Using ICD-10-AM codes to characterise hospital-acquired complications

This paper describes the limitations of using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) to characterise patient harm in hospitals. Limitations were identified during a project to use diagnoses flagged by Victorian coders as hospital-acquired to devise a classification of 144 categories of hospital acquired diagnoses (the Classification of Hospital Acquired Diagnoses or CHADx). CHADx is a comprehensive data monitoring system designed to allow hospitals to monitor their complication rates month-to-month using a standard method. Difficulties in identifying a single event from linear sequences of codes due to the absence of code linkage were the major obstacles to developing the classification. Obstetric and perinatal episodes also presented challenges in distinguishing condition onset, that is, whether conditions were present on admission or arose after formal admission to hospital. Used in the appropriate way, the CHADx allows hospitals to identify areas for future patient safety and quality initiatives. The value of timing information and code linkage should be recognised in the planning stages of any future electronic systems.

Marginal costs of hospital-acquired conditions : information for priority-setting for patient safety programmes and research

Objective: To estimate the relative inpatient costs of hospital-acquired conditions. Methods: Patient level costs were estimated using computerized costing systems that log individual utilization of inpatient services and apply sophisticated cost estimates from the hospital's general ledger. Occurrence of hospital-acquired conditions was identified using an Australian ‘condition-onset' flag for diagnoses not present on admission. These were grouped to yield a comprehensive set of 144 categories of hospital-acquired conditions to summarize data coded with ICD-10. Standard linear regression techniques were used to identify the independent contribution of hospital-acquired conditions to costs, taking into account the case-mix of a sample of acute inpatients (n = 1,699,997) treated in Australian public hospitals in Victoria (2005/06) and Queensland (2006/07). Results: The most costly types of complications were post-procedure endocrine/metabolic disorders, adding AU$21,827 to the cost of an episode, followed by MRSA (AU$19,881) and enterocolitis due to Clostridium difficile (AU$19,743). Aggregate costs to the system, however, were highest for septicaemia (AU$41.4 million), complications of cardiac and vascular implants other than septicaemia (AU$28.7 million), acute lower respiratory infections, including influenza and pneumonia (AU$27.8 million) and UTI (AU$24.7 million). Hospital-acquired complications are estimated to add 17.3% to treatment costs in this sample. Conclusions: Patient safety efforts frequently focus on dramatic but rare complications with very serious patient harm. Previous studies of the costs of adverse events have provided information on ‘indicators’ of safety problems rather than the full range of hospital-acquired conditions. Adding a cost dimension to priority-setting could result in changes to the focus of patient safety programmes and research. Financial information should be combined with information on patient outcomes to allow for cost-utility evaluation of future interventions.

Creating good lives through computer games

In this chapter we aim to explore how videogames can lead to improvements in wellbeing. Following Keyes (2007) and Huppert and So (2012) we view wellbeing as a multidimensional concept with both hedonic and eudaimonic aspects. In this chapter we take a broad approach in terms of exploring the impact of videogames on the psychological, social, and physical components of wellbeing. We explore how videogames have been shown to have an impact in each of these domains. Although there is a great deal of evidence for the actual and potential positive impacts of videogames, there are many unanswered questions regarding the situations in which there is likely to be an impact of videogame play on wellbeing, as well as the aspects of wellbeing that are likely to be impacted by videogame play. We conclude the chapter by outlining the key questions for future research. Our focus in this chapter is on the positive influences of videogames. We do not explore research on contexts in which negative impacts are possible or subgroups for which videogames could cause harm. However, these questions are obviously important and we see balanced engagement with age-appropriate videogames as a key prerequisite for any of the wellbeing benefits discussed below.

Polybrominated diphenyl ethers and age: analysis of pooled human blood serum from birth to over 60 years

Polybrominated diphenyl ethers (PBDEs) are considered to be a cost effective and efficient way to reduce flammability therefore reducing harm caused by fires. PBDEs are incorporated into a variety of manufactured products and are found worldwide in biological and environmental samples (e.g. Hites et al. 2004). Unlike other persistent organic pollutants there is limited data on PBDE concentrations by age and/or other population specific factors. Some studies have shown no variation in adult serum PBDE concentrations with age (e.g. Mazdai et al., 2003, Meironyte Guvenius et al., 2003) while Petreas et al. (2003) and Schecter et al. (2005) found results to be suggestive of an age trend in adult data but no statistically significant correlation was found. In addition to the data on adult concentrations there is limited data which investigates the levels of PBDEs in infants and young children. Fangström et al. (2005) showed that in seven year olds there was no difference in PBDE concentration when compared to adult concentrations. While Thomsen et al. (2002, 2005) found the concentration of PBDEs in pooled samples of blood serum from a 0-4 years age group to be higher than other age groups (4 to > 60 years). In addition, a family of four was studied in the U.S. and the concentrations were found to be greatest in the 18-month-old infant followed by the 5 year old child, then the mother and father (Fischer et al., 2006). The objectives of this study were to assess age, gender and regional trends of PBDE concentrations in a representative sample of the Australian population.

