Patient preference for falls prevention in hospitals revealed through willingness-to-pay, contingent valuation survey

Rationale, aims and objectives: Patient preference for interventions aimed at preventing in-hospital falls has not previously been investigated. This study aims to contrast the amount patients are willing to pay to prevent falls through six intervention approaches. ----- ----- Methods: This was a cross-sectional willingness-to-pay (WTP), contingent valuation survey conducted among hospital inpatients (n = 125) during their first week on a geriatric rehabilitation unit in Queensland, Australia. Contingent valuation scenarios were constructed for six falls prevention interventions: a falls consultation, an exercise programme, a face-to-face education programme, a booklet and video education programme, hip protectors and a targeted, multifactorial intervention programme. The benefit to participants in terms of reduction in risk of falls was held constant (30% risk reduction) within each scenario. ----- ----- Results: Participants valued the targeted, multifactorial intervention programme the highest [mean WTP (95% CI): $(AUD)268 ($240, $296)], followed by the falls consultation [$215 ($196, $234)], exercise [$174 ($156, $191)], face-to-face education [$164 ($146, $182)], hip protector [$74 ($62, $87)] and booklet and video education interventions [$68 ($57, $80)]. A ‘cost of provision’ bias was identified, which adversely affected the valuation of the booklet and video education intervention. ----- ----- Conclusion: There may be considerable indirect and intangible costs associated with interventions to prevent falls in hospitals that can substantially affect patient preferences. These costs could substantially influence the ability of these interventions to generate a net benefit in a cost–benefit analysis.

Lateral shearing interferometry for analysis of tear film surface kinetics

Purpose: To date, there have been no measuring techniques available that could clearly identify all phases of tear film surface kinetics in one interblink interval. ----- ----- Methods: Using a series of cases, we show that lateral shearing interferometry equipped with a set of robust parameter estimation techniques is able to characterize up to five different phases of tear film surface kinetics that include: (i) initial fast tear film build-up phase, (ii) further slower tear film build-up phase, (iii) tear film stability, (iv) tear film thinning, and (v), after a detected break-up, subsequent tear film deterioration. ----- ----- Results: Several representative examples are given for estimating tear film surface kinetics in measurements in which the subjects were asked to blink and keep their eyes open as long as they could. ----- ----- Conclusions: Lateral shearing interferometry is a noninvasive technique that provides means for temporal characterization of tear film surface kinetics and the opportunity for the analysis of the two-step tear film build-up process.

Medication warnings about driving : risk perceptions among French and Australian Communities

Increased crash risk is associated with sedative medications and researchers and health-professionals have called for improvements to medication warnings about driving. The tiered warning system in France since 2005 indicates risk level, uses a color-coded pictogram, and advises the user to seek the advice of a doctor before driving. In Queensland, Australia, the mandatory warning on medications that may cause drowsiness advises the user not to drive or operate machinery if they self-assess that they are affected, and calls attention to possible increased impairment when combined with alcohol. Objectives The reported aims of the study were to establish and compare risk perceptions associated with the Queensland and French warnings among medication users. It was conducted to complement the work of DRUID in reviewing the effectiveness of existing campaigns and practice guidelines. Methods Medication users in France and Queensland were surveyed using warnings about driving from both contexts to compare risk perceptions associated with each label. Both samples were assessed for perceptions of the warning that carried the strongest message of risk. The Queensland study also included perceptions of the likelihood of crash and level of impairment associated with the warning. Results Findings from the French study (N = 75) indicate that when all labels were compared, the majority of respondents perceived the French Level-3 label as the strongest warning about risk concerning driving. Respondents in Queensland had significantly stronger perceptions of potential impairment to driving ability, z = -13.26, p <.000 (n = 325), and potential chance of having a crash, z = -11.87, p < .000 (n = 322), after taking a medication that displayed the strongest French warning, compared with the strongest Queensland warning. Conclusions Evidence suggests that warnings about driving displayed on medications can influence risk perceptions associated with use of medication. Further analyses will determine whether risk perceptions influence compliance with the warnings.

