Identification of factors contributing to recurrence of venous leg ulcers

Background and Significance Venous leg ulcers are a significant cause of chronic ill-health for 1–3% of those aged over 60 years, increasing in incidence with age. The condition is difficult and costly to heal, consuming 1–2.5% of total health budgets in developed countries and up to 50% of community nursing time. Unfortunately after healing, there is a recurrence rate of 60 to 70%, frequently within the first 12 months after heaing. Although some risk factors associated with higher recurrence rates have been identified (e.g. prolonged ulcer duration, deep vein thrombosis), in general there is limited evidence on treatments to effectively prevent recurrence. Patients are generally advised to undertake activities which aim to improve the impaired venous return (e.g. compression therapy, leg elevation, exercise). However, only compression therapy has some evidence to support its effectiveness in prevention and problems with adherence to this strategy are well documented. Aim The aim of this research was to identify factors associated with recurrence by determining relationships between recurrence and demographic factors, health, physical activity, psychosocial factors and self-care activities to prevent recurrence. Methods Two studies were undertaken: a retrospective study of participants diagnosed with a venous leg ulcer which healed 12 to 36 months prior to the study (n=122); and a prospective longitudinal study of participants recruited as their ulcer healed and data collected for 12 months following healing (n=80). Data were collected from medical records on demographics, medical history and ulcer history and treatments; and from self-report questionnaires on physical activity, nutrition, psychosocial measures, ulcer history, compression and other self-care activities. Follow-up data for the prospective study were collected every three months for 12 months after healing. For the retrospective study, a logistic regression model determined the independent influences of variables on recurrence. For the prospective study, median time to recurrence was calculated using the Kaplan-Meier method and a Cox proportional-hazards regression model was used to adjust for potential confounders and determine effects of preventive strategies and psychosocial factors on recurrence. Results In total, 68% of participants in the retrospective study and 44% of participants in the prospective study suffered a recurrence. After mutual adjustment for all variables in multivariable regression models, leg elevation, compression therapy, self efficacy and physical activity were found to be consistently related to recurrence in both studies. In the retrospective study, leg elevation, wearing Class 2 or 3 compression hosiery, the level of physical activity, cardiac disease and self efficacy scores remained significantly associated (p<0.05) with recurrence. The model was significant (p <0.001); with a R2 equivalent of 0.62. Examination of relationships between psychosocial factors and adherence to wearing compression hosiery found wearing compression hosiery was significantly positively associated with participants’ knowledge of the cause of their condition (p=0.002), higher self-efficacy scores (p=0.026) and lower depression scores (p=0.009). Analysis of data from the prospective study found there were 35 recurrences (44%) in the 12 months following healing and median time to recurrence was 27 weeks. After adjustment for potential confounders, a Cox proportional hazards regression model found that at least an hour/day of leg elevation, six or more days/week in Class 2 (20–25mmHg) or 3 (30–40mmHg) compression hosiery, higher social support scale scores and higher General Self-Efficacy scores remained significantly associated (p<0.05) with a lower risk of recurrence, while male gender and a history of DVT remained significant risk factors for recurrence. Overall the model was significant (p <0.001); with an R2 equivalent 0.72. Conclusions The high rates of recurrence found in the studies highlight the urgent need for further information in this area to support development of effective strategies for prevention. Overall, results indicate leg elevation, physical activity, compression hosiery and strategies to improve self-efficacy are likely to prevent recurrence. In addition, optimal management of depression and strategies to improve patient knowledge and self-efficacy may positively influence adherence to compression therapy. This research provides important information for development of strategies to prevent recurrence of venous leg ulcers, with the potential to improve health and decrease health care costs in this population.

The evaluation of qualitative methods selection in the field of design and emotion

The aim of this paper is to aid researchers in selecting appropriate qualitative methods in order to develop and improve future studies in the field of emotional design. These include observations, think-aloud protocols, questionnaires, diaries and interviews. Based on the authors’ experiences, it is proposed that the methods under review can be successfully used for collecting data on emotional responses to evaluate user product relationships. This paper reviews the methods; discusses the suitability, advantages and challenges in relation to design and emotion studies. Furthermore, the paper outlines the potential impact of technology on the application of these methods, discusses the implications of these methods for emotion research and concludes with recommendations for future work in this area.

