Measuring falls events in acute hospitals-A comparison of three reporting methods to identify missing data in the hospital reporting system

OBJECTIVES: To compare three different methods of falls reporting and examine the characteristics of the data missing from the hospital incident reporting system. DESIGN: Fourteen-month prospective observational study nested within a randomized controlled trial. SETTING: Rehabilitation, stroke, medical, surgical, and orthopedic wards in Perth and Brisbane, Australia. PARTICIPANTS: Fallers (n5153) who were part of a larger trial (1,206 participants, mean age 75.1 � 11.0). MEASUREMENTS: Three falls events reporting measures: participants’ self-report of fall events, fall events reported in participants’ case notes, and falls events reported through the hospital reporting systems. RESULTS: The three reporting systems identified 245 falls events in total. Participants’ case notes captured 226 (92.2%) falls events, hospital incident reporting systems captured 185 (75.5%) falls events, and participant selfreport captured 147 (60.2%) falls events. Falls events were significantly less likely to be recorded in hospital reporting systems when a participant sustained a subsequent fall, (P5.01) or when the fall occurred in the morning shift (P5.01) or afternoon shift (P5.01). CONCLUSION: Falls data missing from hospital incident report systems are not missing completely at random and therefore will introduce bias in some analyses if the factor investigated is related to whether the data ismissing.Multimodal approaches to collecting falls data are preferable to relying on a single source alone.

Environmental health risk assessment of dioxin exposure through foods in a Dioxin hot spot—Bien Hoa City, Vietnam

This study used the Australian Environmental Health Risk Assessment Framework to assess the human health risk of dioxin exposure through foods for local residents in two wards of Bien Hoa City, Vietnam. These wards are known hot-spots for dioxin and a range of stakeholders from central government to local levels were involved in this process. Publications on dioxin characteristics and toxicity were reviewed and dioxin concentrations in local soil, mud, foods, milk and blood samples were used as data for this risk assessment. A food frequency survey of 400 randomly selected households in these wards was conducted to provide data for exposure assessment. Results showed that local residents who had consumed locally cultivated foods, especially fresh water fish and bottom-feeding fish, free-ranging chicken, duck, and beef were at a very high risk, with their daily dioxin intake far exceeding the tolerable daily intake recommended by the WHO. Based on the results of this assessment, a multifaceted risk management program was developed and has been recognized as the first public health program ever to have been implemented in Vietnam to reduce the risks of dioxin exposure at dioxin hot-spots.

The 'Dirty Work' of the Lie

The panel "Duplicity/Complicity: Performing and Misperforming Lies" at PSi #15 in Croatia in July 2009 examined the half-truths, hidden assumptions and power relations embedded in every act of performance through an analysis of the way bodies, buildings, personae and communities perform and misperform lies. It was a collection of new academic voices from Australia and Croatia, intersecting and colliding and, at times, outright lying, with each other and with commentary from Alan Read. Inspired by this successful adventure in collaborative academic mis-performance, "The ‘Dirty Work’ of the Lie" takes the challenge set by the Prelude Panel at PSI #15 and subjects the ideas emerging from this panel to "friendly fire" in order to build a multi authored response to 'performance that lies', with reference to the work of A Chorus of Women, disabled artists Bill Shannon, Aaron Williamson and Kathryn Araneillo, US dance performer Ann Liv Young and US theatre and festival director Peter Sellars. In doing so, "The 'Dirty Work' of the Lie" provides a reflexive response to the duplicity inherent in the performances, and also in our own academic analyses. With Alan Read acting as interlocutor, each contributor will creatively respond to a paper presented by another, developing the key intersecting issues that emerged through the formation of the panel. These issues include impression management, self-belief and performers who are 'taken in by their own act', the dirty work of taking others in with an act, the guerrilla dimension of lying, the productivity of the lie, and questions of audience engagement and ethics. As a result, this new paper tests how the 'misperformance' of lies across different cultural sites, be it deliberate or accidental, can become a productive – and, indeed, politicised – aspect of cultural performance, betraying accepted attitudes, ideas and structures of authority and offering alternative visions. Through it’s distinctively multi vocal texture, "The 'Dirty Work' of the Lie" also interrogates the modes of analysis available to us, questioning the 'duplicity' in our reflecting, responding and listening to each other as well as the work.

