Investigation of decision making issues in the use of current clinical information systems

Clinical information systems have become important tools in contemporary clinical patient care. However, there is a question of whether the current clinical information systems are able to effectively support clinicians in decision making processes. We conducted a survey to identify some of the decision making issues related to the use of existing clinical information systems. The survey was conducted among the end users of the cardiac surgery unit, quality and safety unit, intensive care unit and clinical costing unit at The Prince Charles Hospital (TPCH). Based on the survey results and reviewed literature, it was identified that support from the current information systems for decision-making is limited. Also, survey results showed that the majority of respondents considered lack in data integration to be one of the major issues followed by other issues such as limited access to various databases, lack of time and lack in efficient reporting and analysis tools. Furthermore, respondents pointed out that data quality is an issue and the three major data quality issues being faced are lack of data completeness, lack in consistency and lack in data accuracy. Conclusion: Current clinical information systems support for the decision-making processes in Cardiac Surgery in this institution is limited and this could be addressed by integrating isolated clinical information systems.

The use of computerised simulators for training of transthoracic and transoesophageal echocardiography. The future of echocardiographic training?

Echocardiography is the commonest form of non-invasive cardiac imaging and is fundamental to patient management. However, due to its methodology, it is also operator dependent. There are well defined pathways in training and ongoing accreditation to achieve and maintain competency. To satisfy these requirements, significant time has to be dedicated to scanning patients, often in the time pressured clinical environment. Alternative, computer based training methods are being considered to augment echocardiographic training. Numerous advances in technology have resulted in the development of interactive programmes and simulators to teach trainees the skills to perform particular procedures, including transthoracic and transoesophageal echocardiography. 82 sonographers and TOE proceduralists utilised an echocardiographic simulator and assessed its utility using defined criteria. 40 trainee sonographers assessed the simulator and were taught how to obtain an apical 2 chamber (A2C) view and image the superior vena cava (SVC). 100% and 88% found the simulator useful in obtaining the SVC or A2C view respectively. All users found it easy to use and the majority found it helped with image acquisition and interpretation. 42 attendees of a TOE training day utilising the simulator assessed the simulator with 100% finding it easy to use, as well as the augmented reality graphics benefiting image acquisition. 90% felt that it was realistic. This study revealed that both trainee sonographers and TOE proceduralists found the simulation process was realistic, helped in image acquisition and improved assessment of spatial relationships. Echocardiographic simulators may play an important role in the future training of echocardiographic skills.

The use of a Riesz fractional differential-based approach for texture enhancement in image processing

Abstract: Texture enhancement is an important component of image processing, with extensive application in science and engineering. The quality of medical images, quantified using the texture of the images, plays a significant role in the routine diagnosis performed by medical practitioners. Previously, image texture enhancement was performed using classical integral order differential mask operators. Recently, first order fractional differential operators were implemented to enhance images. Experiments conclude that the use of the fractional differential not only maintains the low frequency contour features in the smooth areas of the image, but also nonlinearly enhances edges and textures corresponding to high-frequency image components. However, whilst these methods perform well in particular cases, they are not routinely useful across all applications. To this end, we applied the second order Riesz fractional differential operator to improve upon existing approaches of texture enhancement. Compared with the classical integral order differential mask operators and other fractional differential operators, our new algorithms provide higher signal to noise values, which leads to superior image quality.

