Referral to rehabilitation following traumatic brain injury: practitioners and the process of decision-making

The study aimed to examine the factors influencing referral to rehabilitation following traumatic brain injury (TBI) by using social problems theory as a conceptual model to focus on practitioners and the process of decision-making in two Australian hospitals. The research design involved semi-structured interviews with 18 practitioners and observations of 10 team meetings, and was part of a larger study on factors influencing referral to rehabilitation in the same settings. Analysis revealed that referral decisions were influenced primarily by practitioners' selection and their interpretation of clinical and non-clinical patient factors. Further, practitioners generally considered patient factors concurrently during an ongoing process of decision-making, with the combinations and interactions of these factors forming the basis for interpretations of problems and referral justifications. Key patient factors considered in referral decisions included functional and tracheostomy status, time since injury, age, family, place of residence and Indigenous status. However, rate and extent of progress, recovery potential, safety and burden of care, potential for independence and capacity to cope were five interpretative themes, which emerged as the justifications for referral decisions. The subsequent negotiation of referral based on patient factors was in turn shaped by the involvement of practitioners. While multi-disciplinary processes of decision-making were the norm, allied health professionals occupied a central role in referral to rehabilitation, and involvement of medical, nursing and allied health practitioners varied. Finally, the organizational pressures and resource constraints, combined with practitioners' assimilation of the broader efficiency agenda were central factors shaping referral. (C) 2004 Elsevier Ltd. All rights reserved.

Reflecting on ethical and legal issues in wildlife disease

Disease in wildlife raises a number of issues that have not been widely considered in the bioethical literature. However, wildlife disease has major implications for human welfare. The majority of emerging human infectious diseases are zoonotic: that is, they occur in humans by cross-species transmission from animal hosts. Managing these diseases often involves balancing concerns with human health against animal welfare and conservation concerns. Many infectious diseases of domestic animals are shared with wild animals, although it is often unclear whether the infection spills over from wild animals to domestic animals or vice versa. Culling is the standard means of managing such diseases, bringing economic considerations, animal welfare and conservation into conflict. Infectious diseases are also major threatening processes in conservation biology and their appropriate management by culling, vaccination or treatment raises substantial animal ethics issues. One particular issue of great significance in Australia is an ongoing research program to develop genetically modified pathogens to control vertebrate pests including rabbits, foxes and house mice. Release of any self-replicating GMO vertebrate pathogen gives rise to a whole series of ethical questions. We briefly review current Australian legal responses to these problems. Finally, we present two unresolved problems of general importance that are exemplified by wildlife disease. First, to what extent can or should 'bioethics' be broadened beyond direct concerns with human welfare to animal welfare and environmental welfare? Second, how should the irreducible uncertainty of ecological systems be accounted for in ethical decision making?

Ergonomic issues in team lifting

In this article we review and critique the current body of scientific knowledge regarding the use of team lifting including: (a) psychophysical studies of team lifting capacity, and (b) studies of manual handling, patient handling, and stretcher carriage performed by lifting teams. The consensus of the research literature is that team-lifting capacity is greater than the lifting capacity of an individual, but that the capacity of lifting teams is less than the summed capacity of individual team members. Further, biomechanical, psychophysical, and physiological stress tends to be reduced compared to the equivalent lifts and transfers performed by individuals. However, the stress associated with team lifting depends on a broad range of individual team member, load, task and environmental factors, which can interact in unexpected ways. Caution is therefore recommended against making broad assumptions regarding the use of team lifting. Future studies are needed to examine how effort and load are distributed among lifting team members, with emphasis on identifying factors that may increase the risk of injury.

Multiresolution spatial databases: Making web-based spatial advances faster

Spatial data has now been used extensively in the Web environment, providing online customized maps and supporting map-based applications. The full potential of Web-based spatial applications, however, has yet to be achieved due to performance issues related to the large sizes and high complexity of spatial data. In this paper, we introduce a multiresolution approach to spatial data management and query processing such that the database server can choose spatial data at the right resolution level for different Web applications. One highly desirable property of the proposed approach is that the server-side processing cost and network traffic can be reduced when the level of resolution required by applications are low. Another advantage is that our approach pushes complex multiresolution structures and algorithms into the spatial database engine. That is, the developer of spatial Web applications needs not to be concerned with such complexity. This paper explains the basic idea, technical feasibility and applications of multiresolution spatial databases.

The influence of national culture on the level and outcome of IS decision making in the IS maintenance/redevelopment decision

Would the outcome of a Global multinational organization’s decision be the same if the same decision were to be made in different countries throughout the world? Within the same organization, we propose that national cultural differences can influence decision making in different countries and cultural clusters. While much work has been done on organizational cultural influences, this study examines the influence that national culture has on organizational decision making in respect to the evolution/redevelopment decision that organizations face when a system is believed to be entering the obsolescence phase. Building on findings from the Globe research program, we show by empirical testing of a theoretical model that national cultural dimensions are significantly associated with a) the outcome of the decision to enhance or re-develop a system, and b) the organizational level at which such decisions are made. This research is significant as a means to improve management decision making, particularly with regard to the enhancement versus re-development decision. The research suggests that a relatively uniform sub-culture exists across the global IS project level but that national cultural dimensions play a more important role in determining the organizational management level at which decisions are made.