Clinical reasoning: The relative contribution of identification, interpretation and hypothesis errors to misdiagnosis

The aim of this study was to identify and describe the types of errors in clinical reasoning that contribute to poor diagnostic performance at different levels of medical training and experience. Three cohorts of subjects, second- and fourth- (final) year medical students and a group of general practitioners, completed a set of clinical reasoning problems. The responses of those whose scores fell below the 25th centile were analysed to establish the stage of the clinical reasoning process - identification of relevant information, interpretation or hypothesis generation - at which most errors occurred and whether this was dependent on problem difficulty and level of medical experience. Results indicate that hypothesis errors decrease as expertise increases but that identification and interpretation errors increase. This may be due to inappropriate use of pattern recognition or to failure of the knowledge base. Furthermore, although hypothesis errors increased in line with problem difficulty, identification and interpretation errors decreased. A possible explanation is that as problem difficulty increases, subjects at all levels of expertise are less able to differentiate between relevant and irrelevant clinical features and so give equal consideration to all information contained within a case. It is concluded that the development of clinical reasoning in medical students throughout the course of their pre-clinical and clinical education may be enhanced by both an analysis of the clinical reasoning process and a specific focus on each of the stages at which errors commonly occur.

Disorderly categories in picture postcards from colonial Papua and New Guinea

At the turn of the century in Melbourne, a notice typed on the verso of a postcard stated that the South Yarra Baptist Young Men's class was meeting on the following Sunday at 2.45 p.m. The card, published in the United Kingdom, was numbered 51828 in the Valentine series of Papuan postcards.1 The image, a photograph of Hanuabada village taken in the early 1880s, and the text, written early in 1900, are contradictory and constitute separate realms of evidence that invite a renegotiation of meaning, analysis, and interpretation of the relationships between images, tourism, colonial rule, and ethnographic knowing. The visual evidence suggests the postcard may have played an ethnographic, educative role in the public understanding of Papua, which had just become an Australian Territory and was not yet well known. It is also suggestive of educative roles related to mission endeavours, subimperialist ambitions and the new tourist traffic through the ports of Port Moresby, Samarai, and Rabaul.

Information technology support to improved construction processes : inter-disciplinarity in research and practice

Research and innovation in the built environment is increasingly taking on an inter-disciplinary nature. The built environment industry and professional practice have long adopted multi and inter-disciplinary practices. The application of IT in Construction is moving beyond the automation and replication of discrete mono and multi-disciplinary tasks to replicate and model the improved inter-disciplinary processes of modern design and construction practice. A major long-term research project underway at the University of Salford seeks to develop IT modelling capability to support the design of buildings and facilities that are buildable, maintainable, operable, sustainable, accessible, and have properties of acoustic, thermal and business support performance that are of a high standard. Such an IT modelling tool has been the dream of the research community for a long time. Recent advances in technology are beginning to make such a modelling tool feasible.----- Some of the key problems with its further research and development, and with its ultimate implementation, will be the challenges of multiple research and built environment stakeholders sharing a common vision, language and sense of trust. This paper explores these challenges as a set of research issues that underpin the development of appropriate technology to support realisable advances in construction process improvements.

Encounters and content sharing in an urban village : reading texts through an archaeological lens

Archaeology provides a framework of analysis and interpretation that is useful for disentangling the textual layers of a contemporary lived-in urban space. The producers and readers of texts may include those who planned and developed the site and those who now live, visit and work there. Some of the social encounters and content sharing between these people may be artificially produced or manufactured in the hope that certain social situations will occur. Others may be serendipitous. With archaeology’s original focus on places that are no longer inhabited it is often only the remaining artefacts and features of the built environment that form the basis for interpreting the social relationships of past people. Our analysis however, is framed within a contemporary notion of archaeological artefacts in an urban setting. Unlike an excavation, where the past is revealed through digging into the landscape, the application of landscape archaeology within a present day urban context is necessarily more experiential, visual and based on recording and analysing the physical traces of social encounters and relationships between residents and visitors. These physical traces are present within the creative content, and the built and natural elements of the environment. This chapter explores notions of social encounters and content sharing in an urban village by analysing three different types of texts: the design of the built environment; content produced by residents through a geospatial web application; and, print and online media produced in digital storytelling workshops.