Primary classroom teachers' use of social and emotional wellbeing programs and the factors influencing program use

There has been a rapid escalation in the development and evaluation of social and emotional well-being (SEW) programs in primary schools over the last few decades. Despite the plethora of programs available, primary teachers’ use of SEW programs is not well documented in Australian schools, with even less consideration of the factors influencing program use. A cross-sectional survey was undertaken with primary classroom teachers across twelve schools in the Brisbane and Sunshine Coast Education Districts in Queensland, Australia, during 2005. A checklist of SEW programs and an audit of SEW practices in schools were employed to investigate the number, range and types of SEW programs used by primary classroom teachers and the contextual factors influencing program use. Whilst the majority of implementation studies have been conducted under intervention conditions, this study was designed to capture primary classroom teachers’ day-to-day use of SEW programs and the factors influencing program use under real-world conditions. The findings of this research indicate that almost three quarters of the primary classroom teachers involved in the study reported using at least one SEW program during 2005. Wide variation in the number and range of programs used was evident, suggesting that teachers are autonomous in their use of SEW programs. Evidence-based SEW programs were used by a similar proportion of teachers to non-evidence-based programs. However, irrespective of the type of program used, primary teachers overwhelmingly reported using part of a SEW program rather than the whole program. This raises some issues about the quality of teachers’ program implementation in real-world practice, especially with respect to programs that are evidence-based. A content analysis revealed that a wide range of factors have been examined as potential influences on teachers’ implementation of health promotion programs in schools, including SEW programs, despite the limited number of studies undertaken to date. However, variation in the factors examined and study designs employed both within and across health promotion fields limited the extent to which studies could be compared. A methodological and statistical review also revealed substantial variation in the quality of reporting of studies. A variety of factors were examined as potential influences on primary classroom teachers’ use of SEW programs across multiple social-ecological levels of influence (ranging from community to school and individual levels). In this study, parent or caregiver involvement in class activities and the availability of wellbeing-related policies in primary schools were found to be influential in primary classroom teachers’ use of SEW programs. Teachers who often or always involve parents or caregivers in class activities were at a higher odds of program use relative to teachers who never or rarely involved parents or caregivers in class activities. However, teachers employed in schools with the highest number of wellbeing-related policies available were at a lower odds of program use relative to teachers employed in schools with fewer wellbeing-related policies available. Future research should investigate primary classroom teachers’ autonomy and motivations for using SEW programs and the reasons behind the selection and use of particular types of programs. A larger emphasis should also be placed upon teachers not using SEW programs to identify valid reasons for non-use. This would provide another step towards bridging the gap between the expectations of program developers and the needs of teachers who implement programs in practice. Additionally, the availability of wellbeing-related school policies and the types of activities that parents and caregivers are involved with in the classroom warrant more in-depth investigation. This will help to ascertain how and why these factors influence primary classroom teachers’ use of SEW programs on a day-to-day basis in schools.

The use of artificial neural networks for identifying sustainable biodiesel feedstocks

Over the past few decades, biodiesel produced from oilseed crops and animal fat is receiving much attention as a renewable and sustainable alternative for automobile engine fuels, and particularly petroleum diesel. However, current biodiesel production is heavily dependent on edible oil feedstocks which are unlikely to be sustainable in the longer term due to the rising food prices and the concerns about automobile engine durability. Therefore, there is an urgent need for researchers to identify and develop sustainable biodiesel feedstocks which overcome the disadvantages of current ones. On the other hand, artificial neural network (ANN) modeling has been successfully used in recent years to gain new knowledge in various disciplines. The main goal of this article is to review recent literatures and assess the state of the art on the use of ANN as a modeling tool for future generation biodiesel feedstocks. Biodiesel feedstocks, production processes, chemical compositions, standards, physio-chemical properties and in-use performance are discussed. Limitations of current biodiesel feedstocks over future generation biodiesel feedstock have been identified. The application of ANN in modeling key biodiesel quality parameters and combustion performance in automobile engines is also discussed. This review has determined that ANN modeling has a high potential to contribute to the development of renewable energy systems by accelerating biodiesel research.

