Exploiting SNOMED CT concepts and relationships for clinical information retrieval : Australian e-Health Research Centre and Queensland University of Technology at the TREC 2012 Medical Track

The Australian e-Health Research Centre and Queensland University of Technology recently participated in the TREC 2012 Medical Records Track. This paper reports on our methods, results and experience using an approach that exploits the concept and inter-concept relationships defined in the SNOMED CT medical ontology. Our concept-based approach is intended to overcome specific challenges in searching medical records, namely vocabulary mismatch and granularity mismatch. Queries and documents are transformed from their term-based originals into medical concepts as defined by the SNOMED CT ontology, this is done to tackle vocabulary mismatch. In addition, we make use of the SNOMED CT parent-child `is-a' relationships between concepts to weight documents that contained concept subsumed by the query concepts; this is done to tackle the problem of granularity mismatch. Finally, we experiment with other SNOMED CT relationships besides the is-a relationship to weight concepts related to query concepts. Results show our concept-based approach performed significantly above the median in all four performance metrics. Further improvements are achieved by the incorporation of weighting subsumed concepts, overall leading to improvement above the median of 28% infAP, 10% infNDCG, 12% R-prec and 7% Prec@10. The incorporation of other relations besides is-a demonstrated mixed results, more research is required to determined which SNOMED CT relationships are best employed when weighting related concepts.

Semantic judgement of medical concepts : combining syntagmatic and paradigmatic information with the tensor encoding model

This paper outlines a novel approach for modelling semantic relationships within medical documents. Medical terminologies contain a rich source of semantic information critical to a number of techniques in medical informatics, including medical information retrieval. Recent research suggests that corpus-driven approaches are effective at automatically capturing semantic similarities between medical concepts, thus making them an attractive option for accessing semantic information. Most previous corpus-driven methods only considered syntagmatic associations. In this paper, we adapt a recent approach that explicitly models both syntagmatic and paradigmatic associations. We show that the implicit similarity between certain medical concepts can only be modelled using paradigmatic associations. In addition, the inclusion of both types of associations overcomes the sensitivity to the training corpus experienced by previous approaches, making our method both more effective and more robust. This finding may have implications for researchers in the area of medical information retrieval.

Encouraging, assisting and time to EAT : improved nutritional intake for older medical patients receiving Protected Mealtimes and/or additional nursing feeding assistance

Background & Aims: Inadequate feeding assistance and mealtime interruptions during hospitalisation may contribute to malnutrition and poor nutritional intake in older people. This study aimed to implement and compare three interventions designed to specifically address mealtime barriers and improve energy intakes of medical inpatients aged ≥65 years. Methods: Pre-post study compared three mealtime assistance interventions: PM: Protected Mealtimes with multidisciplinary education; AIN: additional assistant-in-nursing (AIN) with dedicated meal role; PM+AIN: combined intervention. Dietary intake of 254 patients (pre: n=115, post: n=141; mean age 80±8) was visually estimated on a single day in the first week of hospitalisation and compared with estimated energy requirements. Assistance activities were observed and recorded. Results: Mealtime assistance levels significantly increased in all interventions (p<0.01). Post-intervention participants were more likely to achieve adequate energy intake (OR=3.4, p=0.01), with no difference noted between interventions (p=0.29). Patients with cognitive impairment or feeding dependency appeared to gain substantial benefit from mealtime assistance interventions. Conclusions: Protected Mealtimes and additional AIN assistance (implemented alone or in combination) may produce modest improvements in nutritional intake. Targeted feeding assistance for certain patient groups holds promise; however, alternative strategies are required to address the complex problem of malnutrition in this population.

