Emergency department in hospitals, a window of the world : a preliminary comparison between Australia and China

BACKGROUND: This study aimed to make a preliminary comparison of emergency department (ED) presentations between Australia and China. The comparison could provide insights into the health systems and burden of diseases and potentially stimulate discussion about the development of acute health system in China. METHODS: An observational study was performed to compare Australian ED presentations using data obtained from a single adult tertiary-referral teaching hospital in metropolitan Brisbane against Chinese ED presentations using public domain information published in existing Chinese and international medical journals. RESULTS: There are major differences in ED presentations between Australia and China. In 2008, 1) 35.4% of patients arrived at a tertiary teaching hospital ED in Brisbane, Australia by ambulance; 2) 1.7% were treated for poisoning; 3) 1.4% for cerebral vascular disease; 4) 1.7% for cardiac disease; and 5) 42.6% for trauma. The top events diagnosed were mental health problems including general psychiatric examination, psychiatric review, alcohol abuse, and counselling for alcohol abuse, which accounted for 5.5% of all ED presentations. Among ED patients in China, 6.7% arrived at a tertiary teaching hospital by ambulance in Shenyang in 1997; 3.7% were treated for poisoning in Shanxi Zhouzhi County People's Hospital ED in 2006; 14.9% for cerebral vascular diseases at Qinghai People's Hospital ED in 1993-1995; 1.7% for cardiac diseases at the Second People's Hospital ED, Shenzhen Longgang in 1993; and 44.3% for trauma at Shanxi Zhouzhi County People's Hospital ED in 2006. The top events were trauma and poisoning among the young and cerebral infarction in the older population. CONCLUSIONS: Compared with Australian, Chinese ED patients had 1) lower ambulance usage; 2) higher proportion of poisoning; 3) higher proportion of cerebral vascular diseases; 4) similar proportion of cardiac disease; 5) similar proportion of trauma; and 6) little reported mental health problems. Possible explanations for these differences in China include a pay for service pre-hospital care system, lack of public awareness about poisons, inadequate hypertension management, and lack of recognition of mental health problems.

Talking of many things : using topical networks to study discussions in social media

This paper outlines a method for studying online activity using both qualitative and quantitative methods: topical network analysis. A topical network refers to "the collection of sites commenting on a particular event or issue, and the links between them" (Highfield, Kirchhoff, & Nicolai, 2011, p. 341). The approach is a complement for the analysis of large datasets enabling the examination and comparison of different discussions as a means of improving our understanding of the uses of social media and other forms of online communication. Developed for an analysis of political blogging, the method also has wider applications for other social media websites such as Twitter.

Grouping people in social networks using a weighted multi-constraints clustering method

Grouping users in social networks is an important process that improves matching and recommendation activities in social networks. The data mining methods of clustering can be used in grouping the users in social networks. However, the existing general purpose clustering algorithms perform poorly on the social network data due to the special nature of users' data in social networks. One main reason is the constraints that need to be considered in grouping users in social networks. Another reason is the need of capturing large amount of information about users which imposes computational complexity to an algorithm. In this paper, we propose a scalable and effective constraint-based clustering algorithm based on a global similarity measure that takes into consideration the users' constraints and their importance in social networks. Each constraint's importance is calculated based on the occurrence of this constraint in the dataset. Performance of the algorithm is demonstrated on a dataset obtained from an online dating website using internal and external evaluation measures. Results show that the proposed algorithm is able to increases the accuracy of matching users in social networks by 10% in comparison to other algorithms.

eHealth in Australia and elsewhere : a comparison and lessons for the near future

Meticulous planning and preparation do not always guarantee that eHealth programs unfold as predicted. eHealth entails interdependent social interactions which are difficult to predict without past experience or reference to lessons learned. Judicious insight into past case studies and eventualities, therefore, is essential towards building a successful eHealth solution. Australia’s eHealth program is at a crucial stage where appropriate policy considerations and operational changes are in order. In this paper, we present an initial exploration of prominent eHealth initiatives of other countries to identify similarities, differences and to seek lessons towards making Australia’s eHealth initiative a better journey.

