Expert elicitation and its interface with technology : a review with a view to designing Elicitator

Expert knowledge is valuable in many modelling endeavours, particularly where data is not extensive or sufficiently robust. In Bayesian statistics, expert opinion may be formulated as informative priors, to provide an honest reflection of the current state of knowledge, before updating this with new information. Technology is increasingly being exploited to help support the process of eliciting such information. This paper reviews the benefits that have been gained from utilizing technology in this way. These benefits can be structured within a six-step elicitation design framework proposed recently (Low Choy et al., 2009). We assume that the purpose of elicitation is to formulate a Bayesian statistical prior, either to provide a standalone expert-defined model, or for updating new data within a Bayesian analysis. We also assume that the model has been pre-specified before selecting the software. In this case, technology has the most to offer to: targeting what experts know (E2), eliciting and encoding expert opinions (E4), whilst enhancing accuracy (E5), and providing an effective and efficient protocol (E6). Benefits include: -providing an environment with familiar nuances (to make the expert comfortable) where experts can explore their knowledge from various perspectives (E2); -automating tedious or repetitive tasks, thereby minimizing calculation errors, as well as encouraging interaction between elicitors and experts (E5); -cognitive gains by educating users, enabling instant feedback (E2, E4-E5), and providing alternative methods of communicating assessments and feedback information, since experts think and learn differently; and -ensuring a repeatable and transparent protocol is used (E6).

Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments.

Executive summary Objective: The aims of this study were to identify the impact of Pandemic (H1N1) 2009 Influenza on Australian Emergency Departments (EDs) and their staff, and to inform planning, preparedness, and response management arrangements for future pandemics, as well as managing infectious patients presenting to EDs in everyday practice. Methods This study involved three elements: 1. The first element of the study was an examination of published material including published statistics. Standard literature research methods were used to identify relevant published articles. In addition, data about ED demand was obtained from Australian Government Department of Health and Ageing (DoHA) publications, with several state health departments providing more detailed data. 2. The second element of the study was a survey of Directors of Emergency Medicine identified with the assistance of the Australasian College for Emergency Medicine (ACEM). This survey retrieved data about demand for ED services and elicited qualitative comments on the impact of the pandemic on ED management. 3. The third element of the study was a survey of ED staff. A questionnaire was emailed to members of three professional colleges—the ACEM; the Australian College of Emergency Nursing (ACEN); and the College of Emergency Nursing Australasia (CENA). The overall response rate for the survey was 18.4%, with 618 usable responses from 3355 distributed questionnaires. Topics covered by the survey included ED conditions during the (H1N1) 2009 influenza pandemic; information received about Pandemic (H1N1) 2009 Influenza; pandemic plans; the impact of the pandemic on ED staff with respect to stress; illness prevention measures; support received from others in work role; staff and others’ illness during the pandemic; other factors causing ED staff to miss work during the pandemic; and vaccination against Pandemic (H1N1) 2009 Influenza. Both qualitative and quantitative data were collected and analysed. Results: The results obtained from Directors of Emergency Medicine quantifying the impact of the pandemic were too limited for interpretation. Data sourced from health departments and published sources demonstrated an increase in influenza-like illness (ILI) presentations of between one and a half and three times the normal level of presentations of ILIs. Directors of Emergency Medicine reported a reasonable level of preparation for the pandemic, with most reporting the use of pandemic plans that translated into relatively effective operational infection control responses. Directors reported a highly significant impact on EDs and their staff from the pandemic. Growth in demand and related ED congestion were highly significant factors causing distress within the departments. Most (64%) respondents established a ‘flu clinic’ either as part of Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments. the ED operations or external to it. They did not note a significantly higher rate of sick leave than usual. Responses relating to the impact on staff were proportional to the size of the colleges. Most respondents felt strongly that Pandemic (H1N1) 2009 Influenza had a significant impact on demand in their ED, with most patients having low levels of clinical urgency. Most respondents felt that the pandemic had a negative impact on the care of other patients, and 94% revealed some increase in stress due to lack of space for patients, increased demand, and filling staff deficits. Levels of concern about themselves or their family members contracting the illness were less significant than expected. Nurses displayed significantly higher levels of stress overall, particularly in relation to skill-mix requirements, lack of supplies and equipment, and patient and patients’ family aggression. More than one-third of respondents became ill with an ILI. Whilst respondents themselves reported taking low levels of sick leave, respondents cited difficulties with replacing absent staff. Ranked from highest to lowest, respondents gained useful support from ED colleagues, ED administration, their hospital occupational health department, hospital administration, professional colleges, state health department, and their unions. Respondents were generally positive about the information they received overall; however, the volume of information was considered excessive and sometimes inconsistent. The media was criticised as scaremongering and sensationalist and as being the cause of many unnecessary presentations to EDs. Of concern to the investigators was that a large proportion (43%) of respondents did not know whether a pandemic plan existed for their department or hospital. A small number of staff reported being redeployed from their usual workplace for personal risk factors or operational reasons. As at the time of survey (29 October –18 December 2009), 26% of ED staff reported being vaccinated against Pandemic (H1N1) 2009 Influenza. Of those not vaccinated, half indicated they would ‘definitely’ or ‘probably’ not get vaccinated, with the main reasons being the vaccine was ‘rushed into production’, ‘not properly tested’, ‘came out too late’, or not needed due to prior infection or exposure, or due to the mildness of the disease. Conclusion: Pandemic (H1N1) 2009 Influenza had a significant impact on Australian Emergency Departments. The pandemic exposed problems in existing plans, particularly a lack of guidelines, general information overload, and confusion due to the lack of a single authoritative information source. Of concern was the high proportion of respondents who did not know if their hospital or department had a pandemic plan. Nationally, the pandemic communication strategy needs a detailed review, with more engagement with media networks to encourage responsible and consistent reporting. Also of concern was the low level of immunisation, and the low level of intention to accept vaccination. This is a problem seen in many previous studies relating to seasonal influenza and health care workers. The design of EDs needs to be addressed to better manage infectious patients. Significant workforce issues were confronted in this pandemic, including maintaining appropriate staffing levels; staff exposure to illness; access to, and appropriate use of, personal protective equipment (PPE); and the difficulties associated with working in PPE for prolonged periods. An administrative issue of note was the reporting requirement, which created considerable additional stress for staff within EDs. Peer and local support strategies helped ensure staff felt their needs were provided for, creating resilience, dependability, and stability in the ED workforce. Policies regarding the establishment of flu clinics need to be reviewed. The ability to create surge capacity within EDs by considering staffing, equipment, physical space, and stores is of primary importance for future pandemics.

