Trauma and Injury Severity Score (TRISS) coefficients 2009 revision

Background: Currently used Trauma and Injury Severity Score (TRISS) coefficients, which measure probability of survival (Ps), were derived from the Major Trauma Outcome Study (MTOS) in 1995 and are now unlikely to be optimal. This study aims to estimate new TRISS coefficients using a contemporary database of injured patients presenting to emergency departments in the United States; and to compare these against the MTOS coefficients.---------- Methods: Data were obtained from the National Trauma Data Bank (NTDB) and the NTDB National Sample Project (NSP). TRISS coefficients were estimated using logistic regression. Separate coefficients were derived from complete case and multistage multiple imputation analyses for each NTDB and NSP dataset. Associated Ps over Injury Severity Score values were graphed and compared by age (adult ≥ 15 years; pediatric < 15 years) and injury mechanism (blunt; penetrating) groups. Area under the Receiver Operating Characteristic curves was used to assess coefficients’ predictive performance.---------- Results: Overall 1,072,033 NTDB and 1,278,563 weighted NSP injury events were included, compared with 23,177 used in the original MTOS analyses. Large differences were seen between results from complete case and imputed analyses. For blunt mechanism and adult penetrating mechanism injuries, there were similarities between coefficients estimated on imputed samples, and marked divergences between associated Ps estimated and those from the MTOS. However, negligible differences existed between area under the receiver operating characteristic curves estimates because the overwhelming majority of patients had minor trauma and survived. For pediatric penetrating mechanism injuries, variability in coefficients was large and Ps estimates unreliable.---------- Conclusions: Imputed NTDB coefficients are recommended as the TRISS coefficients 2009 revision for blunt mechanism and adult penetrating mechanism injuries. Coefficients for pediatric penetrating mechanism injuries could not be reliably estimated.

Validation of the impact of Health Information Technology (I-HIT) scale : an international collaborative

In 2005, the Healthcare Information Management Systems Society (HIMSS) Nursing Informatics Community developed a survey to measure the impact of health information technology (HIT), the IHIT Scale, on the role of nurses and interdisciplinary communication in hospital settings. In 2007, nursing informatics colleagues from Australia, England, Finland, Ireland, New Zealand, Scotland and the United States formed a research collaborative to validate the IHIT across countries. All teams have completed construct and face validation in their countries. Five out of six teams have initiated reliability testing by practicing nurses. This paper reports the international collaborative’s validation of the IHIT Scale completed to date.

Digital design communication : measuring learner technological prowess and self-efficacy in problem resolution

Currently the Bachelor of Design is the generic degree offered to the four disciplines of Architecture, Landscape Architecture, Industrial Design, and Interior Design within the School of Design at the Queensland University of Technology. Regardless of discipline, Digital Communication is a core unit taken by the 600 first year students entering the Bachelor of Design degree. Within the design disciplines the communication of the designer's intentions is achieved primarily through the use of graphic images, with written information being considered as supportive or secondary. As such, Digital Communication attempts to educate learners in the fundamentals of this graphic design communication, using a generic digital or software tool. Past iterations of the unit have not acknowledged the subtle difference in design communication of the different design disciplines involved, and has used a single generic software tool. Following a review of the unit in 2008, it was decided that a single generic software tool was no longer entirely sufficient. This decision was based on the recognition that there was an increasing emergence of discipline specific digital tools, and an expressed student desire and apparent aptitude to learn these discipline specific tools. As a result the unit was reconstructed in 2009 to offer both discipline specific and generic software instruction, if elected by the student. This paper, apart from offering the general context and pedagogy of the existing and restructured units, will more importantly offer research data that validates the changes made to the unit. Most significant of this new data is the results of surveys that authenticate actual student aptitude versus desire in learning discipline specific tools. This is done through an exposure of student self efficacy in problem resolution and technological prowess - generally and specifically within the unit. More traditional means of validation is also presented that includes the results of the generic university-wide Learning Experience Survey of the unit, as well as a comparison between the assessment results of the restructured unit versus the previous year.