The family attitude scale : reliability and validity of a new scale for measuring the emotional climate of families

Research on outcomes from psychiatric disorders has highlighted the importance of expressed emotion (EE), but its cost-effective measurement remains a challenge. This article describes development of the Family Attitude Scale (FAS), a 30-item instrument that can be completed by any informant. Its psychometric characteristics are reported in parents of undergraduate students and in 70 families with a schizophrenic member. The total FAS had high internal consistency in all samples, and reports of angry behaviour in FAS items showed acceptable inter-rater agreement. The FAS was associated with the reported anger, anger expression and anxiety of respondents. Substantial associations between the parents' FAS and the anger and anger expression of students was also observed. Parents of schizophrenic patients had higher FAS scores than parents of students, and the FAS was higher if disorder duration was longer or patient functioning was poorer. Hostility, high criticism and low warmth on the Camberwell Family Interview (CFI) were associated with a more negative FAS. The highest FAS in the family was a good predictor of a highly critical environment on the CFI. The FAS is a reliable and valid indicator of relationship stress and expressed anger that has wide applicability.

Investigation into submicrometer particle and gaseous emissions from airport ground running procedures

Emissions from airport operations are of significant concern because of their potential impact on local air quality and human health. The currently limited scientific knowledge of aircraft emissions is an important issue worldwide, when considering air pollution associated with airport operation, and this is especially so for ultrafine particles. This limited knowledge is due to scientific complexities associated with measuring aircraft emissions during normal operations on the ground. In particular this type of research has required the development of novel sampling techniques which must take into account aircraft plume dispersion and dilution as well as the various particle dynamics that can affect the measurements of the aircraft engine plume from an operational aircraft. In order to address this scientific problem, a novel mobile emission measurement method called the Plume Capture and Analysis System (PCAS), was developed and tested. The PCAS permits the capture and analysis of aircraft exhaust during ground level operations including landing, taxiing, takeoff and idle. The PCAS uses a sampling bag to temporarily store a sample, providing sufficient time to utilize sensitive but slow instrumental techniques to be employed to measure gas and particle emissions simultaneously and to record detailed particle size distributions. The challenges in relation to the development of the technique include complexities associated with the assessment of the various particle loss and deposition mechanisms which are active during storage in the PCAS. Laboratory based assessment of the method showed that the bag sampling technique can be used to accurately measure particle emissions (e.g. particle number, mass and size distribution) from a moving aircraft or vehicle. Further assessment of the sensitivity of PCAS results to distance from the source and plume concentration was conducted in the airfield with taxiing aircraft. The results showed that the PCAS is a robust method capable of capturing the plume in only 10 seconds. The PCAS is able to account for aircraft plume dispersion and dilution at distances of 60 to 180 meters downwind of moving a aircraft along with particle deposition loss mechanisms during the measurements. Characterization of the plume in terms of particle number, mass (PM2.5), gaseous emissions and particle size distribution takes only 5 minutes allowing large numbers of tests to be completed in a short time. The results were broadly consistent and compared well with the available data. Comprehensive measurements and analyses of the aircraft plumes during various modes of the landing and takeoff (LTO) cycle (e.g. idle, taxi, landing and takeoff) were conducted at Brisbane Airport (BNE). Gaseous (NOx, CO2) emission factors, particle number and mass (PM2.5) emission factors and size distributions were determined for a range of Boeing and Airbus aircraft, as a function of aircraft type and engine thrust level. The scientific complexities including the analysis of the often multimodal particle size distributions to describe the contributions of different particle source processes during the various stages of aircraft operation were addressed through comprehensive data analysis and interpretation. The measurement results were used to develop an inventory of aircraft emissions at BNE, including all modes of the aircraft LTO cycle and ground running procedures (GRP). Measurements of the actual duration of aircraft activity in each mode of operation (time-in-mode) and compiling a comprehensive matrix of gas and particle emission rates as a function of aircraft type and engine thrust level for real world situations was crucial for developing the inventory. The significance of the resulting matrix of emission rates in this study lies in the estimate it provides of the annual particle emissions due to aircraft operations, especially in terms of particle number. In summary, this PhD thesis presents for the first time a comprehensive study of the particle and NOx emission factors and rates along with the particle size distributions from aircraft operations and provides a basis for estimating such emissions at other airports. This is a significant addition to the scientific knowledge in terms of particle emissions from aircraft operations, since the standard particle number emissions rates are not currently available for aircraft activities.

Theoretical critique of the work of art : co-producers in research

The ways in which the "traditional" tension between words and artwork can be perceived has huge implications for understanding the relationship between critical or theoretical interpretation, art and practice, and research. Within the practice-led PhD this can generate a strange sense of disjuncture for the artist-researcher particularly when engaged in writing the exegesis. This paper aims to explore this tension through an introductory investigation of the work of the philosopher Andrew Benjamin. For Benjamin criticism completes the work of art. Criticism is, with the artwork, at the centre of our experience and theoretical understanding of art – in this way the work of art and criticism are co-productive. The reality of this co-productivity can be seen in three related articles on the work of American painter Marcia Hafif. In each of these articles there are critical negotiations of just how the work of art operates as art and theoretically, within the field of art. This focus has important ramifications for the writing and reading of the exegesis within the practice-led research higher degree. By including art as a significant part of the research reporting process the artist-researcher is also staking a claim as to the critical value of their work. Rather than resisting the tension between word and artwork the practice-led artist-researcher need to embrace the co-productive nature of critical word and creative work to more completely articulate their practice and its significance as research. The ideal venue and opportunity for this is the exegesis.