Assessing the short-term effects of heatwaves on mortality and morbidity in Brisbane, Australia : comparison of case-crossover and time series analyses

Background Heat-related impacts may have greater public health implications as climate change continues. It is important to appropriately characterize the relationship between heatwave and health outcomes. However, it is unclear whether a case-crossover design can be effectively used to assess the event- or episode-related health effects. This study examined the association between exposure to heatwaves and mortality and emergency hospital admissions (EHAs) from non-external causes in Brisbane, Australia, using both case-crossover and time series analyses approaches. Methods Poisson generalised additive model (GAM) and time-stratified case-crossover analyses were used to assess the short-term impact of heatwaves on mortality and EHAs. Heatwaves exhibited a significant impact on mortality and EHAs after adjusting for air pollution, day of the week, and season. Results For time-stratified case-crossover analysis, odds ratios of mortality and EHAs during heatwaves were 1.62 (95% confidence interval (CI): 1.36–1.94) and 1.22 (95% CI: 1.14–1.30) at lag 1, respectively. Time series GAM models gave similar results. Relative risks of mortality and EHAs ranged from 1.72 (95% CI: 1.40–2.11) to 1.81 (95% CI: 1.56–2.10) and from 1.14 (95% CI: 1.06–1.23) to 1.28 (95% CI: 1.21–1.36) at lag 1, respectively. The risk estimates gradually attenuated after the lag of one day for both case-crossover and time series analyses. Conclusions The risk estimates from both case-crossover and time series models were consistent and comparable. This finding may have implications for future research on the assessment of event- or episode-related (e.g., heatwave) health effects.

A comparison of children's needs models in the Australian and Chinese context

The diverse needs of children have been drawing global attention from both academic and practitioner communities. Based on semi-structured interviews with 23 kin caregivers and five school personnel in the Shijiapu Town of Jilin Province, China, this paper presents a needs model for rural school-age children left behind by their migrant parents. This Chinese model is compared to the needs identification mechanism developed by the Australian Research Alliance for Children and youth. The paper outlines the common needs of children in different contexts, and also highlights the needs that are not explicit in the Australian Research Alliance for Children and Youth framework, such as empowerment and agency or perhaps given insufficient weight, such as education. In discussing relationships among different needs, aspects that are missing in the framework it is argued that culture should be more explicitly recognised when defining need.

Motivating domestic energy conservation through comparative feedback in mobile applications and social networking sites

The progress of technology has led to the increased adoption of energy monitors among household energy consumers. While the monitors available on the market deliver real-time energy usage feedback to the consumer, the form of this data is usually unengaging and mundane. Moreover, it fails to address consumers with different motivations and needs to save and compare energy. This master‟s thesis project presents a study that seeks to inform design guidelines for differently motivated energy consumers. The focus of the research is on comparative feedback supported by a community of energy consumers. In particular, the discussed comparative feedback types are explanatory comparison, temporal self-comparison, norm comparison, one-on-one comparison and ranking, whereby the last three support exploring the potential of socialising energy-related feedback in social networking sites, such as Facebook. These feedback types were integrated in EnergyWiz – a mobile application that enables users to compare with their past performance, neighbours, contacts from social networking sites and other EnergyWiz users. The application was developed through a theory-driven approach and evaluated in personal, semi-structured interviews which provided insights on how motivation-related comparative feedback should be designed. It was also employed in expert focus group discussions which resulted in defining opportunities and challenges before mobile, social energy monitors. The findings have unequivocally shown that users with different motivations to compare and to conserve energy have different preferences for comparative feedback types and design. It was established that one of the most influential factors determining design factors is the people users compare to. In addition, the research found that even simple communication strategies in Facebook, such as wall posts and groups can contribute to engagement with energy conservation practices. The concept of mobility of the application was evaluated as positive since it provides place and time-independent access to the energy consumption data.

A multilevel investigation into the effects of the philosophical community of inquiry on 6th grade students' reading comprehension, interest in maths, self-esteem, pro-social behaviours and emotional well-being

This investigation measured the effects of a one year participation in an Australian Philosophical Community of Inquiry program on 280 sixth grade students' reading comprehension, interest in maths, self-esteem, social behaviours, and emotional well-being. A multilevel model for change was used to detect differences in the response variables, between a quasi-experimental group and comparison group. Results showed that, for participants, reading comprehension significantly increased while interest in maths decreased. No differences between the groups were found for pro-social behaviour and emotional well-being. Self esteem, however, declined for participants while nonparticipants' self esteem increased.