Development of an innovative technology-based youth passenger safety program : an evidence-based approach

Young drivers are overrepresented in motor vehicle crash rates, and their risk increases when carrying similar aged passengers. Graduated Driver Licensing strategies have demonstrated effectiveness in reducing fatalities among young drivers, however complementary approaches may further reduce crash rates. Previous studies conducted by the researchers have shown that there is considerable potential for a passenger focus in youth road safety interventions, particularly involving the encouragement of young passengers to intervene in their peers’ risky driving (Buckley, Chapman, Sheehan & Davidson, 2012). Additionally, this research has shown that technology-based applications may be a promising means of delivering passenger safety messages, particularly as young people are increasingly accessing web-based and mobile technologies. This research describes the participatory design process undertaken to develop a web-based road safety program, and involves feasibility testing of storyboards for a youth passenger safety application. Storyboards and framework web-based materials were initially developed for a passenger safety program, using the results of previous studies involving online and school-based surveys with young people. Focus groups were then conducted with 8 school staff and 30 senior school students at one public high school in the Australian Capital Territory. Young people were asked about the situations in which passengers may feel unsafe and potential strategies for intervening in their peers’ risky driving. Students were also shown the storyboards and framework web-based material and were asked to comment on design and content issues. Teachers were also shown the material and asked about their perceptions of program design and feasibility. The focus group data will be used as part of the participatory design process, in further developing the passenger safety program. This research describes an evidence-based approach to the development of a web-based application for youth passenger safety. The findings of this research and resulting technology will have important implications for the road safety education of senior high school students.

Development of a school connectedness component of an adolescent injury prevention program : lessons for implementation

The school environment plays an important role in shaping adolescent outcomes, and research increasingly demonstrates the need to target the school social context in health promotion programs. This paper describes the research process undertaken to design a school connectedness component of an injury prevention program for early adolescents, Skills for Preventing Injury in Youth (SPIY). The connectedness component takes the form of a professional development workshop for teachers on increasing students’ connectedness to school, and this paper describes the research process used to construct program material. It also describes the methods used to encourage teachers’ implementation of connectedness strategies following program delivery. A multi-stage process of data collection included, (i) surveys with 540 Grade 9 students to examine links between school connectedness and risk-related injury, (ii) a systematic literature review of previously-evaluated school connectedness programs to determine key strategies that encourage implementation fidelity and program effectiveness, and (iii) interviews with 14 high school teachers to understand current use of connectedness strategies and ideas for program design. Findings from each stage are discussed in terms of how results informed the program design. The survey data provided information from which to frame program content, and the results of the systematic review demonstrated effective program strategies. The teacher interview data also provided program content incorporating target participants’ views and aligning with their priorities, which is important to ensure effective implementation of program strategies. A comprehensive design process provides an understanding of methods for, and may encourage, teachers’ future implementation of program strategies.

Reaching high-risk adolescents : a process evaluation of a school based injury prevention program

High-risk adolescents are a population most vulnerable to harm from injury due to increased engagement in risk taking behaviour. There is a gap in the literature regarding how universal school based injury prevention programs apply to high-risk adolescents. This study involves a component of the process evaluation of a school based injury prevention program, as it relates to high-risk adolescents (13-14 years)...

Safety impacts of alcohol and other drugs in construction : development of an industry policy and cultural change management program

There is increasing concern about the impact of employees‟ alcohol and other drug (AOD) consumption on workplace safety and performance, particularly within the construction industry. While most Australian jurisdictions have identified this as a critical safety issue, information is limited regarding the prevalence of AODs in the workplace and there is limited evidential guidance regarding how to effectively and efficiently address such an issue. The current research aims to scientifically evaluate the use of AODs within the Australian construction industry in order to reduce the potential resulting safety and performance impacts and engender a cultural change in the workforce - to render it unacceptable to arrive at a construction workplace with impaired judgement from AODs. The study will adopt qualitative and quantitative methods to firstly evaluate the extent of general AOD use in the industry. Secondly, the development of an appropriate industry policy will adopt a non-punitive and rehabilitative approach developed in consultation with employers and employees across the infrastructure and building sectors, with the aim it be adopted nationally for adoption at the construction workplace. Finally, an industry specific cultural change management program and implementation plan will be developed through a nationally collaborative approach. Final results indicate that a proportion of those sampled in the construction sector may be at risk of hazardous alcohol consumption. A total of 286 respondents (58%) scored above the cut-off cumulative score for risky or hazardous alcohol. Other drug use was also identified as a major issue. Results support the need for evidence-based, preventative educational initiatives that are tailored to the industry. This paper will discuss the final survey and interview results.

