) and the decision tree (DT) method, J48, have MR of 8.85 and 9.0 respectively. DT rules are most comprehensible and clinically relevant. The predictive accuracy increase achieved by addition of risk factor variables to time-series variable based models is significant. The addition of time-series derived variables to models based on risk factor variables alone is associated with a trend to improved performance. Data mining of feature reduced, anaesthesia time-series variables together with risk factor variables can produce compact and moderately accurate models able to predict coronary vascular disease. Decision tree analysis of time-series data combined with risk factor variables yields rules which are more accurate than models based on time-series data alone. The limited additional value provided by electrocardiographic variables when compared to use of risk factors alone is similar to recent suggestions that exercise electrocardiography (exECG) under standardised conditions has limited additional diagnostic value over risk factor analysis and symptom pattern. The effect of the pre-processing used in this study had limited effect when time-series variables and risk factor variables are used as model input. In the absence of risk factor input, the use of time-series variables after outlier removal and time series variables based on physiological variable values’ being outside the accepted normal range is associated with some improvement in model performance.

Mentoring experiences as professional development for leaders in environmental education : the cascade of influence

Environmental education is a field which has only come of age since the late nineteen sixties. While its content and practice have been widely debated and researched, its leadership has been minimally studied and, therefore, is only partially understood. The role of mentoring in the development of leaders has been alluded to, but has attracted scant research. Therefore, this study explores the importance of mentoring during the personal and professional development of leaders in environmental education. Four major research questions were investigated. Firstly, have leaders been men to red during their involvement with environmental education? Secondly, when and how has that mentoring taken place? Thirdly, what was the personal and professional effectiveness of the mentoring relationship? Fourthly, is there any continuation of the mentoring process which might be appropriate for professional development within the field of environmental education? Leaders were solicited from a broad field of environmental educators including teachers, administrators, academics, natural resource personnel, business and community persons. They had to be recognized as active leaders across several environmental education networks. The research elicited qualitative and quantitative survey data from fifty seven persons in Queensland, Australia and Colorado, USA. Seventeen semi-structured interviews were subsequently conducted with selected leaders who had nominated their mentors. This led to a further thirteen 'linked interviews' with some of the mentors' mentors and new mentorees. The interview data is presented as four cases reflecting pairs, triads, chains and webs of relationships- a major finding of the research process. The analysis of the data from the interviews and the surveys was conducted according to a grounded theory approach and was facilitated by NUD.IST, a computer program for non-numerical text analysis. The findings of the study revealed many variations on the classical mentoring patterns found in the literature. Gender and age were not seen as mportant factors, as there were examples of contemporaries in age, older men to younger women, older women to younger men, and women to women. Personal compatibility, professional respect and philosophical congruence were critical. Mentoring was initiated from early, mid and late career stages with the average length of the relationship being fourteen years. There was seldom an example of the mentoree using the mentor for hierarchical career climbing, although frequent career changes were made. However, leadership actions were found to increase after the intervention of a mentoring relationship. Three major categories of informal mentoring were revealed - perceived,acknowledged and deliberate. Further analysis led to the evolution of the core concept, a 'cascade of influence'. The major finding of this study was that this sample of leaders, mentors and new mentorees moved from the perception of having been mentored to the acknowledgment of these relationships and an affirmation of their efficacy for both personal and professional growth. Hence, the participants were more likely to continue future mentoring, not as a serendipitous happening, but through a deliberate choice. Heightened awareness and more frequent 'cascading' of mentoring have positive implications for the professional development of future leaders in environmental education in both formal and informal settings. Effective mentoring in environmental education does not seek to create 'clones' of the mentors, but rather to foster the development of autonomous mentorees who share a philosophical grounding. It is a deliberate invitation to 'join the clan'.

The development of science concepts emergent from science museum and post-visit activity experiences : students' construction of knowledge

This research investigated students' construction of knowledge about the topics of magnetism and electricity emergent from a visit to an interactive science centre and subsequent classroom-based activities linked to the science centre exhibits. The significance of this study is that it analyses critically an aspect of school visits to informal learning centres that has been neglected by researchers in the past, namely the influence of post-visit activities in the classroom on subsequent learning and knowledge construction. Employing an interpretive methodology, the study focused on three areas of endeavour. Firstly, the establishment of a set of principles for the development of post-visit activities, from a constructivist framework, to facilitate students' learning of science. Secondly, to describe and interpret students' scientific understandings : prior t o a visit t o a science museum; following a visit t o a science museum; and following post-visit activities that were related to their museum experiences. Finally, to describe and interpret the ways in which students constructed their understandings: prior to a visit to a science museum; following a visit to a science museum; and following post-visit activities directly related to their museum experiences. The study was designed and implemented in three stages: 1) identification and establishment of the principles for design and evaluation of post-visit activities; 2) a pilot study of specific post-visit activities and data gathering strategies related to student construction of knowledge; and 3) interpretation of students' construction of knowledge from a visit to a science museum and subsequent completion of post-visit activities, which constituted the main study. Twelve students were selected from a year 7 class to participate in the study. This study provides evidence that the series of post-visit activities, related to the museum experiences, resulted in students constructing and reconstructing their personal knowledge of science concepts and principles represented in the science museum exhibits, sometimes towards the accepted scientific understanding and sometimes in different and surprising ways. Findings demonstrate the interrelationships between learning that occurs at school, at home and in informal learning settings. The study also underscores for teachers and staff of science museums and similar centres the importance of planning pre- and post-visit activities, not only to support the development of scientific conceptions, but also to detect and respond to alternative conceptions that may be produced or strengthened during a visit to an informal learning centre. Consistent with contemporary views of constructivism, the study strongly supports the views that : 1) knowledge is uniquely structured by the individual; 2) the processes of knowledge construction are gradual, incremental, and assimilative in nature; 3) changes in conceptual understanding are can be interpreted in the light of prior knowledge and understanding; and 4) knowledge and understanding develop idiosyncratically, progressing and sometimes appearing to regress when compared with contemporary science. This study has implications for teachers, students, museum educators, and the science education community given the lack of research into the processes of knowledge construction in informal contexts and the roles that post-visit activities play in the overall process of learning.