Retailer-driven agricultural restructuring - Australia, the UK and Norway in comparison

In recent decades, the governance of food safety, food quality, on-farm environmental management and animal welfare has been shifting from the realm of 'the government' to that of the private sector. Corporate entities, especially the large supermarkets, have responded to neoliberal forms of governance and the resultant 'hollowed-out' state by instituting private standards for food, backed by processes of certification and policed through systems of third party auditing. Today's food regime is one in which supermarkets impose 'private standards' along the food supply chain to ensure compliance with a range of food safety goals-often above and beyond those prescribed by government. By examining regulatory governance in Australia, Norway and the United Kingdom we highlight emerging trajectories of food governance. We argue that the imposition of the new private forms of monitoring and compliance continue the project of agricultural restructuring that began with government support for structural adjustment schemes in agriculture and that these are most evident in the UK and Australia where neoliberalism is an entrenched philosophy. However, despite Norway's identity as a social democracy, we also identify neoliberal 'creep' into the system of food governance. Small-scale producers in all three nations are finding themselves increasingly subject to governance through private, market-based mechanisms that, to varying degrees, are dominated by major supermarket chains. The result is agricultural restructuring not through the traditional avenues of elected governments, but via non-elected market operatives.

The Global Financial Crisis : Neo-Liberalism, Social Democracy, and Criminology

This chapter begins with a discussion of the economic, political, and social context of the recent global financial crisis, which casts into relief current boundaries of criminology, permeated and made fluid in criminology's recent cultural turn. This cultural turn has reinvigorated criminology, providing new objects of analysis and rich and thick descriptions of the relationship between criminal justice and the conditions of life in ‘late modernity’. Yet in comparison with certain older traditions that sought to articulate criminal justice issues with a wider politics of contestation around political economies and social welfare policies of different polities, many of the current leading culturalist accounts tend in their globalized convergences to produce a strangely decontextualized picture in which we are all subject to the zeitgeist of a unitary ‘late modernity’ which does not differ between, for example, social democratic and neo-liberal polities, let alone allow for the widespread persistence of the pre-modern. It is argued that that contrary to this globalizing trend there are signs within criminology that life is being breathed back into social democratic and penal welfare concerns, habitus, and practices. The chapter discusses three of these signs: the emergence of neo-liberalism as a subject of criminology; a developing comparative penology which recognizes differences in the political economies of capitalist states and evinces a renewed interest in inequality; and a nascent revolt against the ‘generative grammar’, ‘pathological disciplinarities’, and ‘imaginary penalities’ of neoliberal managerialism.

Control strategies to prevent total hip replacement-related infections : a systematic review and mixed treatment comparison

OBJECTIVE: To synthesise the available evidence and estimate the comparative efficacy of control strategies to prevent total hip replacement (THR)-related surgical site infections (SSIs) using a mixed treatment comparison. DESIGN: Systematic review and mixed treatment comparison. SETTING: Hospital and other healthcare settings. PARTICIPANTS: Patients undergoing THR. PRIMARY AND SECONDARY OUTCOME MEASURES: The number of THR-related SSIs occurring following the surgical operation. RESULTS: 12 studies involving 123 788 THRs and 9 infection control strategies were identified. The strategy of 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation' significantly reduced the risk of THR-related SSI compared with the referent strategy (no systemic antibiotics+plain cement+conventional ventilation), OR 0.13 (95% credible interval (CrI) 0.03-0.35), and had the highest probability (47-64%) and highest median rank of being the most effective strategy. There was some evidence to suggest that 'systemic antibiotics+antibiotic-impregnated cement+laminar airflow' could potentially increase infection risk compared with 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation', 1.96 (95% CrI 0.52-5.37). There was no high-quality evidence that antibiotic-impregnated cement without systemic antibiotic prophylaxis was effective in reducing infection compared with plain cement with systemic antibiotics, 1.28 (95% CrI 0.38-3.38). CONCLUSIONS: We found no convincing evidence in favour of the use of laminar airflow over conventional ventilation for prevention of THR-related SSIs, yet laminar airflow is costly and widely used. Antibiotic-impregnated cement without systemic antibiotics may not be effective in reducing THR-related SSIs. The combination with the highest confidence for reducing SSIs was 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation'. Our evidence synthesis underscores the need to review current guidelines based on the available evidence, and to conduct further high-quality double-blind randomised controlled trials to better inform the current clinical guidelines and practice for prevention of THR-related SSIs.

A rule-based hybrid method for anomaly detection in online-social-network graphs

Detecting anomalies in the online social network is a significant task as it assists in revealing the useful and interesting information about the user behavior on the network. This paper proposes a rule-based hybrid method using graph theory, Fuzzy clustering and Fuzzy rules for modeling user relationships inherent in online-social-network and for identifying anomalies. Fuzzy C-Means clustering is used to cluster the data and Fuzzy inference engine is used to generate rules based on the cluster behavior. The proposed method is able to achieve improved accuracy for identifying anomalies in comparison to existing methods.