Reading nineteenth century schoolbooks online : user behavior in a digitized special collection

Special collections, because of the issues associated with conservation and use, a feature they share with archives, tend to be the most digitized areas in libraries. The Nineteenth Century Schoolbooks collection is a collection of 9000 rarely held nineteenth-century schoolbooks that were painstakingly collected over a lifetime of work by Prof. John A. Nietz, and donated to the Hillman Library at the University of Pittsburgh in 1958, which has since grown to 15,000. About 140 of these texts are completely digitized and showcased in a publicly accessible website through the University of Pittsburgh’s Library, along with a searchable bibliography of the entire collection, which expanded the awareness of this collection and its user base to beyond the academic community. The URL for the website is http://digital.library.pitt.edu/nietz/. The collection is a rich resource for researchers studying the intellectual, educational, and textbook publishing history of the United States. In this study, we examined several existing records collected by the Digital Research Library at the University of Pittsburgh in order to determine the identity and searching behaviors of the users of this collection. Some of the records examined include: 1) The results of a 3-month long user survey, 2) User access statistics including search queries for a period of one year, a year after the digitized collection became publicly available in 2001, and 3) E-mail input received by the website over 4 years from 2000-2004. The results of the study demonstrate the differences in online retrieval strategies used by academic researchers and historians, archivists, avocationists, and the general public, and the importance of facilitating the discovery of digitized special collections through the use of electronic finding aids and an interactive interface with detailed metadata.

Risk factor analysis and spatiotemporal CART model of cryptosporidiosis in Queensland, Australia

Background: It remains unclear whether it is possible to develop a spatiotemporal epidemic prediction model for cryptosporidiosis disease. This paper examined the impact of social economic and weather factors on cryptosporidiosis and explored the possibility of developing such a model using social economic and weather data in Queensland, Australia. ----- ----- Methods: Data on weather variables, notified cryptosporidiosis cases and social economic factors in Queensland were supplied by the Australian Bureau of Meteorology, Queensland Department of Health, and Australian Bureau of Statistics, respectively. Three-stage spatiotemporal classification and regression tree (CART) models were developed to examine the association between social economic and weather factors and monthly incidence of cryptosporidiosis in Queensland, Australia. The spatiotemporal CART model was used for predicting the outbreak of cryptosporidiosis in Queensland, Australia. ----- ----- Results: The results of the classification tree model (with incidence rates defined as binary presence/absence) showed that there was an 87% chance of an occurrence of cryptosporidiosis in a local government area (LGA) if the socio-economic index for the area (SEIFA) exceeded 1021, while the results of regression tree model (based on non-zero incidence rates) show when SEIFA was between 892 and 945, and temperature exceeded 32°C, the relative risk (RR) of cryptosporidiosis was 3.9 (mean morbidity: 390.6/100,000, standard deviation (SD): 310.5), compared to monthly average incidence of cryptosporidiosis. When SEIFA was less than 892 the RR of cryptosporidiosis was 4.3 (mean morbidity: 426.8/100,000, SD: 319.2). A prediction map for the cryptosporidiosis outbreak was made according to the outputs of spatiotemporal CART models. ----- ----- Conclusions: The results of this study suggest that spatiotemporal CART models based on social economic and weather variables can be used for predicting the outbreak of cryptosporidiosis in Queensland, Australia.

Long term immunity to live attenuated Japanese encephalitis chimeric virus vaccine : randomized, double-blind, 5-year phase II study in healthy adults.

In a randomized, double-blind study, 202 healthy adults were randomized to receive a live, attenuated Japanese encephalitis chimeric virus vaccine (JE-CV) and placebo 28 days apart in a cross-over design. A subgroup of 98 volunteers received a JE-CV booster at month 6. Safety, immunogenicity, and persistence of antibodies to month 60 were evaluated. There were no unexpected adverse events (AEs) and the incidence of AEs between JE-CV and placebo were similar. There were three serious adverse events (SAE) and no deaths. A moderately severe case of acute viral illness commencing 39 days after placebo administration was the only SAE considered possibly related to immunization. 99% of vaccine recipients achieved a seroprotective antibody titer ≥ 10 to JE-CV 28 days following the single dose of JE-CV, and 97% were seroprotected at month 6. Kaplan Meier analysis showed that after a single dose of JE-CV, 87% of the participants who were seroprotected at month 6 were still protected at month 60. This rate was 96% among those who received a booster immunization at month 6. 95% of subjects developed a neutralizing titer ≥ 10 against at least three of the four strains of a panel of wild-type Japanese encephalitis virus (JEV) strains on day 28 after immunization. At month 60, that proportion was 65% for participants who received a single dose of JE-CV and 75% for the booster group. These results suggest that JE-CV is safe, well tolerated and that a single dose provides long-lasting immunity to wild-type strains

