The epidemiology of ecstasy use and harms in New South Wales, Australia

Aims:This paper examines the epidemiology of ecstasy use and harm in Australia using multiple data sources.

Design: The data included (1) Australian Customs Service 3,4-methylenedioxymethamphetamine (MDMA) detections; (2) the National Drug Strategy Household and Australian Secondary Student Alcohol and Drug Surveys; (3) data from Australia's ecstasy and Related Drugs Reporting System; (4) the number of recorded police incidents for ecstasy possession and distribution collated by the N.S.W. Bureau of Crime Statistics and Research; (5) the number of calls to the Alcohol and Drug Information Service and Family Drug Support relating to ecstasy; (6) the Alcohol and Other Drug Treatment Services National Minimum Dataset on number of treatment episodes for ecstasy, and (7) N.S.W. Division of Analytical Laboratories toxicology data on number of deaths where MDMA was detected.

Findings: Recent ecstasy use among adults in the general population has increased, whereas among secondary students it has remained low and stable. The patterns of ecstasy consumption among regular ecstasy users have changed over time. Polydrug use and use for extended periods of time (>48 h) remain common among this group. Frequent ecstasy use is associated with a range of risk behaviours and other problems, which tend to be attributed to a number of drugs along with ecstasy. Few ecstasy users present for treatment for problems related to their ecstasy consumption.

Conclusions: Messages and interventions to reduce the risks associated with polydrug use and patterns of extended periods of use are clearly warranted. These messages should be delivered outside of traditional health care settings, as few of these users are engaged with such services.

A Steinian approach to an empathic understanding of hope among patients and clinicians in the culture of palliative care

Aim. This article presents a discussion of empathy in the context of human person, reason and hopes in the clinical setting.

Background. Empathy was introduced to nursing as part of an ethical and philosophical foundation for caring. It helped to solve the tension and meet the demands that empathy placed upon nursing practice.

Data sources. This article is based on two studies undertaken between 2008 and 2010 to understand the concept of hope and empathy among people with terminal cancer and doctors who care for them. Doctoral dissertations and theses of Edith Stein (1916–1917), Marianne Sawicki [Body, Text and Science. The Literary of Investigative Practices and the Phenomenology of Edith Stein (1997) Kluwer Academic Publisher, Dordrecht], and Sister M. Judith Parsons (2005) have been used to examine: ‘the essence of acts of empathy’, ‘the constitution of the psycho-physical individual’ and ‘empathy as understanding of intellectual persons’. CINAHL, MEDLINE and PROQUEST have provided further supporting data.

Discussion. Steinian empathy requires that we use affective resonance, cognitive understanding and distance, as we grasp another person’s emotional and situational reality while in the caring role as nurses.

Implications for current nursing. Steinian empathy is about recognizing a lived experience and standing side-by-side with that person. Nurses can transmit this knowledge to enable and support courage and wisdom to reduce feelings of helplessness when caring for people with terminal illness.

Conclusion. Not only is empathy a safe and permissible emotion, it is the linchpin to a caring patient–nurse relationship and we must embrace this.

Clinical nurse research consultant : a clinical and academic role to advance practice and the discipline of nursing

Aims:  This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing role. Background:  Although healthcare delivery continues to evolve, nursing has lacked highly specialized clinical and research leadership that, as a primary responsibility, drives evidence-based practice change in collaboration with bedside clinicians. Data sources:  International literature published over the last 25 years in the databases of CINAHL, OVID, Medline Pubmed, Science Direct, Expanded Academic, ESBSCOhost, Scopus and Proquest is cited to create a case for the Clinical Nurse Research Consultant. Discussion:  The Clinical Nurse Research Consultant will address the research/practice gap and assist in facilitating evidence-based clinical practice. To fulfil the responsibilities of this proposed role, the Clinical Nurse Research Consultant must be a doctorally prepared recognized clinical expert, have educational expertise, and possess advanced interpersonal, teamwork and communication skills. This role will enable clinical nurses to maintain and share their clinical expertise, advance practice through research and role model the clinical/research nexus. Implications for nursing:  Critically, the Clinical Nurse Research Consultant must be appointed in a clinical and academic partnership to provide for career progression and role support. Conclusion:  The creation of the Clinical Nurse Research Consultant will advance nursing practice and the discipline of nursing.