Restraint in the age of speed: Protecting vulnerable news sources in the 24/7 global news cycle

As news communication speeds up, investigative journalists have an increasing responsibility to minimise the risk of harm to vulnerable news sources. In addition, the increased longevity and instant global search-ability of news coverage and investigative journalism outputs such as documentaries, places upon journalists an increased responsibility for accuracy since online coverage cannot be easily corrected or retracted. This paper will examine how the risks to a news source and her family were considered and mitigated during the production of a radio documentary and newspaper story about an intended victim of child sacrifice. Pre-publication considerations included the possible risks to the mental health of the news source, the potential physical risk to her children and the risk to future family relationships. To hear the ABC Radio National documentary, A living sacrifice, on 360 Documentaries prior to the conference, see http://www.abc.net.au/radionational/programs/360/a-living-sacrifice/5359744. To read the Sunday Mail newspaper coverage of the story see http://www.couriermail.com.au/news/queensland/susannah-birch-talks-about-her-throat-being-slit-by-her-mother-when-she-was-a-baby/story-fnihsrf2-1226881911465.

The neural correlates of justified and unjustified killing: An fMRI study

Despite moral prohibitions on hurting other humans, some social contexts allow for harmful actions such as the killing of others. One example is warfare, where killing enemy soldiers is seen as morally justified. Yet, the neural underpinnings distinguishing between justified and unjustified killing are largely unknown. To improve understanding of the neural processes involved in justified and unjustified killing, participants had to imagine being the perpetrator whilst watching “first-person perspective” animated videos where they shot enemy soldiers (‘justified violence’) and innocent civilians (‘unjustified violence’). When participants imagined themselves shooting civilians compared to soldiers, greater activation was found in the lateral orbitofrontal cortex (OFC). Regression analysis revealed that the more guilt participants felt about shooting civilians, the greater the response in the lateral OFC. Effective connectivity analyses further revealed an increased coupling between lateral OFC and the tempoparietal junction (TPJ) when shooting civilians. The results show that the neural mechanisms typically implicated with harming others, such as the OFC, become less active when the violence against a particular group is seen as justified. This study therefore provides unique insight into how normal individuals can become aggressors in specific situations.

The culture of young women's drinking: Implications for developing effective policing strategies. Report to National Drug Strategy Law Enforcement Committee

Alcohol-related mortality and morbidity represents a substantial financial burden on communities across the world. Adolescence and young adulthood is a peak period for heavy episodic alcohol consumption, with over a third of all people aged 14-19 years having been at risk of acute alcoholrelated harm at least once in the previous 12 months (Australian Institute of Health and Welfare [AIHW], 2011). Excessive alcohol consumption has long been seen as a male problem; however, a gradual shift towards a social acceptance of female drunkenness has narrowed the gap in drinking quantity and style between men and women (Grucza, Bucholz, Rice, & Bierut, 2008). The presented data point to the vulnerability of women to the consequences of acute alcohol intoxication and indicate that alcohol-related offending by women is on the rise. Taken together, these findings reveal that alcohol-related harms and aggression for young women are becoming more prevalent and problematic. This report addressed these issues from a policing perspective...

