Mobility, accessibility and activity participation : a comparative assessment of methods to identify rural transport disadvantage

Traditionally, transport disadvantage has been identified using accessibility analysis although the effectiveness of the accessibility planning approach to improving access to goods and services is not known. This paper undertakes a comparative assessment of measures of mobility, accessibility, and participation used to identify transport disadvantage using the concept of activity spaces. A 7 day activity-travel diary data for 89 individuals was collected from two case study areas located in rural Northern Ireland. A spatial analysis was conducted to select the case study areas using criteria derived from the literature. The criteria are related to the levels of area accessibility and area mobility which are known to influence the nature of transport disadvantage. Using the activity-travel diary data individuals weekly as well as day to day variations in activity-travel patterns were visualised. A model was developed using the ArcGIS ModelBuilder tool and was run to derive scores related to individual levels of mobility, accessibility, and participation in activities from the geovisualisation. Using these scores a multiple regression analysis was conducted to identify patterns of transport disadvantage. This study found a positive association between mobility and accessibility, between mobility and participation, and between accessibility and participation in activities. However, area accessibility and area mobility were found to have little impact on individual mobility, accessibility, and participation in activities. Income vis-àvis ´ car-ownership was found to have a significant impact on individual levels of mobility, and accessibility; whereas participation in activities were found to be a function of individual levels of income and their occupational status.

Non-invasive assessment of tear film surface quality

The tear film plays an important role preserving the health of the ocular surface and maintaining the optimal refractive power of the cornea. Moreover dry eye syndrome is one of the most commonly reported eye health problems. This syndrome is caused by abnormalities in the properties of the tear film. Current clinical tools to assess the tear film properties have shown certain limitations. The traditional invasive methods for the assessment of tear film quality, which are used by most clinicians, have been criticized for the lack of reliability and/or repeatability. A range of non-invasive methods of tear assessment have been investigated, but also present limitations. Hence no “gold standard” test is currently available to assess the tear film integrity. Therefore, improving techniques for the assessment of the tear film quality is of clinical significance and the main motivation for the work described in this thesis. In this study the tear film surface quality (TFSQ) changes were investigated by means of high-speed videokeratoscopy (HSV). In this technique, a set of concentric rings formed in an illuminated cone or a bowl is projected on the anterior cornea and their reflection from the ocular surface imaged on a charge-coupled device (CCD). The reflection of the light is produced in the outer most layer of the cornea, the tear film. Hence, when the tear film is smooth the reflected image presents a well structure pattern. In contrast, when the tear film surface presents irregularities, the pattern also becomes irregular due to the light scatter and deviation of the reflected light. The videokeratoscope provides an estimate of the corneal topography associated with each Placido disk image. Topographical estimates, which have been used in the past to quantify tear film changes, may not always be suitable for the evaluation of all the dynamic phases of the tear film. However the Placido disk image itself, which contains the reflected pattern, may be more appropriate to assess the tear film dynamics. A set of novel routines have been purposely developed to quantify the changes of the reflected pattern and to extract a time series estimate of the TFSQ from the video recording. The routine extracts from each frame of the video recording a maximized area of analysis. In this area a metric of the TFSQ is calculated. Initially two metrics based on the Gabor filter and Gaussian gradient-based techniques, were used to quantify the consistency of the pattern’s local orientation as a metric of TFSQ. These metrics have helped to demonstrate the applicability of HSV to assess the tear film, and the influence of contact lens wear on TFSQ. The results suggest that the dynamic-area analysis method of HSV was able to distinguish and quantify the subtle, but systematic degradation of tear film surface quality in the inter-blink interval in contact lens wear. It was also able to clearly show a difference between bare eye and contact lens wearing conditions. Thus, the HSV method appears to be a useful technique for quantitatively investigating the effects of contact lens wear on the TFSQ. Subsequently a larger clinical study was conducted to perform a comparison between HSV and two other non-invasive techniques, lateral shearing interferometry (LSI) and dynamic wavefront sensing (DWS). Of these non-invasive techniques, the HSV appeared to be the most precise method for measuring TFSQ, by virtue of its lower coefficient of variation. While the LSI appears to be the most sensitive method for analyzing the tear build-up time (TBUT). The capability of each of the non-invasive methods to discriminate dry eye from normal subjects was also investigated. The receiver operating characteristic (ROC) curves were calculated to assess the ability of each method to predict dry eye syndrome. The LSI technique gave the best results under both natural blinking conditions and in suppressed blinking conditions, which was closely followed by HSV. The DWS did not perform as well as LSI or HSV. The main limitation of the HSV technique, which was identified during the former clinical study, was the lack of the sensitivity to quantify the build-up/formation phase of the tear film cycle. For that reason an extra metric based on image transformation and block processing was proposed. In this metric, the area of analysis was transformed from Cartesian to Polar coordinates, converting the concentric circles pattern into a quasi-straight lines image in which a block statistics value was extracted. This metric has shown better sensitivity under low pattern disturbance as well as has improved the performance of the ROC curves. Additionally a theoretical study, based on ray-tracing techniques and topographical models of the tear film, was proposed to fully comprehend the HSV measurement and the instrument’s potential limitations. Of special interested was the assessment of the instrument’s sensitivity under subtle topographic changes. The theoretical simulations have helped to provide some understanding on the tear film dynamics, for instance the model extracted for the build-up phase has helped to provide some insight into the dynamics during this initial phase. Finally some aspects of the mathematical modeling of TFSQ time series have been reported in this thesis. Over the years, different functions have been used to model the time series as well as to extract the key clinical parameters (i.e., timing). Unfortunately those techniques to model the tear film time series do not simultaneously consider the underlying physiological mechanism and the parameter extraction methods. A set of guidelines are proposed to meet both criteria. Special attention was given to a commonly used fit, the polynomial function, and considerations to select the appropriate model order to ensure the true derivative of the signal is accurately represented. The work described in this thesis has shown the potential of using high-speed videokeratoscopy to assess tear film surface quality. A set of novel image and signal processing techniques have been proposed to quantify different aspects of the tear film assessment, analysis and modeling. The dynamic-area HSV has shown good performance in a broad range of conditions (i.e., contact lens, normal and dry eye subjects). As a result, this technique could be a useful clinical tool to assess tear film surface quality in the future.