Interventions to promote cycling: a systematic review

Objectives To determine what interventions are effective in promoting cycling, the size of the effects of interventions, and evidence of any associated benefits on overall physical activity or anthropometric measures.

Design Systematic review.

Data sources Published and unpublished reports in any language identified by searching 13 electronic databases, websites, reference lists, and existing systematic reviews, and papers identified by experts in the field.

Review methods Controlled “before and after” experimental or observational studies of the effect of any type of intervention on cycling behaviour measured at either individual or population level.

Results Twenty five studies (of which two were randomised controlled trials) from seven countries were included. Six studies examined interventions aimed specifically at promoting cycling, of which four (an intensive individual intervention in obese women, high quality improvements to a cycle route network, and two multifaceted cycle promotion initiatives at town or city level) were found to be associated with increases in cycling. Those studies that evaluated interventions at population level reported net increases of up to 3.4 percentage points in the population prevalence of cycling or the proportion of trips made by bicycle. Sixteen studies assessing individualised marketing of “environmentally friendly” modes of transport to interested households reported modest but consistent net effects equating to an average of eight additional cycling trips per person per year in the local population. Other interventions that targeted travel behaviour in general were not associated with a clear increase in cycling. Only two studies assessed effects of interventions on physical activity; one reported a positive shift in the population distribution of overall physical activity during the intervention.

Conclusions Community-wide promotional activities and improving infrastructure for cycling have the potential to increase cycling by modest amounts, but further controlled evaluative studies incorporating more precise measures are required, particularly in areas without an established cycling culture. Studies of individualised marketing report consistent positive effects of interventions on cycling behaviour, but these findings should be confirmed using more robust study designs. Future research should also examine how best to promote cycling in children and adolescents and through workplaces. Whether interventions to promote cycling result in an increase in overall physical activity or changes in anthropometric measures is unclear.

Health burden of hip and other fractures in Australia beyond 2000

Objective: To calculate the expected increase in the number of fractures in adults attributable to the predicted increase in the number of elderly Australians.

Data sources: All fractures in adult residents (> 35 years) of the Barwon Statistical Division (total population, 218 000) were identified from radiological reports from February 1994 to February 1996. The Australian Bureau of Statistics supplied predictions of Australia's population (1996 to 2051).

Main outcome measure: The projected annual number of fractures in Australian adults up to 2051 (based on stable rates of fracture in each age group).

Results: The number of fractures per year is projected to increase 25% from 1996 to 2006 (from 83 000 fractures to 104 000). Hip fractures are projected to increase 36% (from 15 000 to 21 000) because of a substantial rise in the number of elderly aged 85 years and over. Hip fractures are expected to double by 2026 and increase fourfold by 2051.

Conclusions: In contrast to Europe and North America, where numbers of hip fractures are expected to double by 2026 and then stabilise, in Australia hip fractures will continue to place a growing demand on healthcare resources for many decades. These projections can be used for setting goals and evaluating the costs and benefits of interventions in Australia.

Student views of computer based-mathematics in the middle years : does gender make a difference?

How the use of computers in mathematics classrooms was viewed by students in two middle years mathematics classrooms was the focus of the research described in this paper. The primary data sources consisted of questionnaires, classroom observations supported by videotaping of mathematics lessons, and interviews with two girls and two boys from each class. Thus both qualitative and quantitative methods were used. Girls viewed the computer-based lessons less favourably than did boys. In general, the boys were likely to believe that computers contributed to their experiencing pleasure in these lessons, and to making mathematics more relevant to them. Girls were typically more concerned about whether computers facilitated learning and enabled success in mathematics. The attitudes of students to computer-based mathematics were related to their views of computers.