The management of transport construction projects : a survey of public sector organisations in Queensland Australia

Construction procurement organisations in the Australian framework provide broad guidelines on project management in setting benchmark performance measurements and processes for evaluating their projects. Despite this, little has been known in the project management practise in transport construction projects in Australia, in particular Queensland. Questionnaire data from 53 project management practitioners employed in State and City public sector organisations in Queensland,suggested that many practitioners in the public sector have little or a lack of understanding of government regulatory policies, which are used as economic evaluation tools for project options. Public sector project managers perceive socio-economic evaluation tools as inappropriate for public sector projects. The survey results also found conducting risk management analysis, developing a risk register and mitigation of risks were most effective way of managing risk. This study provides an opportunity for the public sector to review and provide training on project management practices and government regulatory policies governing public projects. This will improve project management practitioners’ understanding and interpretation of government regulatory policies.

Simulation and measurement of an electrostatic discharge

Electrostatic discharge is the sudden and brief electric current that flashes between two objects at different voltages. This is a serious issue ranging in application from solid-state electronics to spectacular and dangerous lightning strikes (arc flashes). The research herein presents work on the experimental simulation and measurement of the energy in an electrostatic discharge. The energy released in these discharges has been linked to ignitions and burning in a number of documented disasters and can be enormously hazardous in many other industrial scenarios. Simulations of electrostatic discharges were designed to specifications by IEC standards. This is typically based on the residual voltage/charge on the discharge capacitor, whereas this research examines the voltage and current in the actual spark in order to obtain a more precise comparative measurement of the energy dissipated.

Panel studies of new venture creation : a review and suggestions for future research

We review all journal articles based on “PSED-type” research, i.e., longitudinal, empirical studies of large probability samples of on-going, business start-up efforts. We conclude that the research stream has yielded interesting findings; sometimes by confirming prior research with a less bias-prone methodology and at other times by challenging whether prior conclusions are valid for the early stages of venture development. Most importantly, the research has addressed new, process-related research questions that prior research has shunned or been unable to study in a rigorous manner. The research has revealed an enormous and fascinating variability in new venture creation that also makes it challenging to arrive at broadly valid generalizations. An analysis of the findings across studies as well as an examination of those studies that have been relatively more successful at explaining outcomes give good guidance regarding what is required in order to achieve strong and credible results. We compile and present such advice to users of existing data sets and designers of new projects in the following areas: Statistically representative and/or theoretically relevant sampling; Level of analysis issues; Dealing with process heterogeneity; Dealing with other heterogeneity issues, and Choice and interpretation of dependent variables.

Prevalence and determinants of the health promotion and risk reduction practices of younger female survivors of breast cancer

This thesis describes a discrete component of a larger mixed-method (survey and interview) study that explored the health-promotion and risk-reduction practices of younger premenopausal survivors of ovarian, breast and haematological cancers. This thesis outlines my distinct contribution to the larger study, which was to: (1) Produce a literature review that thoroughly explored all longer-term breast cancer treatment outcomes, and which outlined the health risks to survivors associated with these; (2) Describe and analyse the health-promotion and risk-reduction behaviours of nine younger female survivors of breast cancer as articulated in the qualitative interview dataset; and (3) Test the explanatory power of the Precede-Proceed theoretical framework underpinning the study in relation to the qualitative data from the breast cancer cohort. The thesis reveals that breast cancer survivors experienced many adverse outcomes as a result of treatment. While they generally engaged in healthy lifestyle practices, a lack of knowledge about many recommended health behaviours emerged throughout the interviews. The participants also described significant internal and external pressures to behave in certain ways because of the social norms surrounding the disease. This thesis also reports that the Precede-Proceed model is a generally robust approach to data collection, analysis and interpretation in the context of breast cancer survivorship. It provided plausible explanations for much of the data in this study. However, profound sociological and psychological implications arose during the analysis that were not effectively captured or explained by the theories underpinning the model. A sociological filter—such as Turner’s explanation of the meaning of the body and embodiment in the social sphere (Turner, 2008)—and the psychological concerns teased out in Mishel’s (1990) Uncertainty in Illness Theory, provided a useful dimension to the findings generated through the Precede-Proceed model. The thesis concludes with several recommendations for future research, clinical practice and education in this context.