Where does it say I have to do that? How can secondary schools enact assessment policy for students with disabilities

This paper describes effective ways secondary school leaders can enact curriculum policy, particularly assessment practices, to support learning for students with disabilities in mainstream schools. Assessment for learning (AfL) as a pedagogic practice, has gained recent importance through inclusion in curriculum policy in Queensland, Australia. AfL is the frequent assessment of student progress that identifies learning needs and informs future teaching and learning. Assessment of student progress of the standards based curriculum has provided challenges for schools attempting to meet the needs of “all” learners. This paper highlights findings of a small case study to model successful leadership practices used in an inclusive secondary school to improve achievement of students with disabilities through assessment. Successful leadership practices that can be generalized to improve achievement of all learners include making sense of policy for staff; developing staff common and shared beliefs and actions; organizing professional learning opportunities and arranging collaborative curriculum planning and co-teaching.

Communicating assessment criteria is not sufficient for influencing students' approaches to assessment tasks – perspectives from a differential equations class

This report presents the findings of an exploratory study into the perceptions held by students regarding the use of criterion-referenced assessment in an undergraduate differential equations class. Students in the class were largely unaware of the concept of criterion referencing and of the various interpretations that this concept has among mathematics educators. Our primary goal was to investigate whether explicitly presenting assessment criteria to students was useful to them and guided them in responding to assessment tasks. Quantitative data and qualitative feedback from students indicates that while students found the criteria easy to understand and useful in informing them as to how they would be graded, the manner in which they actually approached the assessment activity was not altered as a result of the use of explicitly communicated grading criteria.