The role of informal networks in providing effective work opportunities for people with an intellectual disability

Being in paid employment is socially valued, and is linked to health, financial security and time use. Issues arising from a lack of occupational choice and control, and from diminished role partnerships are particularly problematic in the lives of people with an intellectual disability. Informal support networks are shown to influence work opportunities for people without disabilities, but their impact on the work experiences of people with disability has not been thoroughly explored. The experience of 'work' and preparation for work was explored with a group of four people with an intellectual disability (the participants) and the key members of their informal support networks (network members) in New South Wales, Australia. Network members and participants were interviewed and participant observations of work and other activities were undertaken. Data analysis included open, conceptual and thematic coding. Data analysis software assisted in managing the large datasets across multiple team members. The insight and actions of network members created and sustained the employment and support opportunities that effectively matched the needs and interests of the participants. Recommendations for future research are outlined.

Intake of isoflavone and lignan phytoestrogens and associated demographic and lifestyle factors in older Australian women

The purpose was to determine intake of phytoestrogens in a sample of older Australian women, and to investigate associated lifestyle factors. Subjects were an age-stratified sample of 511 women aged 40-80 y, randomly selected from the electoral roll and participating in the Longitudinal Assessment of Ageing in Women at the Royal Brisbane and Women’s Hospital. A cross-sectional study was conducted to assess isoflavone and lignan intake over the past month from food and supplements using a 112-item phytoestrogen frequency questionnaire. Data were also collected on nutrient intakes, physical activity, smoking, alcohol, non-prescription supplements, hormone therapy, education and occupation. Logistic regression was used to evaluate associations between demographic and lifestyle variables and soy/linseed consumption while controlling for age. Isoflavone intakes were significantly higher in the younger compared to older age groups (p<0.001); there were no age-related differences in lignan intake. Forty-five percent of women consumed at least one serve of a soy and/or linseed item and were defined as a soy/linseed consumer. Median (range) intakes by consumers for isoflavones and lignans (3.9 (0-172) mg/d and 2.4 (0.1-33) mg/d) were higher than intakes by non-consumers (0.004 (0-2.6) mg/d and 1.57 (0.44-4.7) mg/d), respectively (p<0.001). Consumers had higher intakes of dietary fibre (p=0.003), energy (p=0.04) and polyunsaturated fat (p=0.004), and higher levels of physical activity (p=0.006), socio-economic position (p<0.001), education (p<0.001) and supplement use (p<0.001). Women who consumed soy or linseed foods differed in lifestyle and demographic characteristics suggesting these factors should be considered when investigating associations with chronic disease outcomes.

Using routinely collected hospital data for child maltreatment surveillance : issues, methods and patterns

Background: International data on child maltreatment are largely derived from child protection agencies, and predominantly report only substantiated cases of child maltreatment. This approach underestimates the incidence of maltreatment and makes inter-jurisdictional comparisons difficult. There has been a growing recognition of the importance of health professionals in identifying, documenting and reporting suspected child maltreatment. This study aimed to describe the issues around case identification using coded morbidity data, outline methods for selecting and grouping relevant codes, and illustrate patterns of maltreatment identified. Methods: A comprehensive review of the ICD-10-AM classification system was undertaken, including review of index terms, a free text search of tabular volumes, and a review of coding standards pertaining to child maltreatment coding. Identified codes were further categorised into maltreatment types including physical abuse, sexual abuse, emotional or psychological abuse, and neglect. Using these code groupings, one year of Australian hospitalisation data for children under 18 years of age was examined to quantify the proportion of patients identified and to explore the characteristics of cases assigned maltreatment-related codes. Results: Less than 0.5% of children hospitalised in Australia between 2005 and 2006 had a maltreatment code assigned, almost 4% of children with a principal diagnosis of a mental and behavioural disorder and over 1% of children with an injury or poisoning as the principal diagnosis had a maltreatment code assigned. The patterns of children assigned with definitive T74 codes varied by sex and age group. For males selected as having a maltreatment-related presentation, physical abuse was most commonly coded (62.6% of maltreatment cases) while for females selected as having a maltreatment-related presentation, sexual abuse was the most commonly assigned form of maltreatment (52.9% of maltreatment cases). Conclusion: This study has demonstrated that hospital data could provide valuable information for routine monitoring and surveillance of child maltreatment, even in the absence of population-based linked data sources. With national and international calls for a public health response to child maltreatment, better understanding of, investment in and utilisation of our core national routinely collected data sources will enhance the evidence-base needed to support an appropriate response to children at risk.