Changing relationships: activating student and staff engagement in a design studio

In the design studio learning environment, traditional student and staff expectations are of close contact teaching and learning. In recent years at QUT students have experienced reduced personal staff attention, and have increasingly felt “anonymous” and correspondingly disengaged, to the detriment of quality learning (Carbone 1998: 8; Biggs 2003). Concurrently, there has been a necessary increase in teaching by sessional staff at QUT with varied levels of experience and assurance. This paper outlines the first iteration of an action research project exploring whether changing the current QUT design studio student and staff relationships may lead to more engaged, dynamic learning environments. “Engagement” is understood as a primarily emotional, rather than operational student concern (Solomonides and Martin 2008; Austerlitz and Aravot 2007). The project inverted the standard QUT design studio teaching structure, and evaluated the new structure and activation of student engagement across four identified markers: attendance, participation, learning and performance (ACER 2009; NSSE 2005; Chapman 2003). Student and staff surveys and focus groups, corporate data, and informal feedback informed these evaluations. Overall, the results support the premise that when students and staff feel part of a reasonably-sized studio class with a dedicated lecturer and self-selected project, the majority are inclined to value these relationships, to feel actively engaged, and to experience some improvement in their learning and teaching performances.

Motivations and intentions : a case study of design-led activism

With a focus on intention and motivation, this paper describes a study involving three organisational communities and their collective effort to develop and provide more inclusive housing for people with disabilities and their families. While many studies, such as that by Rocha & Miles (2009), focus on commercial organisations, and sustainability from an economic perspective, this study involves a not-for-profit organisation (the accommodation and service provider) as well as a research organisation and a design action group volunteering their services free of charge. From this pro-bono context, the paper describes a case study that explores the nature of the collective as a basis for creative practice and political activism and the theoretical implications and wider application in terms of emerging research in the area of collaborative entrepreneurship and design activism.

Richard Rorty, innovation strategies & movie inspiration

Movie innovation is a conversation between screenwriters and producers in our mixed economy – a concept of innovation supported by Richard Rorty and Aristole's Poetics. During innovation conversations, inspired writers describe fresh movie actions to empathetic producers. Some inspired actions may confuse. Writers and producers use strategies to inquire about confusing actions. This Australian study redescribes 25 writer-producer strategies in the one place for the first time. It adds a new strategy. And, with more evidence than the current literature, it investigates writer inspiration, which drives film innovation. It reports inspiration in pioneering, verifiable detail.

'Which is the best Doctor Who story?' : a case study in value judgements outside the academy'

One of Cultural Studies' most important contributions to academic thinking about culture is the acceptance as axiomatic that we must not simply accept traditional value hierarchies in relation to cultural objects (see, for example, McGuigan, 1992: 157; Brunsdon, 1997: 5; Wark, 2001). Since Richard Hoggart and Raymond Williams took popular culture as a worthy object of study, Cultural Studies practitioners have accepted that the terms in which cultural debate had previously been conducted involved a category error. Opera is not 'better' than pop music, we believe in Cultural Studies - 'better for what?', we would ask. Similarly, Shakespeare is not 'better' than Mills and Boon, unless you can specify the purpose for which you want to use the texts. Shakespeare is indeed better than Mills and Boon for understanding seventeenth century ideas about social organisation; but Mills and Boon is unquestionably better than Shakespeare if you want slightly scandalous, but ultimately reassuring representations of sexual intercourse. The reason that we do not accept traditional hierarchies of cultural value is that we know that the culture that is commonly understood to be 'best' also happens to be that which is preferred by the most educated and most materially well-off people in any given culture (Bourdieu, 1984: 1- 2; Ross, 1989: 211). We can interpret this information in at least two ways. On the one hand, it can be read as proving that the poorer and less well-educated members of a society do indeed have tastes which are innately less worthwhile than those of the material and educational elite. On the other hand, this information can be interpreted as demonstrating that the cultural and material elite publicly represent their own tastes as being the only correct ones. In Cultural Studies, we tend to favour the latter interpretation. We reject the idea that cultural objects have innate value, in terms of beauty, truth, excellence, simply 'there' in the object. That is, we reject 'aesthetic' approaches to culture (Bourdieu, 1984: 6; 485; Hartley, 1994: 6)1. In this, Cultural Studies is similar to other postmodern institutions, where high and popular culture can be mixed in ways unfamiliar to modernist culture (Sim, 1992: 1; Jameson, 1998: 100). So far, so familiar.