The use of navigation to achieve soft tissue balance in total knee arthroplasty : a randomised clinical study

Background: Achieving soft tissue balance is an operative goal in total knee arthroplasty. This randomised, prospective study compared computer navigation to conventional techniques in achieving soft tissue balance. Methods: Forty one consecutive knee arthroplasties were randomised to either a non-navigated or navigated group. In the non-navigated group, balancing was carried out using surgeon judgement. In the navigated group, balancing was carried out using navigation software. In both groups, the navigation software was used as a measuring tool. Results: Balancing of the mediolateral extension gap was superior in the navigation group (p=0.001). No significant difference was found between the two groups in balancing the mediolateral flexion gap or in achieving equal flexion and extension gaps. Conclusions: Computer navigation offered little advantage over experienced surgeon judgement in achieving soft tissue balance in knee replacement. However, the method employed in the navigated group did provide a reproducible and objective assessment of flexion and extension gaps and may therefore benefit surgeons in training.

Development and use of risk adjusted statistical process control tools for the monitoring and improvement of clinical outcomes in interventional cardiology

This thesis explored the development of statistical methods to support the monitoring and improvement in quality of treatment delivered to patients undergoing coronary angioplasty procedures. To achieve this goal, a suite of outcome measures was identified to characterise performance of the service, statistical tools were developed to monitor the various indicators and measures to strengthen governance processes were implemented and validated. Although this work focused on pursuit of these aims in the context of a an angioplasty service located at a single clinical site, development of the tools and techniques was undertaken mindful of the potential application to other clinical specialties and a wider, potentially national, scope.

Fundamental understanding on the use of Bluetooth scanner as a complementary transport data

Literature is limited in its knowledge of the Bluetooth protocol based data acquisition process and in the accuracy and reliability of the analysis performed using the data. This paper extends the body of knowledge surrounding the use of data from the Bluetooth Media Access Control Scanner (BMS) as a complementary traffic data source. A multi layer simulation model named Traffic and Communication Simulation (TCS) is developed. TCS is utilised to model the theoretical properties of the BMS data and analyse the accuracy and reliability of travel time estimation using the BMS data.

Enabling open access to and re-use of publicly funded research data in Malaysian public universities : a legal and policy analysis

Numerous statements and declarations have been made over recent decades in support of open access to research data. The growing recognition of the importance of open access to research data has been accompanied by calls on public research funding agencies and universities to facilitate better access to publicly funded research data so that it can be re-used and redistributed as public goods. International and inter-governmental bodies such as the ICSU/CODATA, the OECD and the European Union are strong supporters of open access to and re-use of publicly funded research data. This thesis focuses on the research data created by university researchers in Malaysian public universities whose research activities are funded by the Federal Government of Malaysia. Malaysia, like many countries, has not yet formulated a policy on open access to and re-use of publicly funded research data. Therefore, the aim of this thesis is to develop a policy to support the objective of enabling open access to and re-use of publicly funded research data in Malaysian public universities. Policy development is very important if the objective of enabling open access to and re-use of publicly funded research data is to be successfully achieved. In developing the policy, this thesis identifies a myriad of legal impediments arising from intellectual property rights, confidentiality, privacy and national security laws, novelty requirements in patent law and lack of a legal duty to ensure data quality. Legal impediments such as these have the effect of restricting, obstructing, hindering or slowing down the objective of enabling open access to and re-use of publicly funded research data. A key focus in the formulation of the policy was the need to resolve the various legal impediments that have been identified. This thesis analyses the existing policies and guidelines of Malaysian public universities to ascertain to what extent the legal impediments have been resolved. An international perspective is adopted by making a comparative analysis of the policies of public research funding agencies and universities in the United Kingdom, the United States and Australia to understand how they have dealt with the identified legal impediments. These countries have led the way in introducing policies which support open access to and re-use of publicly funded research data. As well as proposing a policy supporting open access to and re-use of publicly funded research data in Malaysian public universities, this thesis provides procedures for the implementation of the policy and guidelines for addressing the legal impediments to open access and re-use.