Design from the everyday: continuously evolving, embedded exploratory prototypes

One of the major challenges in the design of social technologies is the evaluation of their qualities of use and how they are appropriated over time. While the field of HCI abounds in short-term exploratory design and studies of use, relatively little attention has focused on the continuous development of prototypes longitudinally and studies of their emergent use. We ground the exploration and analysis of use in the everyday world, embracing contingency and open-ended use, through the use of a continuously-available exploratory prototype. Through examining use longitudinally, clearer insight can be gained of realistic, non-novelty usage and appropriation into everyday use. This paper sketches out a framework for design that puts a premium on immediate use and evolving the design in response to use and user feedback. While such design practices with continuously developing systems are common in the design of social technologies, they are little documented. We describe our approach and reflect upon its key characteristics, based on our experiences from two case studies. We also present five major patterns of long-term usage which we found useful for design.

Supervisory safety practices in the work-related driving context

Work-related driving crashes are the most common cause of work-related injury, death, and absence from work in Australia and overseas. Surprisingly however, limited attention has been given to initiatives designed to improve safety outcomes in the work-related driving setting. This research paper will present preliminary findings from a research project designed to examine the effects of increasing work-related driving safety discussions on the relationship between drivers and their supervisors and motivations to drive safely. The research project was conducted within a community nursing population, where 112 drivers were matched with 23 supervisors. To establish discussions between supervisors and drivers, safety sessions were conducted on a monthly basis with supervisors of the drivers. At these sessions, the researcher presented context specific, audio-based anti-speeding messages. Throughout the course of the intervention and following each of these safety sessions, supervisors were instructed to ensure that all drivers within their workgroup listened to each particular anti-speeding message at least once a fortnight. In addition to the message, supervisors were also encouraged to frequently promote the anti-speeding message through any contact they had with their drivers (i.e., face to face, email, SMS text, and/or paper based contact). Fortnightly discussions were subsequently held with drivers, whereby the researchers ascertained the number and type of discussions supervisors engaged in with their drivers. These discussions also assessed drivers’ perceptions of the group safety climate. In addition to the fortnightly discussion, drivers completed a daily speed reporting form which assessed the proportion of their driving day spent knowingly over the speed limit. As predicted, the results found that if supervisors reported a good safety climate prior to the intervention, increasing the number of safety discussions resulted in drivers reporting a high quality relationship (i.e., leader-member exchange) with their supervisor post intervention. In addition, if drivers reported a good safety climate, increasing the number of discussions resulted in increased motivation to drive safely post intervention. Motivations to drive safely prior to the intervention also predicted self-reported speeding over the subsequent three months of reporting. These results suggest safety discussions play an important role in improving the exchange between supervisors and their drivers and drivers’ subsequent motivation to drive safely and, in turn, self reported speeding.

Age and gender differences in ambulance utilisation in Queensland

Introduction Queensland has the highest ambulance utilisation (150 per 1000 population) in Australia and growing 4.4% annually. However, the impact of gender and age on utilisation is unknown. Methods & Materials Data on ambulance utilisation from Queensland Ambulance Service for the period 2002-2009 were analysed. Results Between 2002 and 2009, the number of ambulance patients per 1000 population increased overall by 17% (females) and 18% (males). The utilisation rate remained highest among the elderly but grew differently across age groups. For females, the rates were 55% (0-14yo), 73% (15-29yo), 38% (30-44yo), 22% (45-59yo), -9% (60-74yo) and -6% (75,+ yo); for males they were 48%, 59%, 38%, 17%, -13% and -2% respectively. Within the same age groups and period, the population adjusted number of males per 100 females (M:F ratio) changed from 134 to 128 (-5% growth), 98 to 91 (-8%), 101 to 100 (-0.4%), 115 to 111 (-3%), 114 to 108 (-5%) and 106 to 111 (4%). Conclusion Understanding the impact of patients’ demographic profiles on service utilisation and broader effects on the emergency health system is imperative for policy-making, demand management, designing public health campaigns and health promotions. Gender and age characteristics of ambulance users in Queensland appear to be changing most noticeably in the youngest and oldest groups. Physical and mental health, attitudinal, lifestyle, parenting, financial and socio-cultural reasons may account for these trends, but little evidence exists. A theoretical framework will be discussed to contextualise the findings.