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

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

Collaborative research to develop a specialist, post-graduate competency-based education curriculum and continuing professional development structure for health librarians in Australia

Through a grant received from the Australian Library and Information Association (ALIA), members of Health Libraries Australia (HLA) are collaborating with a researcher/educator to conduct a twelve month research project with the goal of developing an educational framework for the Australian health librarianship workforce of the future. The collaboration comprises the principal researcher and a representative group of practitioners from different sectors of the health industry who are affiliated with ALIA in various committees, advisory groups and roles. The research has two main aims: to determine the future skills requirements for the health librarian workforce in Australia; and to develop a structured, modular education framework for specialist post-graduate qualifications together with a structure for ongoing continuing professional development. The paper highlights some of the major trends in the health sector and some of the main environmental influences that may act as drivers for change for health librarianship as a profession, and particularly for educating the future workforce. The research methodology is outlined and the main results are described; the findings are discussed with regard to their implications for the development of a structured, competency-based education framework.

Mrs Klein

Described as ‘ferociously sharp’, Crossbow Production’s Mrs Klein is about the formidable psychoanalyst Melanie Klein whose ruthlessly ‘objective’ case studies of her children won her acclaim as both an inspiring and appalling woman. Did her ‘study’ drive her son to suicide? Starring Therese Collie (La Boite), Louise Brehmer (QTC, La Boite) and Caroline Beck (New York Broadway credits). Directed by Dr Christian Heim. Live classical music and sharp wit combine to make this a memorable production.

Cigarette smoking in young adults : the influence of the HTR2A T102C polymorphism and punishment sensitivity

Background: The C allele of a common polymorphism of the serotonin 2A receptor (HTR2A) gene, T102C, results in reduced synthesis of 5-HT2A receptors and has been associated with current smoking status in adults. The -1438A/G polymorphism, located in the regulatory region of this gene, is in linkage disequilibrium with T102C, and the A allele is associated with increased promoter activity and with smoking in adult males. We investigated the contributions of the HTR2A gene, chronic psychological stress, and impulsivity to the prediction of cigarette smoking status and dependence in young adults. Methods: T102C and -1438A/G genotyping was conducted on 132 healthy Caucasian young adults (47 smokers) who completed self-report measures of chronic stress, depressive symptoms, impulsive personality and cigarette use. Results: A logistic regression analysis of current cigarette smoker user status, after adjusting for gender, depressive symptom severity and chronic stress, indicated that the T102C TT genotype relative to the CC genotype (OR = 7.53), and lower punishment sensitivity (OR = 0.91) were each significant predictive risk factors. However, for number of cigarettes smoked, only lower punishment sensitivity was a significant predictor (OR = 0.81). Conclusions: These data indicate the importance of the T102C polymorphism to tobacco use but not number of cigarettes smoked for Caucasian young adults. Future studies should examine whether this is explained by effects of nicotine on the serotonin system. Lower punishment sensitivity increased risk of both smoking and of greater consumption, perhaps via a reduced sensitivity to cigarette health warnings and negative physiological effects.

Dark humour invigorates familiar fables ; a review

THEATRE: Grimm Tales. By Carol Ann Duffy and Tim Supple. Queensland Theatre Company, Brisbane. November 16. QUEENSLAND Theatre Company concludes its season with Grimm Tales, Carol Ann Duffy and Tim Supple's adaptation of classic cautionary tales as set down by the Brothers Grimm in the 19th century. This programming decision is clearly designed to present fun family entertainment as Christmas approaches. In Grimm Tales, well-known stories such as Hansel and Gretel, Snow White and Rumpelstiltskin pack a little more punch than in your standard picture book. Duffy and Supple's play is by no means the sort of poetic, postmodern or politicised adaptation of the fairytale we see from writers such as Angela Carter, and it is not intended to be subversive or to question the social and gender assumptions that underpin the tales. Start of sidebar. Skip to end of sidebar. End of sidebar. Return to start of sidebar. Rather, a return to the grislier original incarnations of the tales - the wicked stepsisters who lop off parts of their feet to fit the slipper and win the prince, or the hare so confused by the hedgehog's stratagem to make him think he is losing the race, he runs himself to death - has a comic effect. In this production, directed by Michael Futcher, heightened performances from some of Brisbane's best comic and physical actors, live music and an open, acknowledged relationship with the audience establish the atmosphere for the piece. While the production is a little sombre and slow to start with the first tale, Hansel and Gretel, the knowingness and almost slapstick quality with which the cast plays out the gruesome, scatological or silly moments in the other tales are well pitched to carry the comedy. The action is supported by a fantastic set by Greg Clarke of wooden planked walls, stairs and walkways which, with the help of David Walter's lighting design, is transformed into forests, ballrooms and castles as the cast moves up, over and under it. The overall highlight is probably the cast Futcher has brought together. Established QTC actors Eugene Gilfedder, Lucas Stibbard and Scott Witt, and emerging QTC actor Melanie Zanetti, join Liz Buchanan, Dan Crestani and Emma Pursey, all well known for their independent work in Brisbane but making their mainstage debut for the QTC. Every one of them metamorphoses with ease from character to character, human to animal, and central player to support. There is nothing particularly new in Grimm Tales, and it doesn't try to do anything more (or, indeed, less) than entertain, but skilful direction and a strong cast ensure it succeeds on those terms.