Implementing an emergency department patient admission predictive tool : insights from practice

Purpose: This paper aims to show that identification of expectations and software functional requirements via consultation with potential users is an integral component of the development of an emergency department patient admissions prediction tool. ---------- Design/methodology/approach: Thematic analysis of semi-structured interviews with 14 key health staff delivered rich data regarding existing practice and future needs. Participants included emergency department staff, bed managers, nurse unit managers, directors of nursing, and personnel from health administration. ---------- Findings: Participants contributed contextual insights on the current system of admissions, revealing a culture of crisis, imbued with misplayed communication. Their expectations and requirements of a potential predictive tool provided strategic data that moderated the development of the Emergency Department Patient Admissions Prediction Tool, based on their insistence that it feature availability, reliability and relevance. In order to deliver these stipulations, participants stressed that it should be incorporated, validated, defined and timely. ---------- Research limitations/implications: Participants were envisaging a concept and use of a tool that was somewhat hypothetical. However, further research will evaluate the tool in practice. ---------- Practical implications: Participants' unsolicited recommendations regarding implementation will not only inform a subsequent phase of the tool evaluation, but are eminently applicable to any process of implementation in a healthcare setting. ---------- Originality/value: The consultative process engaged clinicians and the paper delivers an insider view of an overburdened system, rather than an outsider's observations.

Geekdom for Grrrls health : Australian undergraduate experiences developing and promoting women’s health in cyberspace

There is an increasing global reliance on the Internet for retrieving information on health, illness, and recovery (Sillence et al, 2007; Laurent et al, 2009; Adams, 2010). People suffering from a vast array of illnesses, conditions, and complaints, as well as healthy travelers seeking advice about safe practices abroad, and teens seeking information about safe sexual practices are all now more likely to go to the internet for information than they are to rely solely on a general practitioner or physician (Santor et al, 2007; Moreno et al, 2009; Bartlett et al, 2010). Women in particular seek advice and support online for a number of health-related concerns regarding issues such as puberty, conception, pregnancy, postnatal depression, mothering, breast-cancer recovery, and ageing healthily (van Zutphen, 2008; Raymond et al, 2005). In keeping with this increasing socio-technological trend, the Women’s Health Unit at the Queensland University of Technology (Q.U.T), Brisbane, Australia, introduced the research, design, and development of online information resources for issues affecting the health of Australian women as an assessment item for students in the undergraduate Public Health curriculum. Students were required to research a particular health issue affecting Australian women, including pregnancy, pregnancy terminations, postnatal depression, returning to the work force after having a baby, breast cancer recovery, chronic disease prevention, health and safety for sex-workers, and ageing healthily. Students were required to design and develop websites that supported people living with these conditions, or who were in these situations. The websites were designed for communicating effectively with both women seeking information about their health, and their health practitioners. The pedagogical challenge inherent in this exercise was twofold: firstly, to encourage students to develop the skills to design and maintain software for online health forums; and secondly, to challenge public health students to go beyond generating ‘awareness’ and imparting health information to developing a nuanced understanding of the worlds and perspectives of their audiences, who require supportive networks and options that resonate with their restrictions, capabilities, and dispositions. This latter challenge spanned the realms of research, communication, and aesthetic design. This paper firstly, discusses an increasing reliance on the Internet by women seeking health-related information and the potential health risks and benefits of this trend. Secondly, it applies a post-structural analysis of the de-centred and mobile female self, as online social ‘spaces’ and networks supersede geographical ‘places’ and hierarchies, with implications for democracy, equality, power, and ultimately women’s health. Thirdly, it depicts the processes (learning reflections) and products (developed websites) created within this Women’s Health Unit by the students. Finally, we review this development in the undergraduate curriculum in terms of the importance of providing students with skills in research, communication, and technology in order to share and implement improved health care and social marketing for women as both recipients and providers of health care in the Internet Age.