Duty and control in intermediary copyright liability: An Australian perspective

In the internet age, copyright owners are increasingly looking to online intermediaries to take steps to prevent copyright infringement. Sometimes these intermediaries are closely tied to the acts of infringement; sometimes – as in the case of ISPs – they are not. In 2012, the Australian High Court decided the Roadshow Films v iiNet case, in which it held that an Australian ISP was not liable under copyright’s authorization doctrine, which asks whether the intermediary has sanctioned, approved or countenanced the infringement. The Australian Copyright Act 1968 directs a court to consider, in these situations, whether the intermediary had the power to prevent the infringement and whether it took any reasonable steps to prevent or avoid the infringement. It is generally not difficult for a court to find the power to prevent infringement – power to prevent can include an unrefined technical ability to disconnect users from the copyright source, such as an ISP terminating users’ internet accounts. In the iiNet case, the High Court eschewed this broad approach in favor of focusing on a notion of control that was influenced by principles of tort law. In tort, when a plaintiff asserts that a defendant should be liable for failing to act to prevent harm caused to the plaintiff by a third party, there is a heavy burden on the plaintiff to show that the defendant had a duty to act. The duty must be clear and specific, and will often hinge on the degree of control that the defendant was able to exercise over the third party. Control in these circumstances relates directly to control over the third party’s actions in inflicting the harm. Thus, in iiNet’s case, the control would need to be directed to the third party’s infringing use of BitTorrent; control over a person’s ability to access the internet is too imprecise. Further, when considering omissions to act, tort law differentiates between the ability to control and the ability to hinder. The ability to control may establish a duty to act, and the court will then look to small measures taken to prevent the harm to determine whether these satisfy the duty. But the ability to hinder will not suffice to establish liability in the absence of control. This article argues that an inquiry grounded in control as defined in tort law would provide a more principled framework for assessing the liability of passive intermediaries in copyright. In particular, it would set a higher, more stable benchmark for determining the copyright liability of passive intermediaries, based on the degree of actual, direct control that the intermediary can exercise over the infringing actions of its users. This approach would provide greater clarity and consistency than has existed to date in this area of copyright law in Australia.

School-based education programmes for the prevention of child sexual abuse

Background Child sexual abuse is a significant global problem in both magnitude and sequelae. The most widely used primary prevention strategy has been the provision of school-based education programmes. Although programmes have been taught in schools since the 1980s, their effectiveness requires ongoing scrutiny. Objectives To systematically assess evidence of the effectiveness of school-based education programmes for the prevention of child sexual abuse. Specifically, to assess whether: programmes are effective in improving students’ protective behaviours and knowledge about sexual abuse prevention; behaviours and skills are retained over time; and participation results in disclosures of sexual abuse, produces harms, or both. Search methods In September 2014, we searched CENTRAL, OvidMEDLINE, EMBASE and 11 other databases.We also searched two trials registers and screened the reference lists of previous reviews for additional trials. Selection criteria We selected randomised controlled trials (RCTs), cluster-RCTs, and quasi-RCTs of school-based education interventions for the prevention of child sexual abuse compared with another intervention or no intervention. Data collection and analysis Two review authors independently assessed the eligibility of trials for inclusion, extracted data, and assessed risk of bias.We summarised data for six outcomes: protective behaviours; knowledge of sexual abuse or sexual abuse prevention concepts; retention of protective behaviours over time; retention of knowledge over time; harm; and disclosures of sexual abuse. School-

Exploiting inference from semantic annotations for information retrieval

The increasing amount of information that is annotated against standardised semantic resources offers opportunities to incorporate sophisticated levels of reasoning, or inference, into the retrieval process. In this position paper, we reflect on the need to incorporate semantic inference into retrieval (in particular for medical information retrieval) as well as previous attempts that have been made so far with mixed success. Medical information retrieval is a fertile ground for testing inference mechanisms to augment retrieval. The medical domain offers a plethora of carefully curated, structured, semantic resources, along with well established entity extraction and linking tools, and search topics that intuitively require a number of different inferential processes (e.g., conceptual similarity, conceptual implication, etc.). We argue that integrating semantic inference in information retrieval has the potential to uncover a large amount of information that otherwise would be inaccessible; but inference is also risky and, if not used cautiously, can harm retrieval.

Novel loci affecting iron homeostasis and their effects in individuals at risk for hemochromatosis

Variation in body iron is associated with or causes diseases, including anaemia and iron overload. Here, we analyse genetic association data on biochemical markers of iron status from 11 European-population studies, with replication in eight additional cohorts (total up to 48,972 subjects). We find 11 genome-wide-significant (P<5 × 10−8) loci, some including known iron-related genes (​HFE, ​SLC40A1, ​TF, ​TFR2, ​TFRC, ​TMPRSS6) and others novel (​ABO, ​ARNTL, ​FADS2, ​NAT2, ​TEX14). SNPs at ​ARNTL, ​TF, and ​TFR2 affect iron markers in ​HFE C282Y homozygotes at risk for hemochromatosis. There is substantial overlap between our iron loci and loci affecting erythrocyte and lipid phenotypes. These results will facilitate investigation of the roles of iron in disease.