Emotional experience with portable health devices

This paper reports on a six month longitudinal study exploring people’s personal and social emotional experience with health related portable interactive devices (PIDs). The focus is on emotions and how health PIDs mediate this experience in everyday contexts. The study reported here is an extension of a previous experiment conducted by the authors exploring media related PIDs [1]. The findings identified interesting aspects of health device interaction. Findings revealed people interact with health PIDs emotionally both at a personal and a social level. However, in contrast to media PIDs, participants reported significantly less social experiences than personal experiences. Nevertheless, the social level plays an important role such that negative social experiences had a significant influence on the perceived emotional experience over the course of six months. When no negative social experiences were reported the emotional experience over the course of six months became neutral. The findings are discussed in regards to their significance to the field of design, their implication for future health PID design and future research directions.

Enhancing security and continuity management at international airports

Operators of busy contemporary airports have to balance tensions between the timely flow of passengers, flight operations, the conduct of commercial business activities and the effective application of security processes. In addition to specific onsite issues airport operators liaise with a range of organisations which set and enforce aviation-related policies and regulations as well as border security agencies responsible for customs, quarantine and immigration, in addition to first response security services. The challenging demands of coordinating and planning in such complex socio-technical contexts place considerable pressure on airport management to facilitate coordination of what are often conflicting goals and expectations among groups that have standing in respect to safe and secure air travel. What are, as yet, significantly unexplored issues in large airports are options for the optimal coordination of efforts from the range of public and private sector participants active in airport security and crisis management. A further aspect of this issue is how airport management systems operate when there is a transition from business-as-usual into an emergency/crisis situation and then, on recovery, back to ‘normal’ functioning. Business Continuity Planning (BCP), incorporating sub-plans for emergency response, continuation of output and recovery of degraded operating capacity, would fit such a context. The implementation of BCP practices in such a significant high security setting offers considerable potential benefit yet entails considerable challenges. This paper presents early results of a 4 year nationally funded industry-based research project examining the merger of Business Continuity Planning and Transport Security Planning as a means of generating capability for improved security and reliability and, ultimately, enhanced resilience in major airports. The project is part of a larger research program on the Design of Secure Airports that includes most of the gazetted ‘first response’ international airports in Australia, key Aviation industry groups and all aviation-related border and security regulators as collaborative partners. The paper examines a number of initial themes in the research, including: ? Approaches to integrating Business Continuity & Aviation Security Planning within airport operations; ? Assessment of gaps in management protocols and operational capacities for identifying and responding to crises within and across critical aviation infrastructure; ? Identification of convergent and divergent approaches to crisis management used across Austral-Asia and their alignment to planned and possible infrastructure evolution.

Geometry‐specified troposphere decorrelation for subcentimeter real‐time kinematic solutions over long baselines

Real‐time kinematic (RTK) GPS techniques have been extensively developed for applications including surveying, structural monitoring, and machine automation. Limitations of the existing RTK techniques that hinder their applications for geodynamics purposes are twofold: (1) the achievable RTK accuracy is on the level of a few centimeters and the uncertainty of vertical component is 1.5–2 times worse than those of horizontal components and (2) the RTK position uncertainty grows in proportional to the base‐torover distances. The key limiting factor behind the problems is the significant effect of residual tropospheric errors on the positioning solutions, especially on the highly correlated height component. This paper develops the geometry‐specified troposphere decorrelation strategy to achieve the subcentimeter kinematic positioning accuracy in all three components. The key is to set up a relative zenith tropospheric delay (RZTD) parameter to absorb the residual tropospheric effects and to solve the established model as an ill���posed problem using the regularization method. In order to compute a reasonable regularization parameter to obtain an optimal regularized solution, the covariance matrix of positional parameters estimated without the RZTD parameter, which is characterized by observation geometry, is used to replace the quadratic matrix of their “true” values. As a result, the regularization parameter is adaptively computed with variation of observation geometry. The experiment results show that new method can efficiently alleviate the model’s ill condition and stabilize the solution from a single data epoch. Compared to the results from the conventional least squares method, the new method can improve the longrange RTK solution precision from several centimeters to the subcentimeter in all components. More significantly, the precision of the height component is even higher. Several geosciences applications that require subcentimeter real‐time solutions can largely benefit from the proposed approach, such as monitoring of earthquakes and large dams in real‐time, high‐precision GPS leveling and refinement of the vertical datum. In addition, the high‐resolution RZTD solutions can contribute to effective recovery of tropospheric slant path delays in order to establish a 4‐D troposphere tomography.