Practical guidance for the use of a pattern-matching technique in case-study research : a case presentation

This paper reports on a study that demonstrates how to apply pattern matching as an analytical method in case-study research. Case-study design is appropriate for the investigation of highly-contextualized phenomena that occur within the social world. Case-study design is considered a pragmatic approach that permits employment of multiple methods and data sources in order to attain a rich understanding of the phenomenon under investigation. The findings from such multiple methods can be reconciled in case-study analysis, specifically through a pattern-matching technique. Although this technique is theoretically explained in the literature, there is scant guidance on how to apply the method practically when analyzing data. This paper demonstrates the steps taken during pattern matching in a completed case-study project that investigated the influence of cultural diversity in a multicultural nursing workforce on the quality and safety of patient care. The example highlighted in this paper contributes to the practical understanding of the pattern-matching process, and can also make a substantial contribution to case-study methods.

Use of serum and blood samples on filter paper to improve the surveillance of dengue in Pacific Island Countries

Background In Pacific Island Countries (PICs) the epidemiology of dengue is characterized by long-term transmission of a single dengue virus (DENV) serotype. The emergence of a new serotype in one island country often indicates major outbreaks with this serotype will follow in other PICs. Objectives Filter paper (FP) cards on which whole blood or serum from dengue suspected patients had been dried was evaluated as a method for transportation of this material by standard mail delivery throughout the Pacific. Study design Twenty-two FP-dried whole blood samples collected from patients in New Caledonia and Wallis & Futuna Islands, during DENV-1 and DENV-4 transmission, and 76 FP-dried sera collected from patients in Yap State, Majuro (Republic of Marshall Islands), Tonga and Fiji, before and during outbreaks of DENV-2 in Yap State and DENV-4 in Majuro, were tested for the presence of DENV RNA, by serotype specific RT-PCR, at the Institut Louis Malardé in French Polynesia. Results The serotype of DENV could be determined, by a variety of RT-PCR procedures, in the FP-dried samples after more than three weeks of transport at ambient temperatures. In most cases, the sequencing of the envelope gene to genotype the viruses also was possible. Conclusions The serotype and genotype of DENV can be determined from FP-dried serum or whole blood samples transported over thousands of kilometers at ambient, tropical, temperatures. This simple and low-cost approach to virus identification should be evaluated in isolated and resource poor settings for surveillance for a range of significant viral diseases.

The use of acoustic indices to determine avian species richness in audio-recordings of the environment

Interpreting acoustic recordings of the natural environment is an increasingly important technique for ecologists wishing to monitor terrestrial ecosystems. Technological advances make it possible to accumulate many more recordings than can be listened to or interpreted, thereby necessitating automated assistance to identify elements in the soundscape. In this paper we examine the problem of estimating avian species richness by sampling from very long acoustic recordings. We work with data recorded under natural conditions and with all the attendant problems of undefined and unconstrained acoustic content (such as wind, rain, traffic, etc.) which can mask content of interest (in our case, bird calls). We describe 14 acoustic indices calculated at one minute resolution for the duration of a 24 hour recording. An acoustic index is a statistic that summarizes some aspect of the structure and distribution of acoustic energy and information in a recording. Some of the indices we calculate are standard (e.g. signal-to-noise ratio), some have been reported useful for the detection of bioacoustic activity (e.g. temporal and spectral entropies) and some are directed to avian sources (spectral persistence of whistles). We rank the one minute segments of a 24 hour recording in descending order according to an "acoustic richness" score which is derived from a single index or a weighted combination of two or more. We describe combinations of indices which lead to more efficient estimates of species richness than random sampling from the same recording, where efficiency is defined as total species identified for given listening effort. Using random sampling, we achieve a 53% increase in species recognized over traditional field surveys and an increase of 87% using combinations of indices to direct the sampling. We also demonstrate how combinations of the same indices can be used to detect long duration acoustic events (such as heavy rain and cicada chorus) and to construct long duration (24 h) spectrograms.