Pedometry methods for assessing free-living youth

The purpose of this review is to integrate and summarize specific measurement topics (instrument and metric choice, validity, reliability, how many and what types of days, reactivity, and data treatment) appropriate to the study of youth physical activity. Research quality pedometers are necessary to aid interpretation of steps per day collected in a range of young populations under a variety of circumstances. Steps per day is the most appropriate metric choice, but steps per minute can be used to interpret time-in-intensity in specifically delimited time periods (e.g., physical education class). Reported intraclass correlations (ICC) have ranged from .65 over 2 days (although higher values also have been reported for 2 days) to .87 over 8 days (although higher values have been reported for fewer days). Reported ICCs are lower on weekend days (.59) versus weekdays (.75) and lower over vacation days (.69) versus school days (.74). There is no objective evidence of reactivity at this time. Data treatment includes (a) identifying and addressing missing values, (b) identifying outliers and reducing data appropriately if necessary, and (c) transforming the data as required in preparation for inferential analysis. As more pedometry studies in young populations are published, these preliminary methodological recommendations should be modified and refined.

Constituting the teacher of reading in contemporary Australian literacy debates

This chapter documents the history of the National Inquiry into the Teaching of Literacy and the subsequent fate of the figure of the teacher, in terms of how the inquiry has acted to background the teacher and bring new figures into prominence. The classroom teacher is being moved out of a central role of authority in literacy education, in spite of claims about the importance of the teacher in parts of the report. Authority is now being placed in the figure of the scientific researcher who decides what the best techniques are, and develops diagnostic tools that the teacher must use in order to decide which of the techniques to apply. Specialist literacy teachers, well “trained”by these experts, are needed to ensure that teachers do what the experts recommend (evidence-based practice). Thus, the classroom literacy teacher becomes a cipher for applying expertly designed techniques and tests.

Object identification based on 3D spatial models of construction sites

On obstacle-cluttered construction sites, understanding the motion characteristics of objects is important for anticipating collisions and preventing accidents. This study investigates algorithms for object identification applications that can be used by heavy equipment operators to effectively monitor congested local environment. The proposed framework contains algorithms for three-dimensional spatial modeling and image matching that are based on 3D images scanned by a high-frame rate range sensor. The preliminary results show that an occupancy grid spatial modeling algorithm can successfully build the most pertinent spatial information, and that an image matching algorithm is best able to identify which objects are in the scanned scene.

Tackling ‘Wicked’ problems holistically with institutionalist policymaking

One of our most pressing needs in creating a more sustainable world is the explicit development of holistic policy. This is becoming increasingly apparent as we are faced with more and more ‘wicked problems', the most difficult class of problems that we can conceptualize. Such problems consist of ‘clusters’ of problems, and include socio-political and moral-spiritual issues. This paper articulates a methodology that can be applied to the analysis and design of underlying organizational structures and processes that will consistently and effectively address wicked problems while being consistent with the advocated 'learning by doing' approach to change management and policy making. This transdisciplinary methodology—known as the institutionalist policymaking framework—has been developed from the perspective of institutional economics synthesized with perspectives from ecological economics and system dynamics. In particular it draws on the work first presented in Hayden’s 1993 paper ‘Institutionalist Policymaking’—and further developed in his 2006 book, at the heart of which lies the SFM—and the applicability of this approach in tackling complex and wicked problems.

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).

Using computers in the music classroom

Computers are now being widely used in the making of music and the extent of computer use in the music that we hear is farlarger than most people realise. This paper will discuss how computer technology is used in music, with particular reference to music education.