The variant concept of transportation disadvantaged : evidence from Aydin, Turkey and Yamaga, Japan

Transportation disadvantaged groups, in the previous studies, are defined as those who are low income earners, family dependent, limited access to private motor vehicles and public transport services, and also those who oblige to spend relatively more time and money on their trips. Additionally those disable, young and elderly are considered among the natural groups of transportation disadvantaged. Although in general terms this definition seems correct, it is not specific enough to become a common universal definition that could apply to all urban contexts. This paper investigates whether travel difficulty perceptions vary and so does the definition of transportation disadvantaged in socio-culturally different urban contexts. For this investigation the paper undertakes a series of statistical analysis in the case study of Yamaga, Japan, and compares the findings with a previous case study, where the same methodology, hypothesis, and assumptions were utilized in a culturally and demographically different settlement of Aydin, Turkey. After comparing the findings observed in Aydin with the statistical analysis results of Yamaga, this paper reveals that there can be no explicitly detailed universal definition of transportation disadvantaged. The paper concludes by stating characteristics of transportation disadvantage is not globally identical, and policies and solutions that work in a locality may not show the same results in another socio-cultural context.

Improvement through people for the emerging new work practices in manufacturing

This paper describes the changes occurring in manufacturing industries and their effect on knowledge and skills necessary to perform effectively in the new environments. The changes in knowledge and skills are presented as a summary to illustrate the extent of the change. The concept of multiskilling is used to conceptualise the emerging new knowledge and skills and finally some guidelines for designing training programs to acquire multiskilling are presented.

Household food expenditure and its contribution to socioeconomic inequalities in purchasing foods consistent with Australian dietary guideline recommendations

Aim: To examine the amount of money spent on food by household income, and to ascertain whether food expenditure mediates the relationship between household income and the purchase of staple foods consistent with Australian dietary guideline recommendations. ----- ----- Methods: In face-to-face interviews (n = 1003, 66.4% response rate), households in Brisbane, Australia were asked about their purchasing choices for a range of staple foods, including grocery items, fruits and vegetables. For each participant, information was obtained about their total weekly household food expenditure, along with their sociodemographic and household characteristics. ----- ----- Results: Household income was significantly associated with food expenditure; participants residing in higher-income households spent more money on food per household member than those from lower-income households. Lower income households were less likely to make food purchasing choices of dietary staples that were consistent with recommendations. However, food expenditure did not attenuate the relationship between household income and the purchase of staple foods consistent with dietary guideline recommendations. ----- ----- Conclusions: The findings suggest that food expenditure may not contribute to income inequalities in purchasing staple foods consistent with dietary guideline recommendations: instead, other material or psychosocial factors not considered in the current study may be more important determinants of these inequalities. Further research should examine whether expenditure on non-staple items and takeaway foods is a larger contributor to socioeconomic inequalities in dietary behavior.

Vibration characteristics of plate elements subjected in-plane loads (axial loads)

Axial deformations resulting from in-plane loads (axial forces) of plate elements impact significantly on their vibration characteristics. Although, numerous methods have been developed to quantify axial forces and hence deformations of individual plate elements with different boundary conditions based on their natural frequencies, these methods are unable to apply to the plate elements in a structural system. This is because the natural frequency is a global parameter for the entire structure. Thus, this paper proposes a comprehensive vibration based procedure to quantify axial deformations of plate elements in a structural framing system. Unique capabilities of the proposed method present through illustrative examples. Keywords- Plate Elements, Dynamic Stiffness Matrix, Finite Element Method, Vibration Characteristics, Axial Deformation