Exercise and cancer rehabilitation : a systematic review

Introduction: Cancer is increasingly being viewed as a chronic illness requiring long-term management, and there is a growing need for evidence-based rehabilitation interventions for cancer survivors. Previous reviews have evaluated the benefits of exercise interventions for patients undergoing cancer treatment and long-term survivors, but none have investigated the role of exercise during cancer rehabilitation, the period immediately following cancer treatment completion. This systematic review summarises the literature on the health effects of exercise during cancer rehabilitation and evaluates the methodological rigour of studies in this area to date.----------- Methods: Relevant studies were identified through a systematic search of PubMed and Embase to April 2009. Data on study design, recruitment strategy, participants, exercise intervention, adherence rates, and outcomes were extracted. Methodological rigour was assessed using a structured rating system.---------- Results: Ten studies were included. Breast cancer patients were the predominate patient group represented. Most interventions were aerobic or resistance-training exercise programmes, and exercise type, frequency, duration and intensity varied across studies. Improvements in physical functioning, strength, physical activity levels, quality of life, fatigue, immune function, haemoglobin concentrations, potential markers of recurrence, and body composition were reported. However, all studies were limited by incomplete reporting and methodological limitations.---------- Conclusions: Although the methodological limitations of studies in this new field must be acknowledged, initial evidence indicates that exercise is feasible and may provide physiological and psychological benefits for cancer survivors during the rehabilitation period. Future studies with rigorous study designs are now required to advance the field.

What's cooking for dietetics? A review of the literature

Aim: There has been no systematic research on the role of cooking skills for improving dietary intakes in Australia. Cooking skills are proposed to be declining and/or being devalued. If cooking skills have been devalued and declining, then what evidence is there for this decline and what impact might this have on dietary intakes? The aim of the present paper is to explore these assumptions with particular reference to Australia. The objectives of the present paper are to define the terms cooking and cooking skills, discuss evidence on levels of cooking skills in Australia and describe the evidence linking cooking skills to dietary intakes.---------- Methods: A review of the peer-reviewed literature using multiple databases from 1990 to September 2009.---------- Results: Cooking skills are complex and require a range of processes for people to develop efficiency or confidence in food preparation. There is little evidence on the level of cooking skills in the Australian population and how this relates to dietary intakes. The Australian Bureau of Statistic’s latest Time Use Survey and Household Expenditure Survey suggest that cooking is still a gendered activity and that the time devoted to cooking has changed little in the past 15 years, but there is an increasing use of foods prepared outside the home.---------- Conclusion: Further research is required to examine the prevalence of different types and levels of cooking skills in Australia as well as their potential effects on dietary intakes. Dietitians need evidence about the level of cooking skills people require for healthy dietary intakes.