Pitfalls in the use of kappa when interpreting agreement between multiple raters in reliability studies

OBJECTIVE To compare different reliability coefficients (exact agreement, and variations of the kappa (generalised, Cohen's and Prevalence Adjusted and Biased Adjusted (PABAK))) for four physiotherapists conducting visual assessments of scapulae. DESIGN Inter-therapist reliability study. SETTING Research laboratory. PARTICIPANTS 30 individuals with no history of neck or shoulder pain were recruited with no obvious significant postural abnormalities. MAIN OUTCOME MEASURES Ratings of scapular posture were recorded in multiple biomechanical planes under four test conditions (at rest, and while under three isometric conditions) by four physiotherapists. RESULTS The magnitude of discrepancy between the two therapist pairs was 0.04 to 0.76 for Cohen's kappa, and 0.00 to 0.86 for PABAK. In comparison, the generalised kappa provided a score between the two paired kappa coefficients. The difference between mean generalised kappa coefficients and mean Cohen's kappa (0.02) and between mean generalised kappa and PABAK (0.02) were negligible, but the magnitude of difference between the generalised kappa and paired kappa within each plane and condition was substantial; 0.02 to 0.57 for Cohen's kappa and 0.02 to 0.63 for PABAK, respectively. CONCLUSIONS Calculating coefficients for therapist pairs alone may result in inconsistent findings. In contrast, the generalised kappa provided a coefficient close to the mean of the paired kappa coefficients. These findings support an assertion that generalised kappa may lead to a better representation of reliability between three or more raters and that reliability studies only calculating agreement between two raters should be interpreted with caution. However, generalised kappa may mask more extreme cases of agreement (or disagreement) that paired comparisons may reveal.

Use of a photographic food diary method to document dietary intake in people with Parkinson's Disease

Cognitive impairment and physical disability are common in Parkinson’s disease (PD). As a result diet can be difficult to measure. This study aimed to evaluate the use of a photographic dietary record (PhDR) in people with PD. During a 12-week nutrition intervention study, 19 individuals with PD kept 3-day PhDRs on three occasions using point-and-shoot digital cameras. Details on food items present in the PhDRs and those not photographed were collected retrospectively during an interview. Following the first use of the PhDR method, the photographer completed a questionnaire (n=18). In addition, the quality of the PhDRs was evaluated at each time point. The person with PD was the sole photographer in 56% of the cases, with the remainder by the carer or combination of person with PD and the carer. The camera was rated as easy to use by 89%, keeping a PhDR was considered acceptable by 94% and none would rather use a “pen and paper” method. Eighty-three percent felt confident to use the camera again to record intake. Of the photos captured (n=730), 89% were of adequate quality (items visible, in-focus), while only 21% could be used alone (without interview information) to assess intake. Over the study, 22% of eating/drinking occasions were not photographed. PhDRs were considered an easy and acceptable method to measure intake among individuals with PD and their carers. The majority of PhDRs were of adequate quality, however in order to quantify intake the interview was necessary to obtain sufficient detail and capture missing items.

GIS and qualitative data on young mothers’ use of urban neighbourhoods for physical activity

Public health research consistently demonstrates the salience of neighbourhood as a determinant of both health-related behaviours and outcomes across the human life course. This paper will report on the findings from a mixed-methods Brisbane-based study that explores how mothers with primary school children from both high and low socioeconomic suburbs use the local urban environment for the purpose of physical activity. Firstly, we demonstrate findings from an innovative methodology using the geographic information systems (GIS) embedded in social media platforms on mobile phones to track locations, resource-use, distances travelled, and modes of transport of the families in real-time; and secondly, we report on qualitative data that provides insight into reasons for differential use of the environment by both groups. Spatial/mapping and statistical data showed that while the mothers from both groups demonstrated similar daily routines, the mothers from the high SEP suburb engaged in increased levels of physical activity, travelled less frequently and less distance by car, and walked more for transport. The qualitative data revealed differences in the psychosocial processes and characteristics of the households and neighbourhoods of the respective groups, with mothers in the lower SEP suburb reporting more stress, higher conflict, and lower quality relationships with neighbours.