Content-independent embedding scheme for multi-modal medical image watermarking

Background As the increasing adoption of information technology continues to offer better distant medical services, the distribution of, and remote access to digital medical images over public networks continues to grow significantly. Such use of medical images raises serious concerns for their continuous security protection, which digital watermarking has shown great potential to address. Methods We present a content-independent embedding scheme for medical image watermarking. We observe that the perceptual content of medical images varies widely with their modalities. Recent medical image watermarking schemes are image-content dependent and thus they may suffer from inconsistent embedding capacity and visual artefacts. To attain the image content-independent embedding property, we generalise RONI (region of non-interest, to the medical professionals) selection process and use it for embedding by utilising RONI’s least significant bit-planes. The proposed scheme thus avoids the need for RONI segmentation that incurs capacity and computational overheads. Results Our experimental results demonstrate that the proposed embedding scheme performs consistently over a dataset of 370 medical images including their 7 different modalities. Experimental results also verify how the state-of-the-art reversible schemes can have an inconsistent performance for different modalities of medical images. Our scheme has MSSIM (Mean Structural SIMilarity) larger than 0.999 with a deterministically adaptable embedding capacity. Conclusions Our proposed image-content independent embedding scheme is modality-wise consistent, and maintains a good image quality of RONI while keeping all other pixels in the image untouched. Thus, with an appropriate watermarking framework (i.e., with the considerations of watermark generation, embedding and detection functions), our proposed scheme can be viable for the multi-modality medical image applications and distant medical services such as teleradiology and eHealth.

Who struggles most in making a career choice and why? Findings from a cross-sectional survey of Australian high-school students

This paper reports findings from an empirical study examining the influence of student background and educational experiences on the development of career choice capability. Secondary school students attending years 9-12 (N = 706) in New South Wales, Australia, were invited to participate in an online survey that sought to examine factors influencing their readiness to make career choice. The survey included questions relating to student demographics, parental occupation, attitudes to school and to learning, career aspirations, and students’ knowledge of the further education or skills required to achieve their desired goal. We found no significant differences in the proportions of students who were ‘uncertain’ of their future career aspirations with respect to their individual characteristics such as age and gender. There were, however, significant differences in relation to students’ family background, and their perceptions associated with own academic abilities and self-efficacy.

School based experiences as contributors to career decision-making: Findings from a cross-sectional survey of high-school students

This paper is based on a study examining the impact of young people’s backgrounds and educational experiences on career choice capability with the aim of informing education policy. A total of 706 students from secondary schools (Years 9-12) in New South Wales, Australia took part in an online survey. This paper focuses on the differences found between groups on the basis of their educational experiences. Participants who were uncertain of their future career plans were more likely to attend non-selective, non-metropolitan schools and were more likely to hold negative attitudes towards school. Career ‘uncertain’ students were also less likely to be satisfied with the elective subjects offered at their school and reported less access to career education sessions. It is concluded that timely career information and guidance should be provided to students and their families in order to allow them to more meaningfully make use of the resources and opportunities available to them with a view toward converting these into real world benefits.

CLEIMS: Outcomes of a randomised educational trial of extended immersion in medical simulation

To report the outcomes of a randomised educational trial of a new methodology for extended immersion in medical simulation for senior medical students. Clinical Learning through Extended Immersion in Medical Simulation (CLEIMS) is a new methodology for medical student learning. It involves senior students working in teams of 4-5 through the clinical progress of one or more patients over a week, utilising a range of simulation methodologies (simulated patient assessment, simulated significant other briefing, virtual story continuations, pig-trotter wound repair, online simulated on-call modules, interprofessional simulated ward rounds and high fidelity mannequin-based emergency simulations), to enhance learning in associated workshops and seminars. A randomised educational trial comparing the methodology to seminars and workshops alone began in 2010 and interim results were reported at last year’s conference. Updated results are presented here and final primary endpoint outcomes will be available by the time of the conference.

An MRI study of pituitary volume and parasuicidal behavior in teenagers with first-presentation borderline personality disorder

This structural magnetic resonance imaging study examined the relationship between pituitary gland volume (PGV) and lifetime number of parasuicidal behaviors in a first-presentation, teenage borderline personality disorder (BPD) sample with minimal exposure to treatment. Hierarchical regression analysis revealed that age and number of parasuicidal behaviors were significant predictors of PGV. These findings indicate that parasuicidal behavior in BPD might be associated with greater activation of the hypothalamic-pituitary-adrenal (HPA) axis. Further studies are required using direct neuroendocrine measures and exploring other parameters of self-injurious behavior, such as recency of self-injurious behavior, intent to die and medical threat.