Observational assessment and maternal reports of motivation in children and adolescents with Down Syndrome

Despite a lack of consistent empirical evidence, there has been an ongoing assumption that intellectual disability is associated with reduced levels of motivation. The participants in this study were 33 children with Down syndrome ages 10–15 years and 33 typically developing 3–8-year-old children. Motivation was measured through observational assessments of curiosity, preference for challenge, and persistence, as well as maternal reports. There were no significant group differences on motivation tasks, but mothers of children with Down syndrome rated their children significantly lower on motivation than did parents of typically developing children. There were some intriguing group differences in the pattern of correlations among observations and parent reports. The findings challenge long-held views that individuals with intellectual disability are invariably deficient in motivation.

Image-based safety assessment : automated spatial safety risk identification of earthmoving and surface mining activities

This paper presents an automated image‐based safety assessment method for earthmoving and surface mining activities. The literature review revealed the possible causes of accidents on earthmoving operations, investigated the spatial risk factors of these types of accident, and identified spatial data needs for automated safety assessment based on current safety regulations. Image‐based data collection devices and algorithms for safety assessment were then evaluated. Analysis methods and rules for monitoring safety violations were also discussed. The experimental results showed that the safety assessment method collected spatial data using stereo vision cameras, applied object identification and tracking algorithms, and finally utilized identified and tracked object information for safety decision making.

Design of a preliminary error impact analysis model for spatial safety assessment of earthmoving operations

Regardless of technology benefits, safety planners still face difficulties explaining errors related to the use of different technologies and evaluating how the errors impact the performance of safety decision making. This paper presents a preliminary error impact analysis testbed to model object identification and tracking errors caused by image-based devices and algorithms and to analyze the impact of the errors for spatial safety assessment of earthmoving and surface mining activities. More specifically, this research designed a testbed to model workspaces for earthmoving operations, to simulate safety-related violations, and to apply different object identification and tracking errors on the data collected and processed for spatial safety assessment. Three different cases were analyzed based on actual earthmoving operations conducted at a limestone quarry. Using the testbed, the impacts of the errors were investigated for the safety planning purpose.

Nursing and competencies - a natural fit : the politics of skill/competency formation in nursing

The last two decades have seen a significant restructuring of work across Australia and other industrialised economies, a critical part of which has been the appearance of competency based education and assessment. The competency movement is about creating a more flexible and mobile labour force to increase productivity and it does so by redefining work as a set of transferable or ‘soft’ generic skills that are transportable and are the possession of the individual. This article sought to develop an analysis of competency based clinical assessment of nursing students across a bachelor of nursing degree course. This involved an examination of a total of 406 clinical assessment tools that covered the years 1992-2009 and the three years of a bachelor degree. Data analysis generated three analytical findings: the existence of a hierarchy of competencies that prioritises soft skills over intellectual and technical skills; the appearance of skills as personal qualities or individual attributes; and the absence of context in assessment. The article argues that the convergence in nursing of soft skills and the professionalisation project reform has seen the former give legitimacy to the enduring invisibility and devaluation of nursing work.

Evaluation of financial incentives as a quality improvement strategy in the public hospital context : clinician attitudes, design variables, and economic costs