Young drivers’ optimism bias for accident risk and driving skill : accountability and insight experience manipulations

This study aimed to determine whether two brief, low cost interventions would reduce young drivers’ optimism bias for their driving skills and accident risk perceptions. This tendency for such drivers to perceive themselves as more skilful and less prone to driving accidents than their peers may lead to less engagement in precautionary driving behaviours and a greater engagement in more dangerous driving behaviour. 243 young drivers (aged 17 - 25 years) were randomly allocated to one of three groups: accountability, insight or control. All participants provided both overall and specific situation ratings of their driving skills and accident risk relative to a typical young driver. Prior to completing the questionnaire, those in the accountability condition were first advised that their driving skills and accident risk would be later assessed via a driving simulator. Those in the insight condition first underwent a difficult computer-based hazard perception task designed to provide participants with insight into their potential limitations when responding to hazards in difficult and unpredictable driving situations. Participants in the control condition completed only the questionnaire. Results showed that the accountability manipulation was effective in reducing optimism bias in terms of participants’ comparative ratings of their accident risk in specific situations, though only for less experienced drivers. In contrast, among more experienced males, participants in the insight condition showed greater optimism bias for overall accident risk than their counterparts in the accountability or control groups. There were no effects of the manipulations on drivers’ skills ratings. The differential effects of the two types of manipulations on optimism bias relating to one’s accident risk in different subgroups of the young driver sample highlight the importance of targeting interventions for different levels of experience. Accountability interventions may be beneficial for less experienced young drivers but the results suggest exercising caution with the use of insight type interventions, particularly hazard perception style tasks, for more experienced young drivers typically still in the provisional stage of graduated licensing systems.

Indigenous knowledges : informing and supporting Indigenous students during their first year at university

This paper critically examines dominant discourses informing First Year Experience programs delivered for Aboriginal and Torres Strait Islander students participating in higher education. We interrogate traditional ‘deficit models’ through the recognition and acknowledgement of Indigenous knowledge at the cultural interface, the arena in which Aboriginal and Torres Strait Islander students encounter university for the first time. In this paper, we demonstrate how the First Year Experience programs for Indigenous students, developed and delivered by the Oodgeroo Unit, are conceptualised by Indigenous knowledges. By recognising Indigenous knowledges and experiences, and valuing these within the Western academy, we provide an alternative to these dominant mainstream discourses and perspectives for Indigenous students navigating their way through university. We argue that Indigenous standpoints provide tools through which Indigenous students can negotiate the cultural interface that exists within the university environment.

A variant of the KLK4 gene is expressed as a cis sense-antisense chimeric transcript in prostate cancer cells

In humans, more than 30,000 chimeric transcripts originating from 23,686 genes have been identified. The mechanisms and association of chimeric transcripts arising from chromosomal rearrangements with cancer are well established, but much remains unknown regarding the biogenesis and importance of other chimeric transcripts that arise from nongenomic alterations. Recently, a SLC45A3–ELK4 chimera has been shown to be androgen-regulated, and is overexpressed in metastatic or high-grade prostate tumors relative to local prostate cancers. Here, we characterize the expression of a KLK4 cis sense–antisense chimeric transcript, and show other examples in prostate cancer. Using non-protein-coding microarray analyses, we initially identified an androgen-regulated antisense transcript within the 3′ untranslated region of the KLK4 gene in LNCaP cells. The KLK4 cis-NAT was validated by strand-specific linker-mediated RT-PCR and Northern blotting. Characterization of the KLK4 cis-NAT by 5′ and 3′ rapid amplification of cDNA ends (RACE) revealed that this transcript forms multiple fusions with the KLK4 sense transcript. Lack of KLK4 antisense promoter activity using reporter assays suggests that these transcripts are unlikely to arise from a trans-splicing mechanism. 5′ RACE and analyses of deep sequencing data from LNCaP cells treated ±androgens revealed six high-confidence sense–antisense chimeras of which three were supported by the cDNA databases. In this study, we have shown complex gene expression at the KLK4 locus that might be a hallmark of cis sense–antisense chimeric transcription.