The impact of an enhanced graduated driver licensing program in Queensland

The Queensland graduated driver licensing (GDL) context (post-July 2007) - The experiences of young Learner drivers - Comparison of pre- (‘Original-GDL’) and post-July 2007 (‘Enhanced-GDL’) experiences - Post-July 2007 experiences - GDL-related issues - Other factors in young novice driver safety - Person-related factors - Social factors

The experiences of novices in an enhanced graduated driver licensing program in Queensland, Australia

- Young novice drivers - The Queensland graduated driver licensing (GDL) context - Pre-July 2007 (‘Original-GDL’) - Post-July 2007 (‘Enhanced-GDL’) - Experiences of Learners in Queensland’s enhanced-GDL program - Pre-/post-July 2007 comparison - Post-July 2007 only - Implications - Strengths and limitations

Training program impact on thermoplastic immobilization for head and neck radiation therapy

Purpose: To determine whether uniform guidelines and training in the stabilization and formation of thermoplastic shells can improve the reproducibility of set-up for Head and Neck cancer patients. Methods and materials: Image based measurements of the planning and treatment positions for 35 head and neck cancer patients undergoing radical radiotherapy were analysed to provide a baseline of the reproducibility of thermoplastic immobilization. Radiation therapists (RT) were surveyed to establish a perception of their confidence in thermoplastic procedures. An evidence based staff training program was created and implemented. Set-up reproduction and staff perception were reviewed to measure the impact of the training program. Results: The mean (SD) 3D vectors of anatomical displacement, measured on the patient images, improved from 4.64 (2.03) for the baseline group compared to 3.02 (1.65) following training (p < 0.01). The proportion of 3D displacements of patient data exceeding 5 mm 3D vector was decreased from 37.1% to 5.7% (p < 0.001) and the 3 mm vector from 85.7% to 42.9% (p < 0.001). The post-training survey scores demonstrated improved confidence in reproducibility of set-up for head and neck patients. Conclusion: The Thermoplastic Shells Training Program has been found to improve the treatment reproducibility for head and neck radiation therapy patients. Uniform guidelines have increased RT confidence in thermoplastic procedures.

Towards informed learning: Snapshots of a Fulbright Scholar-in-Residence program in Denver

This paper outlines the Fulbright Scholar-in-Residence (SIR) program that I undertook at University of Colorado in Denver, USA, in August-December 2010. It explains how the SIR program proved a most enriching experience for me, professionally and personally. One reason for this paper is to encourage other LIS professionals and educators to apply for Fulbrights and other types of scholarships and exchange programs. And also to reinforce the message that research and further study really can open doors and enrich our professional careers.

Randomised controlled trial of an automated, interactive telephone intervention (TLC Diabetes) to improve type 2 diabetes management : Baseline findings and six-month outcomes

Background: Effective self-management of diabetes is essential for the reduction of diabetes-related complications, as global rates of diabetes escalate. Methods: Randomised controlled trial. Adults with type 2 diabetes (n = 120), with HbA1c greater than or equal to 7.5 %, were randomly allocated (4 × 4 block randomised block design) to receive an automated, interactive telephone-delivered management intervention or usual routine care. Baseline sociodemographic, behavioural and medical history data were collected by self-administered questionnaires and biological data were obtained during hospital appointments. Health-related quality of life (HRQL) was measured using the SF-36. Results: The mean age of participants was 57.4 (SD 8.3), 63 % of whom were male. There were no differences in demographic, socioeconomic and behavioural variables between the study arms at baseline. Over the six-month period from baseline, participants receiving the Australian TLC (Telephone-Linked Care) Diabetes program showed a 0.8 % decrease in geometric mean HbA1c from 8.7 % to 7.9 %, compared with a 0.2 % HbA1c reduction (8.9 % to 8.7 %) in the usual care arm (p = 0.002). There was also a significant improvement in mental HRQL, with a mean increase of 1.9 in the intervention arm, while the usual care arm decreased by 0.8 (p = 0.007). No significant improvements in physical HRQL were observed. Conclusions: These analyses indicate the efficacy of the Australian TLC Diabetes program with clinically significant post-intervention improvements in both glycaemic control and mental HRQL. These observed improvements, if supported and maintained by an ongoing program such as this, could significantly reduce diabetes-related complications in the longer term. Given the accessibility and feasibility of this kind of program, it has strong potential for providing effective, ongoing support to many individuals with diabetes in the future.