Why 'down under' is a cut above: a comparison of rates of and reasons for caesarean section in England and Australia

Background Most studies examining determinants of rising rates of caesarean section have examined patterns in documented reasons for caesarean over time in a single location. Further insights could be gleaned from cross-cultural research that examines practice patterns in locations with disparate rates of caesarean section at a single time point. Methods We compared both rates of and main reason for pre-labour and intrapartum caesarean between England and Queensland, Australia, using data from retrospective cross-sectional surveys of women who had recently given birth in England (n = 5,250) and Queensland (n = 3,467). Results Women in Queensland were more likely to have had a caesarean birth (36.2%) than women in England (25.1% of births; OR = 1.44, 95% CI = 1.28-1.61), after adjustment for obstetric characteristics. Between-country differences were found for rates of pre-labour caesarean (21.2% vs. 12.2%) but not for intrapartum caesarean or assisted vaginal birth. Compared to women in England, women in Queensland with a history of caesarean were more likely to have had a pre-labour caesarean and more likely to have had an intrapartum caesarean, due only to a previous caesarean. Among women with no previous caesarean, Queensland women were more likely than women in England to have had a caesarean due to suspected disproportion and failure to progress in labour. Conclusions The higher rates of caesarean birth in Queensland are largely attributable to higher rates of caesarean for women with a previous caesarean, and for the main reason of having had a previous caesarean. Variation between countries may be accounted for by the absence of a single, comprehensive clinical guideline for caesarean section in Queensland. Keywords: Caesarean section; Childbirth; Pregnancy; Cross-cultural comparison; Vaginal birth after caesarean; Previous caesarean section; Patient-reported data; Quality improvement

Comparison of high sensitivity troponin T and I assays in the diagnosis of non-ST elevation acute myocardial infarction in emergency patients with chest pain

Objectives: Concentrations of troponin measured with high sensitivity troponin assays are raised in a number of emergency department (ED) patients; however many are not diagnosed with acute myocardial infarction (AMI). Clinical comparisons between the early use (2 h after presentation) of high sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) assays for the diagnosis of AMI have not been reported. Design and methods: Early (0 h and 2 h) hs-cTnT and hs-cTnI assay results in 1571 ED patients with potential acute coronary syndrome (ACS) without ST elevation on electrocardiograph (ECG) were evaluated. The primary outcome was diagnosis of index MI adjudicated by cardiologists using the local cTnI assay results taken ≥6 h after presentation, ECGs and clinical information. Stored samples were later analysed with hs-cTnT and hs-cTnI assays. Results: The ROC analysis for AMI (204 patients; 13.0%) for hs-cTnT and hs-cTnI after 2 h was 0.95 (95% CI: 0.94–0.97) and 0.98 (95% CI: 0.97–0.99) respectively. The sensitivity, specificity, PLR, and NLR of hs-cTnT and hs-cTnI for AMI after 2 h were 94.1% (95% CI: 90.0–96.6) and 95.6% (95% CI: 91.8–97.7), 79.0% (95% CI: 76.8–81.1) and 92.5% (95% CI: 90.9–93.7), 4.48 (95% CI: 4.02–5.00) and 12.86 (95% CI: 10.51–15.31), and 0.07 (95% CI: 0.04–0.13) and 0.05 (95% CI:0.03–0.09) respectively. Conclusions: Exclusion of AMI 2 h after presentation in emergency patients with possible ACS can be achieved using hs-cTnT or hs-cTnI assays. Significant differences in specificity of these assays are relevant and if using the hs-cTnT assay, further clinical assessment in a larger proportion of patients would be required.

Social licence to operate and the coal seam gas industry : lessons from social issues in established mining operations?

The recent growth of the coal seam gas industry has increased pressure on regional communities. Debate surrounding the industry is intense and a social licence to operate has yet to be granted to the industry in its entirety. This article presents an analysis of social issues surrounding the coal seam gas industry, making comparisons between two case studies: the Ranger and Jabiluka mines and the Yandicoogina mine. It presents the results of a desktop study, focussed on three topics: community identity; procedural justice and distributive justice, which provides a means for comparison and draws attention to central concerns. It is found that: power imbalances; changing community identities; potentially inequitable distributions of long term benefits and the process to distribute those benefits and negative perceptions of the industry as a whole serve to undermine the provision of a social licence to operate by communities and has the potential to impose significant negative impacts on companies within the industry.