Raman spectroscopy of selected borate minerals of the pinakiolite group

The Raman spectra of a series of related minerals of the pinakiolite group of minerals have been collected and the spectra related to the mineral structure. These minerals are based upon an isolated BO33- ion. The site symmetry is reduced from D3h to C1. Intense Raman bands are observed for the minerals takeuchiite, pinakiolite, fredrikssonite and azoproite at 1084, 1086, 1086 and 1086 cm-1. These bands are assigned to the ν1 BO33- symmetric stretching mode. Low intensity Raman bands are observed for the minerals at 1345, 1748; 1435, 1748; 1435, 1750; 1436, 1749 cm-1. One probable assignment is to ν3 BO33- antisymmetric stretching mode. Intense Raman bands of takeuchiite, pinakiolite, fredrikssonite and azoproite at 712 cm-1 attributed to the ν2 out-of-plane bending mode. Importantly, through the comparison of the Raman spectra, the molecular structure of borate minerals with ill-defined structures can be obtained.

The impact of gender diversity on performance in services and manufacturing organizations

We present three competing predictions of the organizational gender diversity-performance relationship: a positive linear prediction, a negative linear prediction, and an inverted U-shaped curvilinear prediction. The paper also proposes a moderating effect of industry type (services vs. manufacturing). The predictions were tested using archival quantitative data with a longitudinal design. The results show partial support for the positive linear and inverted U-shaped curvilinear predictions as well as for the proposed moderating effect of industry type. The results help reconcile the inconsistent findings of past research. The findings also show that industry context can strengthen or weaken gender diversity effects.

AITPM national newsletter December 2008 president's report

It’s fast approaching the end of the year and the festive season, and I have a few things on my mind. First, how I’ll fit in all of my holiday plans and projects within my period of leave, which always seems to pass oh so quickly! But more important are the two issues of global financial uncertainty and safe travel. Judging by what is in the media, it appears to be proving difficult for any self respecting financial industry specialist to define and grapple with the so-called current economic crisis, let alone those of us who have not been formally and extensively schooled in the sciences of finance and economics. Perhaps the latter is even more of a “black art” than the discipline of transport planning. The situation has affected all of us with our superannuation and/or share portfolios; however, judging by the still-crowded shopping centres in many areas, the downstream general economic impacts appear to be less serious in Australia than in other developed countries, even with the significant market fluctuations taking place. There are many important decisions facing Australian governments, from the top down, on how they manage their budgets and spending. Infrastructure spending is in competition with other necessities such as the public health system and education. But it appears that infrastructure is an avenue of public spending that, over all time windows, may be able to significantly bolster local economies and that of the nation as a whole. This, however, is against the spectre of deficits. I would suggest that now, more than ever, we as transport and other professionals within the system, should use our knowledge and experience to take a key role in helping government and the private sector make sound decisions on infrastructure planning, delivery and management.

AITPM national newsletter President's report May 2010

We’ve had a bit of sticker shock in these parts. Well, apparently. Since my last missive, Brisbane’s Clem Jones Tunnel which was initially free now has a toll, at least partially, at the introductory rate of $2.95 for a one-way car ride between 5a.m. and midnight – free overnight. From 9 May 2010 the toll will be $4.28. Since the introductory toll was introduced, use of the tunnel appears to have declined somewhat – no surprise to transport professionals I suppose. An additional factor may have been that the “novelty value” of driving through the tunnel for free had worn off. This demonstrates to me that much of the community may still see the use of road infrastructure as a rite of passage, with only some actually weighing up the true value of their travel time and vehicle wear and tear against their out of pocket (or onto credit card) cost. Thus, we’re in pioneering times and the role of transport economics in the overall transport infrastructure planning realm is of considerable importance – especially as much of the new big ticket infrastructure is likely to be tolled into the future. The Queensland Premier, Anna Bligh, made poignant commentary about Brisbane City Council’s tunnel use in that such infrastructure is built for future times and not just as a quick fix for current traffic problems. My expectation is that once Airport Link, which is really the northern half of the corridor, opens in 2012, there will be a significant spike in Clem7 usage.

Inclusion of PMU current phasor measurements in a power system state estimator

Three different methods of inclusion of current measurements by phasor measurement units (PMUs) in a power sysetm state estimator is investigated. A comprehensive formulation of the hybrid state estimator incorporating conventional, as well as PMU measurements, is presented for each of the three methods. The behaviour of the elements because of the current measurements in the measurement Jacobian matrix is examined for any possible ill-conditioning of the state estimator gain matrix. The performance of the state estimators are compared in terms of the convergence properties and the varian in the estimated states. The IEEE 14-bus and IEEE 300-bus systems are used as test beds for the study.