Boards of directors' contribution to strategy : a literature review and research agenda

Research Question/Issue: Over the last four decades, research on the relationship between boards of directors and strategy has proliferated. Yet to date there is little theoretical and empirical agreement regarding the question of how boards of directors contribute to strategy. This review assesses the extant literature by highlighting emerging trends and identifying several avenues for future research. Research Findings/Results: Using a content-analysis of 150 articles published in 23 management journals up to 2007, we describe and analyze how research on boards of directors and strategy has evolved over time. We illustrate how topics, theories, settings, and sources of data interact and influence insights about board–strategy relationships during three specific periods. Theoretical Implications: Our study illustrates that research on boards of directors and strategy evolved from normative and structural approaches to behavioral and cognitive approaches. Our results encourage future studies to examine the impact of institutional and context-specific factors on the (expected) contribution of boards to strategy, and to apply alternative methods to fully capture the impact of board processes and dynamics on strategy making. Practical Implications: The increasing interest in boards of directors’ contribution to strategy echoes a movement towards more strategic involvement of boards of directors. However, best governance practices and the emphasis on board independence and control may hinder the board contribution to the strategic decision making. Our study invites investors and policy-makers to consider the requirements for an effective strategic task when they nominate board members and develop new regulations.

Review of the progress in thin bed technology for masonry construction

Thin bed technology for clay/ concrete masonry is gaining popularity in many parts of the developed economy in recent times through active engagement of the industry with the academia. One of the main drivers for the development of thin bed technology is the progressive contraction of the professional brick and block laying workforce as the younger generation is not attracted towards this profession due to the general perception of the society towards manual work as being outdated in the modern digital economy. This situation has led to soaring cost of skilled labour associated with the general delay in completion of construction activities in recent times. In parallel, the advent of manufacturing technologies in producing bricks and blocks with adherence to specified dimensions and shapes and several rapid setting binders are other factors that have contributed to the development of thin bed technology. Although this technology is still emerging, especially for applications to earthquake prone regions, field applications are reported in Germany for over a few decades and in Italy since early 2000. The Australian concrete masonry industry has recently taken keen interest in pursuing research with a view to developing this technology. This paper presents the background information including review of literature and pilot studies that have been carried out to enable planning of the development of thin bed technology. The paper concludes with recommendations for future research.

Nurse-led telephone interventions for people with cardiac disease : A review of the research literature

Background: Nurse-led telephone follow-up offers a relatively inexpensive method of delivering education and support for assisting recovery in the early discharge period; however, its efficacy is yet to be determined. Aim: To perform a critical integrative review of the research literature addressing the effectiveness of nurse-led telephone interventions for people with coronary heart disease (CHD). Methods: A literature search of five health care databases; Sciencedirect, Cumulative Index to Nursing and Allied Health Literature, Pubmed, Proquest and Medline to identify journal articles between 1980 and 2009. People with cardiac disease were considered for inclusion in this review. The search yielded 128 papers, of which 24 met the inclusion criteria. Results: A total of 8330 participants from 24 studies were included in the final review. Seven studies demonstrated statistically significant differences in all outcomes measured, used two group experimental research design and valid and reliable instruments. Some positive effects were detected in eight studies in regards to nurse-led telephone interventions for people with cardiac disease and no differences were detected in nine studies. Discussion: Studies with some positive effects generally had stronger research designs, large samples, used valid and reliable instruments and extensive nurse-led educative interventions. Conclusion: The results suggest that people with cardiac disease showed some benefits from nurse-led/delivered telephone interventions. More rigorous research into this area is needed.

Entertaining the E Word : Barrie Kosky's On Ecstasy [A Review]

A review of Barrie Kosky's essay, On Ecstasy : Most of us describe the E word as a pleasant, out of this world experience—a type of boundless, artificial joy, deliberately induced by some kind of technicoloured drug. For others, it is that “lovey dovey” feeling. A spinning ceiling. Anything Lindt. For sensualist and soup connoisseur Barrie Kosky, it is easier than this. Being On Ecstasy involves, quite simply, his grandmother's chicken specialty—something warm and golden, surrendered with vegetables and a side of transcendental bliss. “A soup that took you to the beginning and end of time itself. A dazzling, pure, clear rhapsody” (7).