A virtual environment for medical radiation collaborative learning

Asoftware-based environment was developed to provide practical training in medical radiation principles and safety. The Virtual Radiation Laboratory application allowed students to conduct virtual experiments using simulated diagnostic and radiotherapy X-ray generators. The experiments were designed to teach students about the inverse square law, half value layer and radiation protection measures and utilised genuine clinical and experimental data. Evaluation of the application was conducted in order to ascertain the impact of the software on students’ understanding, satisfaction and collaborative learning skills and also to determine potential further improvements to the software and guidelines for its continued use. Feedback was gathered via an anonymous online survey consisting of a mixture of Likert-style questions and short answer open questions. Student feedback was highly positive with 80 % of students reporting increased understanding of radiation protection principles. Furthermore 72 % enjoyed using the software and 87 %of students felt that the project facilitated collaboration within small groups. The main themes arising in the qualitative feedback comments related to efficiency and effectiveness of teaching, safety of environment, collaboration and realism. Staff and students both report gains in efficiency and effectiveness associated with the virtual experiments. In addition students particularly value the visualisation of ‘‘invisible’’ physical principles and increased opportunity for experimentation and collaborative problembased learning. Similar ventures will benefit from adopting an approach that allows for individual experimentation while visualizing challenging concepts.

Medical imaging and Biomechanical analysis of scoliosis progression in the growing adolescent spine

Progression of spinal deformity in children was studied with Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) to identify how gravity affects the deformity and to determine the full three-dimensional character of the deformity. The CT study showed that gravity is significant in deformity progression in some patients which has implications for clinical patient management. The world first MRI study showed that the standard clinical measure used to define the extent of the deformity is inadequate and further use of three-dimensional MRI should be considered by spinal surgeons.

Lewis's medical-surgical nursing: Assessment and management of clinical problems [ANZ Edition, 4th Ed.]

"Using the nursing process as a framework for practice, the fourth edition has been extensively revised to reflect the rapid changing nature of nursing practice and the increasing focus on key nursing care priorities. Building on the strengths of the third Australian and New Zealand edition and incorporating relevant global nursing research and practice from the prominent US title Medical-Surgical Nursing, 9Th Edition, Lewis’s Medical-Surgical Nursing, 4th Edition is an essential resource for students seeking to understand the role of the professional nurse in the contemporary health environment."--Publisher website

Medical education and law: Withholding/withdrawing treatment from adults without capacity

BACKGROUND Law is increasingly involved in clinical practice, particularly at the end of life, but undergraduate and postgraduate education in this area remains unsystematic. We hypothesised that attitudes to and knowledge of the law governing withholding/withdrawing treatment from adults without capacity (the WWLST law) would vary and demonstrate deficiencies among medical specialists. AIMS We investigated perspectives, knowledge and training of medical specialists in the three largest (populations and medical workforces) Australian states, concerning the WWLST law. METHODS Following expert legal review, specialist focus groups, pre-testing and piloting in each state, seven specialties involved with end-of-life care were surveyed, with a variety of statistical analyses applied to the responses. RESULTS Respondents supported the need to know and follow the law. There were mixed views about its helpfulness in medical decision-making. Over half the respondents conceded poor knowledge of the law; this was mirrored by critical gaps in knowledge that varied by specialty. There were relatively low but increasing rates of education from the undergraduate to continuing professional development (CPD) stages. Mean knowledge score did not vary significantly according to undergraduate or immediate postgraduate training, but CPD training, particularly if recent, resulted in greater knowledge. Case-based workshops were the preferred CPD instruction method. CONCLUSIONS Teaching of current and evolving law should be strengthened across all stages of medical education. This should improve understanding of the role of law, ameliorate ambivalence towards the law, and contribute to more informed deliberation about end-of-life issues with patients and families.

Exercise-induced DNA damage: Is there a relationship with inflammatory responses?

Both a systemic inflammatory response as well as DNA damage has been observed following exhaustive endurance exercise. Hypothetically, exercise-induced DNA damage might either be a consequence of inflammatory processes or causally involved in inflammation and immunological alterations after strenuous prolonged exercise (e.g. by inducing lymphocyte apoptosis and lymphocytopenia). Nevertheless, up to now only few studies have addressed this issue and there is hardly any evidence regarding a direct relationship between DNA or chromosomal damage and inflammatory responses in the context of exercise. The most conclusive picture that emerges from available data is that reactive oxygen and nitrogen species (RONS) appear to be the key effectors which link inflammation with DNA damage. Considering the time-courses of inflammatory and oxidative stress responses on the one hand and DNA effects on the other the lack of correlations between these responses might also be explained by too short observation periods. This review summarizes and discusses the recent findings on this topic. Furthermore, data from our own study are presented that aimed to verify potential associations between several endpoints of genome stability and inflammatory, immune-endocrine and muscle damage parameters in competitors of an Ironman triathlon until 19 days into recovery. The current results indicate that DNA effects in lymphocytes are not responsible for exercise-induced inflammatory responses. Furthermore, this investigation shows that inflammatory processes, vice versa, do not promote DNA damage, neither directly nor via an increased formation of RONS derived from inflammatory cells. Oxidative DNA damage might have been counteracted by training- and exercise-induced antioxidant responses. However, further studies are needed that combine advanced -omics based techniques (transcriptomics, proteomics) with state-of-the-art biochemical biomarkers to gain more insights into the underlying mechanisms.