Trans digital storytelling : everyday activism, mutable identity and the problem of visibility

Mainstream representations of trans people typically run the gamut from victim to mentally ill and are almost always articulated by non-trans voices. The era of user-generated digital content and participatory culture has heralded unprecedented opportunities for trans people who wish to speak their own stories in public spaces. Digital Storytelling, as an easy accessible autobiographic audio-visual form, offers scope to play with multi-dimensional and ambiguous representations of identity that contest mainstream assumptions of what it is to be ‘male’ or ‘female’. Also, unlike mainstream media forms, online and viral distribution of Digital Stories offer potential to reach a wide range of audiences, which is appealing to activist oriented storytellers who wish to confront social prejudices. However, with these newfound possibilities come concerns regarding visibility and privacy, especially for storytellers who are all too aware of the risks of being ‘out’ as trans. This paper explores these issues from the perspective of three trans storytellers, with reference to the Digital Stories they have created and shared online and on DVD. These examplars are contextualised with some popular and scholarly perspectives on trans representation, in particular embodied and performed identity. It is contended that trans Digital Stories, while appearing in some ways to be quite conventional, actually challenge common notions of gender identity in ways that are both radical and transformative.

Sustaining the next generation of teacher-researchers to work for social justice

This chapter explores a research project involving teachers working with some of the most disadvantaged young people in South Australia, children growing up in poverty, in families struggling with homelessness and ill-health, in the outer southern suburbs. Additionally, there were particular children were struggling with intellectual, emotional and social difficulties which were extreme enough for them not be included in a mainstream class. The research project made two crucial interrelated moves to support teachers to tackle this tough work. First, the project had an explicit social justice agenda. We were not simply researching literacy outcomes, but literacy pedagogies for the students teachers were most worried about. And we wanted to understand how the material conditions of students’ everyday lifeworlds impacted on the working conditions of teachers’ schoolworlds. We sought to open up a discursive space where teachers could talk about poverty, violence, racism and classism in ways that would take them beyond despair and into new imaginings and positive action. Second, the project was designed to start from the urgent questions of early career teachers and to draw on the accumulated practice wisdom of their chosen mentors. Hence we designed not only a teacher-researcher community, but cross-generational networks. Our aim was to build the capacities of both generations to address long-standing educational problems in new ways that drew overtly on their different and complementary resources.

Business process simulation in virtual worlds

This is an invited presentation made as a short preview of the virtual environment research work being undertaken at QUT in the Business Process Management (BPM) research group, known as BPMVE. Three projects are covered, spatial process visualisation, with applications to airport check-in processes, collaborative process modelling using a virtual world BPMN editing tool and business process simulation in virtual worlds using Open Simulator and the YAWL workflow system. In addition, the relationship of this work to Organisational Psychology is briefly explored. Full Video/Audio is available at: http://www.youtube.com/user/BPMVE#p/u/1/rp506c3pPms

Information accountability for online healthcare social networks

Online social networking has become one of the most popular Internet applications in the modern era. They have given the Internet users, access to information that other Internet based applications are unable to. Although many of the popular online social networking web sites are focused towards entertainment purposes, sharing information can benefit the healthcare industry in terms of both efficiency and effectiveness. But the capability to share personal information; the factor which has made online social networks so popular, is itself a major obstacle when considering information security and privacy aspects. Healthcare can benefit from online social networking if they are implemented such that sensitive patient information can be safeguarded from ill exposure. But in an industry such as healthcare where the availability of information is crucial for better decision making, information must be made available to the appropriate parties when they require it. Hence the traditional mechanisms for information security and privacy protection may not be suitable for healthcare. In this paper we propose a solution to privacy enhancement in online healthcare social networks through the use of an information accountability mechanism.

Check-in processing : simulation of passengers with advanced traits

In order to tackle the growth of air travelers in airports worldwide, it is important to simulate and understand passenger flows to predict future capacity constraints and levels of service. We discuss the ability of agent-based models to understand complicated pedestrian movement in built environments. In this paper we propose advanced passenger traits to enable more detailed modelling of behaviors in terminal buildings, particularly in the departure hall around the check-in facilities. To demonstrate the concepts, we perform a series of passenger agent simulations in a virtual airport terminal. In doing so, we generate a spatial distribution of passengers within the departure hall to ancillary facilities such as cafes, information kiosks and phone booths as well as common check-in facilities, and observe the effects this has on passenger check-in and departure hall dwell times, and facility utilization.