Once Upon a Misconception : Mark Juddery's Busted [A Review]

Forget Disney's timeless tales of rags-to-riches. Princesses are the most overrated public figures of all time. Apparently. Cinderella, after all, was 'a calculating, sinister go-getter' who murdered her step-mother at the instruction of a jealous governess (88). Sleeping Beauty was raped as she slept, woken not by the wet kiss of a handsome prince, but the kick and punch of twins stirring in her belly. Over the centuries, only the pea-detecting princess has remained herself: hedonistic, melodramatic and 'still perhaps the most pampered, precious wimp in the history of fairy tales' (88). There are, however, shards of truth to be salvaged from the fractured lives of these glassy-eyed women. After all, even Princess Mary worked in real estate.

Thelma and Disease : Susan Gilman's Undress Me in the Temple of Heaven [A Review]

In the nineteenth century, when female travel narratives of miss(adventure) were still read as excursions rather than expeditions, it was common for women travellers to preface their writing with an apology or admission of guilt—a type of disclaimer that excused the author for engaging in such inappropriate activity and bothering the reader with their trivial endeavours. Susan Gilman’s Undress Me in the Temple of Heaven offers no such thing. Instead Gilman begins her memoir with a confession about its lack of lies, half-truth and spin. ‘This is a true story,’ she writes, ‘recounted as accurate as possible and corroborated by notes I took at the time and by others who were present.’

Lucky or Lagging? Anne Summers's On Luck [A Review]

Described as 'The Lucky Country' over forty-years ago, Australia continues to play on and onward with a fervent belief in luck, her people often described, usually by themselvess, as 'graced' or as living in 'God's Own'. With our comfortable lifestyle and isolated location, white sands and soft mangoes, it is easy to see why we embraced the term so eagerly. Where else could you win the lottery twice? While these national stereotypes are an essential part of the romance that drives and defines us, the idea that luck is the central motif of Australian culture has become a cliche, and a dangerous, almost disastrous one at that. In On Luck, Anne Summers observes, "You hear it everywhere: in all sorts of conversations, in Qantas ads, from the mouths of travellers returning from overseas trips full of complaints about the climate, the crowds, the uncivility of other places".

Review : Surfers Paradise foreshore redevelopment masterplan - urban plaza zone

The Centre for Subtropical Design has prepared this submission to assist the Gold Coast City Council to finalise a plan and detailed design guidelines for the Urban Plaza Zone of Surfers Paradise Foreshore Redevelopment Masterplan which will create a public open space ‘alive’ with the quality appropriate to a place which is both a local centre and an international destination. This review has been informed by the two over-arching values identified as characteristics of a subtropical place and people’s connection to it:  A sense of openness and permeability, and  Engagement with the natural environment. The existing qualities of the foreshore area proposed as the Urban Plaza Zone, reflect these subtropical place values, and are integral to the Surfers Paradise identity:  Seamless visual and spatial access to the beach and sea,  Permeable interface between beach and built zones provided by beach planting and shade to sand by Pandanus,  A shade zone mediating beach and linear promenade, road and commercial zones, enabling a variety of social and visual experiences, on soft and hard finishes, and  A lively, constantly moving shared road and pedestrian way catering for events and day to day activities with visual access to beach and shaded areas. The Centre for Subtropical Design commends the Gold Coast City Council on preparing a plan for a public open space that is a contemporary departure from the adhoc basis of development that has occurred, in that it will make this area more accessible. However, the proposed plan seems to be working too hard in terms of ‘program’. While providing an identifiable interruption in the linear extent of the Foreshore, the lack of continuity of design in terms of both hardscaping (such as perpendicular paving elements) and softscaping (such as tree selections) may contribute to a lack of definition for the entire Foreshore as a place that mediates, along its length, between sea and land. Providing a hard edge to a beach character of soft and planted transitional elements needs to balance the proposed visual and physical barrier with the need for perceived and actual easy access. The Surfers Paradise identity needs strengthening through attention to planting for shade, materials, particularly selection of paving colours, and stronger delineation of the linear nature of the Foreshore. The Urban Plaza zone is an appropriate interruption to the continuous planting, however the link from the commercial zone overtakes the public and beach zone. A more seamless transition from shop to sea, better integration of the roadway and pedestrian zone and improved physical transition from concrete to sand is recommended. Built form solutions must be robust and designed with the subtropical design principles and the Surfers Paradise identity as underpinning parameters for a lasting and memorable public open space.