Regularized nonnegative shared subspace learning

Joint modeling of related data sources has the potential to improve various data mining tasks such as transfer learning, multitask clustering, information retrieval etc. However, diversity among various data sources might outweigh the advantages of the joint modeling, and thus may result in performance degradations. To this end, we propose a regularized shared subspace learning framework, which can exploit the mutual strengths of related data sources while being immune to the effects of the variabilities of each source. This is achieved by further imposing a mutual orthogonality constraint on the constituent subspaces which segregates the common patterns from the source specific patterns, and thus, avoids performance degradations. Our approach is rooted in nonnegative matrix factorization and extends it further to enable joint analysis of related data sources. Experiments performed using three real world data sets for both retrieval and clustering applications demonstrate the benefits of regularization and validate the effectiveness of the model. Our proposed solution provides a formal framework appropriate for jointly analyzing related data sources and therefore, it is applicable to a wider context in data mining.

A cooperative cache architecture in support of caching multimedia objects in MANETs

This paper presents a cooperative caching architecture suitable for continuous media (CM) proxy caching in MANET environments. The proposed scheme introduces an application manager component, which is interposed between traditional Internet CM applications and the network layer. The application manager transparently performs data location and service migration of active CM streaming sessions so as to exploit nearby data sources based on the dynamic topology of a MANET. We propose two data location schemes - Cache-State - a link-state based scheme and Reactive - an on-demand scheme. Since service migration can occur frequently, the application manager uses soft-state signaling techniques to communicate between remote application managers by translating hard-state application signaling, such as Real Time Streaming Protocol (RTSP) into soft-state messages. The proposed schemes are evaluated through simulation studies using the NS simulator. Simulation studies show that both Cache-State and Reactive schemes demonstrate significant QoS improvements and reduced bandwidth consumption.

Dynamic privacy in a smart house environment

A smart house can be regarded as a surveillance environment in which the person being observed carries out activities that range from intimate to more public. What can be observed depends on the activity, the person observing (e.g. a carer) and policy. In assisted living smart house environments, a single privacy policy, applied throughout, would be either too invasive for an occupant, or too restrictive for an observer, due to the conflicting goals of surveillance and private environments. Hence, we propose a dynamic method for altering the level of privacy in the environment based on the context, the situation within the environment, encompassing factors relevant to ensuring the occupant's safety and privacy. The context is mapped to an appropriate level of privacy, which is implemented by controlling access to data sources (e.g. video) using data hiding techniques. The aim of this work is to decrease the invasiveness of the technology, while retaining the purpose of the system.

Mixed-variate restricted Boltzmann machines

Modern datasets are becoming heterogeneous. To this end, we present in this paper Mixed- Variate Restricted Boltzmann Machines for simultaneously modelling variables of multiple types and modalities, including binary and continuous responses, categorical options, multicategorical choices, ordinal assessment and category-ranked preferences. Dependency among variables is modeled using latent binary variables, each of which can be interpreted as a particular hidden aspect of the data. The proposed model, similar to the standard RBMs, allows fast evaluation of the posterior for the latent variables. Hence, it is naturally suitable for many common tasks including, but not limited to, (a) as a pre-processing step to convert complex input data into a more convenient vectorial representation through the latent posteriors, thereby oering a dimensionality reduction capacity, (b) as a classier supporting binary, multiclass, multilabel, and label-ranking outputs, or a regression tool for continuous outputs and (c) as a data completion tool for multimodal and heterogeneous data. We evaluate the proposed model on a large-scale dataset using the world opinion survey results on three tasks: feature extraction and visualization, data completion and prediction.

What is the optimal level of population alcohol consumption for chronic disease prevention in England? Modelling the impact of changes in average consumption levels

Objective To estimate the impact of achieving alternative average population alcohol consumption levels on chronic disease mortality in England.

Design A macro-simulation model was built to simultaneously estimate the number of deaths from coronary heart disease, stroke, hypertensive disease, diabetes, liver cirrhosis, epilepsy and five cancers that would be averted or delayed annually as a result of changes in alcohol consumption among English adults. Counterfactual scenarios assessed the impact on alcohol-related mortalities of changing (1) the median alcohol consumption of drinkers and (2) the percentage of non-drinkers.

Data sources Risk relationships were drawn from published meta-analyses. Age- and sex-specific distributions of alcohol consumption (grams per day) for the English population in 2006 were drawn from the General Household Survey 2006, and age-, sex- and cause-specific mortality data for 2006 were provided by the Office for National Statistics.