Exploring cultural, social and psychosocial influences on women's drinking across age cohorts

This program of research used a mixed methods approach to explore the cultural, social and psychosocial factors that influence women's alcohol consumption. Results indicated that there were a number of common influencing factors across women of all ages but also a number of key influences and behaviours that were distinct for younger and older women. These findings emphasised the need for age-specific interventions that target these influences to reduce women's exposure to alcohol-related harm. This research is one of the first studies to examine alcohol consumption of both younger and older women.

Good for the environment good for health

“First do no harm”. This phrase, attributed to the 19th century surgeon, Thomas Inman, 1 reflects an equivalent phrase found in Epidemics, Book I of the Hippocratic School, “Practise two things in your dealings with disease: either help or do not harm the patient”. Pharmacists have played, and continue to play, an important role in reducing patient harm from medication misadventures. Now, they have a new role to play. The delivery of pharmaceutical care contributes to climate change (e.g. through the embedded carbon in the manufacture and distribution of medicines, disposal of waste, and energy and water use),2 which in turn has a negative impact on health. 3,4 This paradox argues a moral and ethical obligation by pharmacists, to deliver pharmaceutical care more sustainably – do no harm. Sustainability “…. is concerned, on one hand, with resources and how we can preserve them, and, on the other hand, with waste products and how we can best reduce or dispose of them.” 5(p.37) It is about preserving and nurturing Earth’s resources and systems for this generation and future generations to enjoy. Pharmacists play an important role in preventative health strategies such as smoking cessation, promotion of healthier lifestyles and vaccination/immunisation programmes and have the potential to also play a significant role in delivering pharmaceutical care more sustainably. Sustainable pharmaceutical care may be considered a virtuous cycle - what is good for the environment is also good for our health. 5 The good news for community pharmacy owners and managers is that implementing sustainability initiatives in the pharmacy can also have significant financial co-benefits.

The Black Label: trade mark dilution, culture jamming, and the no logo movement

This article considers the ongoing debate over the appropriation of well-known and famous trade marks by the No Logo Movement for the purposes of political and social critique. It focuses upon one sensational piece of litigation in South Africa, Laugh It Off Promotions v. South African Breweries International (Finance) B.V. t/a Sabmark International. In this case, a group called Laugh It Off Promotions subjected the trade marks of the manufacturers of Carling Beer were subjected to parody, social satire, and culture jamming. The beer slogan “Black Label” was turned into a T-Shirt entitled “Black Labour/ White Guilt”. In the ensuing litigation, the High Court of South Africa and the Supreme Court of Appeal were of the opinion that the appropriation of the mark was a case of hate speech. However, the Constitutional Court of South Africa disagreed, finding that the parodies of a well-known, famous trade mark did not constitute trade mark dilution. Moseneke J observed that there was a lack of evidence of economic or material harm; and Sachs J held that there is a need to provide latitude for parody, laughter, and freedom of expression. The decision of the Constitutional Court of South Africa provides some important insights into the nature of trade mark dilution, the role of parody and satire, and the relevance of constitutional protections of freedom of speech and freedom of expression. Arguably, the ruling will be of help in the reformation of trade mark dilution law in other jurisdictions – such as the United States. The decision in Laugh It Off Promotions v. South African Breweries International demonstrates that trade mark law should not be immune from careful constitutional scrutiny.

Environmental Crime and Specialist Courts: The case for a ‘One-Stop (Judicial) Shop’ in Queensland

The increasing international political, public and scientific engagement in matters of environmental sustainability and development has produced a rapidly expanding body of environmental law and policy. The advent of international protocols, directives, and multilateral agreements has occurred concomitantly with the harmonisation of widespread environmental regimes of governance and enforcement within numerous domestic settings. This has created an unprecedented need for environmental legal apparatuses to manage, regulate and adjudicate legislation seeking to protect, sustain and develop global natural habitats. The evolving literature in green criminology continues to explore these developments within discourses of power, harm and justice. Such critiques have emphasised the role of dedicated environmental courts to address environmental crimes and injustices. In this article, we examine the important role of specialist courts in responding to environmental crime, with specific reference to the State of Queensland. We offer a critique of existing processes and practices for the adjudication of environmental crime and propose new jurisdictional and procedural approaches for enhancing justice. We conclude that specialist environmental courts endowed with broad civil and criminal jurisdiction are an integral part of an effective response to environmental crime.