Endurance exercise and DNA stability: Is there a link to duration and intensity?

It is commonly accepted that regular moderate intensity physical activity reduces the risk of developing many diseases. Counter intuitively, however, evidence also exists for oxidative stress resulting from acute and strenuous exercise. Enhanced formation of reactive oxygen and nitrogen species may lead to oxidatively modified lipids, proteins and nucleic acids and possibly disease. Currently, only a few studies have investigated the influence of exercise on DNA stability and damage with conflicting results, small study groups and the use of different sample matrices or methods and result units. This is the first review to address the effect of exercise of various intensities and durations on DNA stability, focusing on human population studies. Furthermore, this article describes the principles and limitations of commonly used methods for the assessment of oxidatively modified DNA and DNA stability. This review is structured according to the type of exercise conducted (field or laboratory based) and the intensity performed (i.e. competitive ultra/endurance exercise or maximal tests until exhaustion). The findings presented here suggest that competitive ultra-endurance exercise (>4h) does not induce persistent DNA damage. However, when considering the effects of endurance exercise (<4h), no clear conclusions could be drawn. Laboratory studies have shown equivocal results (increased or no oxidative stress) after endurance or exhaustive exercise. To clarify which components of exercise participation (i.e. duration, intensity and training status of subjects) have an impact on DNA stability and damage, additional carefully designed studies combining the measurement of DNA damage, gene expression and DNA repair mechanisms before, during and after exercise of differing intensities and durations are required.

Factors associated with mental health of medical students in Vietnam: A national study

This project was the first national study of the health and wellbeing of medical students in Vietnam. Data from over 2,000 students from eight universities indicate that, while the majority are healthy, significant proportions have poor mental and/or physical health and other life adversities. For many students, heavy academic demands were not a major stressor; rather, difficulties within their family, interpersonal relations, dissatisfaction with career choice and housing and financial problems appear to cause the most strain. This study provides evidence that will be useful for the development of professional counseling services in Vietnamese universities.

Predicting people’s intention to donate their body to medical science and research

Predictors of people’s intention to register with a body bequest program for donating their deceased body to medical science and research were examined using standard theory of planned behavior (TPB) predictors (attitude, subjective norm, perceived behavioral control) and adding moral norm, altruism, and knowledge. Australian students (N = 221) at a university with a recently established body bequest program completed measures of the TPB’s underlying beliefs (behavioral, normative, and control beliefs) and standard and extended TPB predictors, with a sub-sample reporting their registration-related behavior 2 months later. The standard TPB accounted for 43.6%, and the extended predictors an additional 15.1% of variance in intention. The significant predictors were attitude, subjective norm, and moral norm, partially supporting an extended TPB in understanding people’s body donation intentions. Further, important underlying beliefs can inform strategies to target prospective donors.

Adapting to concurrent expert evidence in medical litigation

In medical negligence litigation expert evidence has long played a dominant role. The trend towards the use of concurrent expert evidence is now well underway. However, for the lawyers and the doctors involved, the pathway is not yet familiar. Disputes have frequently arisen in the context of pre-hearing expert conclaves, given the adversarial nature of litigation and perhaps fuelled by fears of a less transparent process at this increasingly important stage. This article explains the concurrent expert evidence framework and examines areas of common dispute both in the conclaves and at trial, with a view to providing assistance to legal practitioners working in this area and the medical practitioners called upon to provide expert evidence in such litigation.

General practice coordinated chronic disease management to reduce avoidable hospital admission

Chronic disease accounts for about 80 per cent of the total disease burden in Australia, and its management accounts for 70 per cent of all current health expenditure.1 Effective prevention and management of chronic disease requires a coordinated approach between primary health care, acute care services, and the patients.2 However, what is not clear is whether improvements in primary healthcare management can have a clear benefit in the cost of care of patients with chronic disease. We recently completed a pilot study in rural Western Australia to ascertain the feasibility of a coordinated general practice-based approach to managing chronic respiratory and cardiovascular conditions, and to determine the direct cost savings to the public insurer through reduction in avoidable hospital admission. The aim of this correspondence is to share our preliminary findings and encourage debate on how such a project may be scaled up or adapted to other primary healthcare settings.