Results The optimum median consumption level for drinkers in the model was 5 g/day (about half a unit), which would avert or delay 4579 (2544 to 6590) deaths per year. Approximately equal numbers of deaths from cancers and liver disease would be delayed or averted (∼2800 for each), while there was a small increase in cardiovascular mortality. The model showed no benefit in terms of reduced mortality when the proportion of non-drinkers in the population was increased.

Conclusions Current government recommendations for alcohol consumption are well above the level likely to minimise chronic disease. Public health targets should aim for a reduction in population alcohol consumption in order to reduce chronic disease mortality.

Developing a rural teacher education curriculum package

This paper documents the development of a new website (www. rrrtec. net. au) specifically designed to better equip teacher educators to prepare graduates to teach in rural and regional communities. The two year study (2009-2011) that informed the website's creation included three data sources: A literature review of research into rural teacher education, a survey of pre-service students who had completed a rural practicum and interviews with teacher educators about the current strategies they used to raise awareness and understanding of the needs of rural students, their families, and communities. An analysis of the data revealed that teacher educators need to focus more on developing graduates to be not only 'classroom ready ' but also 'school and community ready'. This analysis provided the framework for the creation of a set of curriculum modules and resources including journal articles, film clips, websites and books that teacher educators could readily and publicly access and use in their own classroom teaching.

Validation of de-identified record linkage to ascertain hospital admissions in a cohort study

Background Cohort studies can provide valuable evidence of cause and effect relationships but are subject to loss of participants over time, limiting the validity of findings. Computerised record linkage offers a passive and ongoing method of obtaining health outcomes from existing routinely collected data sources. However, the quality of record linkage is reliant upon the availability and accuracy of common identifying variables. We sought to develop and validate a method for linking a cohort study to a state-wide hospital admissions dataset with limited availability of unique identifying variables.

Methods A sample of 2000 participants from a cohort study (n = 41 514) was linked to a state-wide hospitalisations dataset in Victoria, Australia using the national health insurance (Medicare) number and demographic data as identifying variables. Availability of the health insurance number was limited in both datasets; therefore linkage was undertaken both with and without use of this number and agreement tested between both algorithms. Sensitivity was calculated for a sub-sample of 101 participants with a hospital admission confirmed by medical record review.

Results Of the 2000 study participants, 85% were found to have a record in the hospitalisations dataset when the national health insurance number and sex were used as linkage variables and 92% when demographic details only were used. When agreement between the two methods was tested the disagreement fraction was 9%, mainly due to "false positive" links when demographic details only were used. A final algorithm that used multiple combinations of identifying variables resulted in a match proportion of 87%. Sensitivity of this final linkage was 95%.

Conclusions High quality record linkage of cohort data with a hospitalisations dataset that has limited identifiers can be achieved using combinations of a national health insurance number and demographic data as identifying variables.

Information needs and the implications for monitoring health systems : the Australian experience

This paper outlines the information needs underlying the health information system in Australia and the implications these have for the ability to monitor the performance of the health system. We discuss the use of indicators in performance monitoring and the role of information frameworks in providing a basis for their development. The major Australian data sources to support the development of performance indicators are outlined, and their current and likely futures uses for performance monitoring discussed.

Exploring the global and local networks of national information system integration initiatives : a case study of national cultural collection integration from an actor-network perspective

Australian Museums Online (AMOL) was the earliest attempt to make Australia’s distributed cultural collections accessible from a single online resource. Despite early successes, significant achievements and the considerable value it offered certain groups, the project ran into operational difficulties and was eventually discontinued. By using Actor-Network Theory and analysing the global and local actor-networks, it is revealed that although the project originated from large, state museums, buy-in was restricted to individuals, rather than institutions and the most significant value was for smaller, regional institutions. Furthermore, although the global networks that governed the project could translate their visions through the local production networks, because the network’s underlying weaknesses were never addressed, over time this destablised the global networks. This case study offers advice for projects attempting to consolidate data sources from disparate sources, and highlights the importance of individual actors in championing the project.