In 2008, a three-year pilot ‘pay for performance’ (P4P) program, known as ‘Clinical Practice Improvement Payment’ (CPIP) was introduced into Queensland Health (QHealth). QHealth is a large public health sector provider of acute, community, and public health services in Queensland, Australia. The organisation has recently embarked on a significant reform agenda including a review of existing funding arrangements (Duckett et al., 2008). Partly in response to this reform agenda, a casemix funding model has been implemented to reconnect health care funding with outcomes. CPIP was conceptualised as a performance-based scheme that rewarded quality with financial incentives. This is the first time such a scheme has been implemented into the public health sector in Australia with a focus on rewarding quality, and it is unique in that it has a large state-wide focus and includes 15 Districts. CPIP initially targeted five acute and community clinical areas including Mental Health, Discharge Medication, Emergency Department, Chronic Obstructive Pulmonary Disease, and Stroke. The CPIP scheme was designed around key concepts including the identification of clinical indicators that met the set criteria of: high disease burden, a well defined single diagnostic group or intervention, significant variations in clinical outcomes and/or practices, a good evidence, and clinician control and support (Ward, Daniels, Walker & Duckett, 2007). This evaluative research targeted Phase One of implementation of the CPIP scheme from January 2008 to March 2009. A formative evaluation utilising a mixed methodology and complementarity analysis was undertaken. The research involved three research questions and aimed to determine the knowledge, understanding, and attitudes of clinicians; identify improvements to the design, administration, and monitoring of CPIP; and determine the financial and economic costs of the scheme. Three key studies were undertaken to ascertain responses to the key research questions. Firstly, a survey of clinicians was undertaken to examine levels of knowledge and understanding and their attitudes to the scheme. Secondly, the study sought to apply Statistical Process Control (SPC) to the process indicators to assess if this enhanced the scheme and a third study examined a simple economic cost analysis. The CPIP Survey of clinicians elicited 192 clinician respondents. Over 70% of these respondents were supportive of the continuation of the CPIP scheme. This finding was also supported by the results of a quantitative altitude survey that identified positive attitudes in 6 of the 7 domains-including impact, awareness and understanding and clinical relevance, all being scored positive across the combined respondent group. SPC as a trending tool may play an important role in the early identification of indicator weakness for the CPIP scheme. This evaluative research study supports a previously identified need in the literature for a phased introduction of Pay for Performance (P4P) type programs. It further highlights the value of undertaking a formal risk assessment of clinician, management, and systemic levels of literacy and competency with measurement and monitoring of quality prior to a phased implementation. This phasing can then be guided by a P4P Design Variable Matrix which provides a selection of program design options such as indicator target and payment mechanisms. It became evident that a clear process is required to standardise how clinical indicators evolve over time and direct movement towards more rigorous ‘pay for performance’ targets and the development of an optimal funding model. Use of this matrix will enable the scheme to mature and build the literacy and competency of clinicians and the organisation as implementation progresses. Furthermore, the research identified that CPIP created a spotlight on clinical indicators and incentive payments of over five million from a potential ten million was secured across the five clinical areas in the first 15 months of the scheme. This indicates that quality was rewarded in the new QHealth funding model, and despite issues being identified with the payment mechanism, funding was distributed. The economic model used identified a relative low cost of reporting (under $8,000) as opposed to funds secured of over $300,000 for mental health as an example. Movement to a full cost effectiveness study of CPIP is supported. Overall the introduction of the CPIP scheme into QHealth has been a positive and effective strategy for engaging clinicians in quality and has been the catalyst for the identification and monitoring of valuable clinical process indicators. This research has highlighted that clinicians are supportive of the scheme in general; however, there are some significant risks that include the functioning of the CPIP payment mechanism. Given clinician support for the use of a pay–for-performance methodology in QHealth, the CPIP scheme has the potential to be a powerful addition to a multi-faceted suite of quality improvement initiatives within QHealth.

An assessment of timber dwellings typical of the Queenslander era, and constraints associated with their relocation, component and adaptive reuse when considering 'regeneration'

This paper presents an explanation of why the reuse of building components after demolition or deconstruction is critical to the future of the construction industry. An examination of the historical cause and response to climate change sets the scene as to why governance is becoming increasingly focused on the built environment as a mechanism to controlling waste generation associated with the process of demolition, construction and operation. Through an annotated description to the evolving design and construction methodology of a range of timber dwellings (typically 'Queenslanders' during the eras of 1880-1900, 1900-1920 & 1920-1940) the paper offers an evaluation to the variety of materials, which can be used advantageously by those wishing to 'regenerate' a Queenslander. This analysis of 'regeneration' details the constraints when considering relocation and/ or reuse by adaption including deconstruction of building components against the legislative framework requirements of the Queensland Building Act 1975 and the Queensland Sustainable Planning Act 2009, with a specific examination to those of the Building Codes of Australia. The paper concludes with a discussion of these constraints, their impacts on 'regeneration' and the need for further research to seek greater understanding of the practicalities and drivers of relocation, adaptive and building components suitability for reuse after deconstruction.