Hospital utilisation among people born in refugee-source countries : an analysis of hospital admissions, Victoria, 1998–2004

Objective: To investigate whether hospital utilisation and health outcomes in Victoria differ between people born in refugee-source countries and those born in Australia. Design and setting: Analysis of a statewide hospital discharge dataset for the 6 financial years from 1 July 1998 to 30 June 2004. Hospital admissions of people born in eight countries for which the majority of entrants to Australia arrived as refugees were included in the analysis. Main outcome measures: Age-standardised rates and rate ratios for: total hospital admissions; emergency admissions; surgical admissions; total days in hospital; discharge at own risk; hospital deaths; admissions due to infectious and parasitic diseases; and admissions due to mental and behavioural disorders. Results: In 2003–04, compared with the Australia-born Victorian population, people born in refugee-source countries had lower rates of surgical admission (rate ratio [RR], 0.85; 95% CI, 0.81–0.88), total days in hospital (RR, 0.74; 95% CI, 0.73–0.75), and admission due to mental and behavioural disorders (RR, 0.70; 95% CI, 0.65–0.76). Over the 6-year period, rates of total days in hospital and rates of admission due to mental and behavioural disorders for people born in refugee-source countries increased towards Australian-born averages, while rates of total admissions, emergency admissions, and admissions due to infectious and parasitic diseases increased above the Australian-born averages. Conclusions: Use of hospital services among people born in refugee-source countries is not higher than that of the Australian-born population and shows a trend towards Australian-born averages. Our findings indicate that the Refugee and Humanitarian Program does not currently place a burden on the Australian hospital system.

Low SES primary school students engaging in an after-school robotics program

Recent attention in education within many western contexts has focused on improved outcomes for students, with a particular focus on closing the gap between those who come from disadvantaged backgrounds and the rest of the student population. Much of this attention has supported a set of simplistic solutions to improving scores on high stakes standardized tests. The collateral damage (Nichols & Berliner, 2007) of such responses includes a narrowing of the curriculum, plateaus in gain scores on the tests, and unproductive blame games aimed by the media and politicians at teachers and communities (Nichols & Berliner, 2007; Synder, 2008). Alternative approaches to improving the quality and equity of schooling remain as viable alternatives to these measures. As an example in a recent study of school literacy reform in low SES schools, Luke, Woods and Dooley (2011) argued for the increase of substantive content and intellectual quality of the curriculum as a necessary means to re-engaging middle school students, improving outcomes of schooling and achieving a high quality, high equity system. The MediaClub is an afterschool program for students in years 4 to 7 (9-12 year old) at a primary school in a low SES area of a large Australian city. It is run as part of an Australian Research Council funded research project. The aim of the program has been to provide an opportunity for students to gain expertise in digital technologies and media literacies in an afterschool setting. It was hypothesized that this expertise might then be used to shift the ways of being literate that these students had to call on within classroom teaching and learning events. Each term, there is a different focus on digital media, and information and communication technology (ICT) activities in the MediaClub. The work detailed in this chapter relates to a robotics program presented as one of the modules within this afterschool setting. As part of the program, the participants were challenged to find creative solutions to problems in a constructivist-learning environment.