Pleasure Consuming Medicine : The Queer Politics of Drugs By Kane Race [Review]

The queer studies field works to deconstruct dominant western discourses which cast gay men as hedonistic partygoers. Concurrently it examines the real social ramifications for some gay men for whom partying, illegal drugs and casual sex is an everyday reality. Another reality of gay male culture is HIV/AIDS and the legal prescribed medicines which accompany these conditions. Pleasure Consuming Medicine: The Queer Politics of Drugs explores these realities and the discourses surrounding them. Exploring the embodiments of illegal and prescription drug users, this book problematises the binary between prescription medicine use, where drug use is configured as a matter of consumer choice, and 'illicit' drug use which is heavily policed and condemned. Returning to the gay community it reviews community approaches to safe sex and drug use, and individual practices, to demonstrate alternative approaches to condemning drug usage.

The Proposal [Film Review]

The Proposal is a well-executed romantic comedy that easily meets its low ambitions. Director Anne Fletcher (Step Up, 27 Dresses) and newcomer writer Peter Chiarelli team up to deliver a lighthearted comedy termpered with heartwarming family values. The cute and lovable cast, headed by Sandra Bullock and Ryan Reynolds, enriches this simple tale...

Review of the under the limit drink driving rehabilitation program

The combination of alcohol and driving is a major health and economic burden to most communities in industrialised countries. The total cost of crashes for Australia in 1996 was estimated at approximately 15 billion dollars and the costs for fatal crashes were about 3 billion dollars (BTE, 2000). According to the Bureau of Infrastructure, Transport and Regional Development and Local Government (2009; BITRDLG) the overall cost of road fatality crashes for 2006 $3.87 billion, with a single fatal crash costing an estimated $2.67 million. A major contributing factor to crashes involving serious injury is alcohol intoxication while driving. It is a well documented fact that consumption of liquor impairs judgment of speed, distance and increases involvement in higher risk behaviours (Waller, Hansen, Stutts, & Popkin, 1986a; Waller et al., 1986b). Waller et al. (1986a; b) asserts that liquor impairs psychomotor function and therefore renders the driver impaired in a crisis situation. This impairment includes; vision (degraded), information processing (slowed), steering, and performing two tasks at once in congested traffic (Moskowitz & Burns, 1990). As BAC levels increase the risk of crashing and fatality increase exponentially (Department of Transport and Main Roads, 2009; DTMR). According to Compton et al. (2002) as cited in the Department of Transport and Main Roads (2009), crash risk based on probability, is five times higher when the BAC is 0.10 compared to a BAC of 0.00. The type of injury patterns sustained also tends to be more severe when liquor is involved, especially with injuries to the brain (Waller et al., 1986b). Single and Rohl (1997) reported that 30% of all fatal crashes in Australia where alcohol involvement was known were associated with Breadth Analysis Content (BAC) above the legal limit of 0.05gms/100ml. Alcohol related crashes therefore contributes to a third of the total cost of fatal crashes (i.e. $1 billion annually) and crashes where alcohol is involved are more likely to result in death or serious injury (ARRB Transport Research, 1999). It is a major concern that a drug capable of impairment such as is the most available and popular drug in Australia (Australian Institute of Health and Welfare, 2007; AIHW). According to the AIHW (2007) 89.9% of the approximately 25,000 Australians over the age of 14 surveyed had consumed at some point in time, and 82.9% had consumed liquor in the previous year. This study found that 12.1% of individuals admitted to driving a motor vehicle whilst intoxicated. In general males consumed more liquor in all age groups. In Queensland there were 21503 road crashes in 2001, involving 324 fatalities and the largest contributing factor was alcohol and or drugs (Road Traffic Report, 2001). 23438 road crashes in 2004, involving 289 fatalities and the largest contributing factor was alcohol and or drugs (DTMR, 2009). Although a number of measures such as random breath testing have been effective in reducing the road toll (Watson, Fraine & Mitchell, 1995) the recidivist drink driver remains a serious problem. These findings were later supported with research by Leal, King, and Lewis (2006). This Queensland study found that of the 24661 drink drivers intercepted in 2004, 3679 (14.9%) were recidivists with multiple drink driving convictions in the previous three years covered (Leal et al., 2006). The legal definition of the term “recidivist” is consistent with the Transport Operations (Road Use Management) Act (1995) and is assigned to individuals who have been charged with multiple drink driving offences in the previous five years. In Australia relatively little attention has been given to prevention programs that target high-risk repeat drink drivers. However, over the last ten years a rehabilitation program specifically designed to reduce recidivism among repeat drink drivers has been operating in Queensland. The program, formally known as the “Under the Limit” drink driving rehabilitation program (UTL) was designed and implemented by the research team at the Centre for Accident Research and Road Safety in Queensland with funding from the Federal Office of Road Safety and the Institute of Criminology (see Sheehan, Schonfeld & Davey, 1995). By 2009 over 8500 drink-drivering offenders had been referred to the program (Australian Institute of Crime, 2009).