Construction safety : development of an assessment tool to reduce risk on building sites

Australian construction and building workers are exposed to serious workplace risks - including injury, illness and death - and although there have been improvements in occupational health and safety (OHS) performance over the past 20 years, the injury and fatality rate in the Australian construction industry remains a matter of concern. The concept of safety culture is rapidly being adopted in the industry, including recognising the critical role that organisational leaders play in overall safety performance. This paper reviews recent research in construction safety leadership and provides some examples and applications relevant to risk reduction in the workforce. By focusing on developing safety competency in those that fulfil safety critical roles, and clearly articulating the relevant safety management tasks, leaders can positively influence the organisation’s safety culture. Finally, some promising research on Safety Effectiveness Indicators (SEIs) may be an industry-friendly solution to reducing workplace risks across the industry, by providing a credible, accurate, and timely measure of safety performance.

Ending the life of the act/omission dispute: Causation in withholding and withdrawing life-sustaining measures

My aim in this paper is to challenge the increasingly common view in the literature that the law on end of life decision making is in disarray and is in need of urgent reform. My argument is that this assessment of the law is based on assumptions about the relationship between the identity of the defendant and their conduct, and about the nature of causation, which, on examination, prove to be indefensible. I then provide a clarification of the relationship between causation and omissions which proves that the current legal position does not need modification, at least on the grounds that are commonly advanced for the converse view. This enables me, in conclusion, to clarify important conceptual and moral differences between withholding, refusing and withdrawing life-sustaining measures on the one hand, and assisted suicide and euthanasia, on the other.

Assessment of corneal dynamics with high-speed swept source optical coherence tomography combined with an air puff system

We present a novel method and instrument for in vivo imaging and measurement of the human corneal dynamics during an air puff. The instrument is based on high-speed swept source optical coherence tomography (ssOCT) combined with a custom adapted air puff chamber from a non-contact tonometer, which uses an air stream to deform the cornea in a non-invasive manner. During the short period of time that the deformation takes place, the ssOCT acquires multiple A-scans in time (M-scan) at the center of the air puff, allowing observation of the dynamics of the anterior and posterior corneal surfaces as well as the anterior lens surface. The dynamics of the measurement are driven by the biomechanical properties of the human eye as well as its intraocular pressure. Thus, the analysis of the M-scan may provide useful information about the biomechanical behavior of the anterior segment during the applanation caused by the air puff. An initial set of controlled clinical experiments are shown to comprehend the performance of the instrument and its potential applicability to further understand the eye biomechanics and intraocular pressure measurements. Limitations and possibilities of the new apparatus are discussed.

Sustainable assessment for large science classes : non-multiple choice, randomised assignments through a Learning Management System

This paper reports on the development of a tool that generates randomised, non-multiple choice assessment within the BlackBoard Learning Management System interface. An accepted weakness of multiple-choice assessment is that it cannot elicit learning outcomes from upper levels of Biggs’ SOLO taxonomy. However, written assessment items require extensive resources for marking, and are susceptible to copying as well as marking inconsistencies for large classes. This project developed an assessment tool which is valid, reliable and sustainable and that addresses the issues identified above. The tool provides each student with an assignment assessing the same learning outcomes, but containing different questions, with responses in the form of words or numbers. Practice questions are available, enabling students to obtain feedback on their approach before submitting their assignment. Thus, the tool incorporates automatic marking (essential for large classes), randomised tasks to each student (reducing copying), the capacity to give credit for working (feedback on the application of theory), and the capacity to target higher order learning outcomes by requiring students to derive their answers rather than choosing them. Results and feedback from students are presented, along with technical implementation details.