That's a rap : the making of an Australian hip hop integrated musical film

To date, the majority of films that utilise or feature hip hop music and culture, have either been in the realms of documentary, or in ‘show musicals’ (where the film musical’s device of characters’ bursting into song, is justified by the narrative of a pursuit of a career in the entertainment industry). Thus, most films that feature hip hop expression have in some way been tied to the subject of hip hop. A research interest and enthusiasm was developed for utilising hip hop expression in film in a new way, which would extend the narrative possibilities of hip hop film to wider topics and themes. The creation of the thesis film Out of My Cloud, and the writing of this accompanying exegesis, investigates a research concern of the potential for the use of hip hop expression in an ‘integrated musical’ film (where characters’ break into song without conceit or explanation). Context and rationale for Out of My Cloud (an Australian hip hop ‘integrated musical’ film) is provided in this writing. It is argued that hip hop is particularly suitable for use in a modern narrative film, and particularly in an ‘integrated musical’ film, due to its: current vibrancy and popularity, rap (vocal element of hip hop) music’s focus on lyrical message and meaning, and rap’s use as an everyday, non-performative method of communication. It is also argued that Australian hip hop deserves greater representation in film and literature due to: its current popularity, and its nature as a unique and distinct form of hip hop. To date, representation of Australian hip hop in film and television has almost solely been restricted to the documentary form. Out of My Cloud borrows from elements of social realist cinema such as: contrasts with mainstream cinema, an exploration/recognition of the relationship between environment and development of character, use of non-actors, location-shooting, a political intent of the filmmaker, displaying sympathy for an underclass, representation of underrepresented character types and topics, and a loose narrative structure that does not offer solid resolution. A case is made that it may be appropriate to marry elements of social realist film with hip hop expression due to common characteristics, such as: representation of marginalised or underrepresented groups and issues in society, political objectives of the artist/s, and sympathy for an underclass. In developing and producing Out of My Cloud, a specific method of working with, and filming actor improvisation was developed. This method was informed by improvisation and associated camera techniques of filmmakers such as Charlie Chaplin, Mike Leigh, Khoa Do, Dogme 95 filmmakers, and Lars von Trier (post-Dogme 95). A review of techniques used by these filmmakers is provided in this writing, as well as the impact it has made on my approach. The method utilised in Out of My Cloud was most influenced by Khoa Do’s technique of guiding actors to improvise fairly loosely, but with a predetermined endpoint in mind. A variation of this technique was developed for use in Out of My Cloud, which involved filming with two cameras to allow edits from multiple angles. Specific processes for creating Out of My Cloud are described and explained in this writing. Particular attention is given to the approaches regarding the story elements and the music elements. Various significant aspects of the process are referred to including the filming and recording of live musical performances, the recording of ‘freestyle’ performances (lyrics composed and performed spontaneously) and the creation of a scored musical scene involving a vocal performance without regular timing or rhythm. The documentation of processes in this writing serve to make the successful elements of this film transferable and replicable to other practitioners in the field, whilst flagging missteps to allow fellow practitioners to avoid similar missteps in future projects. While Out of My Cloud is not without its shortcomings as a short film work (for example in the areas of story and camerawork) it provides a significant contribution to the field as a working example of how hip hop may be utilised in an ‘integrated musical’ film, as well as being a rare example of a narrative film that features Australian hip hop. This film and the accompanying exegesis provide insights that contribute to an understanding of techniques, theories and knowledge in the field of filmmaking practice.

Performance comparison of VSC-based shunt and series compensators used for load voltage control in distribution systems

In this paper, the performance of voltage-source converter-based shunt and series compensators used for load voltage control in electrical power distribution systems has been analyzed and compared, when a nonlinear load is connected across the load bus. The comparison has been made based on the closed-loop frequency resopnse characteristics of the compensated distribution system. A distribution static compensator (DSTATCOM) as a shunt device and a dynamic voltage restorer (DVR) as a series device are considered in the voltage-control mode for the comparison. The power-quality problems which these compensator address include voltage sags/swells, load voltage harmonic distortions, and unbalancing. The effect of various system parameters on the control performance of the compensator can be studied using the proposed analysis. In particular, the performance of the two compensators are compared with the strong ac supply (stiff source) and weak ac-supply (non-still source) distribution system. The experimental verification of the analytical results derived has been obtained using a laboratory model of the single-phase DSTATCOM and DVR. A generalized converter topology using a cascaded multilevel inverter has been proposed for the medium-voltage distribution system. Simulation studies have been performed in the PSCAD/EMTDC software to verify the results in the three-phase system.