Learning opportunities for Australian prevocational hospital doctors: exposure, perceived quality and desired methods of learning.

Objective:

To survey prevocational doctors working in Australian hospitals on aspects of postgraduate learning.
Participants and setting:

470 prevocational doctors in 36 health services in Australia, August 2003 to October 2004.
Design:

Cross-sectional cohort survey with a mix of ordinal multicategory questions and free text.
Main outcome measures:

Perceived preparedness for aspects of clinical practice; perceptions of the quantity and usefulness of current teaching and learning methods and desired future exposure to learning methods.
Results:

64% (299/467) of responding doctors felt generally prepared for their job, 91% (425/469) felt prepared for dealing with patients, and 70% (325/467) for dealing with relatives. A minority felt prepared for medicolegal problems (23%, 106/468), clinical emergencies (31%, 146/469), choosing a career (40%, 188/468), or performing procedures (45%, 213/469). Adequate contact with registrars was reported by 90% (418/465) and adequate contact with consultants by 56% (257/466); 20% (94/467) reported exposure to clinical skills training and 11% (38/356) to high-fidelity simulation. Informal registrar contact was described as useful or very useful by 94% (433/463), and high-fidelity simulation by 83% (179/216). Most prevocational doctors would prefer more formal instruction from their registrars (84%, 383/456) and consultants (81%, 362/447); 84% (265/316) want increased exposure to high-fidelity simulation and 81% (283/350) to professional college tutorials.
Conclusion:

Our findings should assist planning and development of training programs for prevocational doctors in Australian hospitals.

Coronary artery stenoses: detection with calcium scoring, CT angiography, and both methods combined

PURPOSE: To investigate prospectively the relative accuracy of computed tomographic (CT) angiography, calcium scoring (CS), and both methods combined in demonstrating coronary artery stenoses by using conventional angiography as the reference standard. MATERIALS AND METHODS: The study was approved by the institutional review board Human Research Ethics Committee, and all patients completed written informed consent. Fifty patients (40 men, 10 women) aged 62 years ± 11 (± standard deviation) who were suspected of having coronary artery disease underwent both conventional coronary angiography and multisection coronary CT angiography with CS. Sensitivity and specificity of CS, CT angiography, and both methods combined in demonstrating luminal stenosis greater than or equal to 50% were determined for each arterial segment, coronary vessel, and patient. Receiver operating characteristic (ROC) curves were generated for CS prediction of significant stenosis, and the Mann-Whitney U test was used for comparison of CS between groups. RESULTS: When used with segment-specific electrocardiographic phase reconstructions, CT angiography demonstrated stenosed segments with 79% sensitivity and 95% specificity. Mean calcium score was greater in segments, vessels, and patients with stenoses than in segments, vessels, and patients without stenoses (P < .001 for all); nine (16%) of 56 stenosed segments, however, had a calcium score of 0. The patient calcium score correlated strongly with the number of stenosed arteries (Spearman {rho} = 0.75, P < .001). CS was more accurate in demonstrating stenosis in patients than in segments (areas under ROC curve were 0.88 and 0.74, respectively). CT angiography, however, was more accurate than CS in demonstrating stenosis in patients, vessels, and segments. The sensitivity and specificity of CS varied according to the threshold used, but when the calcium score cutoff (ie, >150) matched the specificity of CT angiography (95%), the sensitivity of CS in demonstrating stenosed segments was 29% (compared with 79% for CT angiography). Combining CT angiography with CS (at threshold of 400) improved the sensitivity of CT angiography (from 93% to 100%) in demonstrating significant coronary disease in patients, without a loss of specificity (85%); this finding, however, was not statistically significant. CONCLUSION: CT angiography is more accurate than CS in demonstrating coronary stenoses. A patient calcium score of greater than or equal to 400, however, can be used to potentially identify patients with significant coronary stenoses not detected at CT angiography.

Dispositional resistance to change : measurement equivalence and the link to personal values across 17 nations

The concept of dispositional resistance to change has been introduced in a series of exploratory and confirmatory analyses through which the validity of the Resistance to Change (RTC) Scale has been established (S. Oreg, 2003). However, the vast majority of participants with whom the scale was validated were from the United States. The purpose of the present work was to examine the meaningfulness of the construct and the validity of the scale across nations. Measurement equivalence analyses of data from 17 countries, representing 13 languages and 4 continents, confirmed the cross-national validity of the scale. Equivalent patterns of relationships between personal values and RTC across samples extend the nomological net of the construct and provide further evidence that dispositional resistance to change holds equivalent meanings across nations.

Fuzzy concepts and formal methods

It has been recognised that formal methods are useful as a modelling tool in requirements engineering. Specification languages such as Z permit the precise and unambiguous modelling of system properties and behaviour. However some system problems, particularly those drawn from the information systems problem domain, may be difficult to model in crisp or precise terms. It may also be desirable that formal modelling should commence as early as possible, even when our understanding of parts of the problem domain is only approximate. This thesis suggests fuzzy set theory as a possible representation scheme for this imprecision or approximation. A fuzzy logic toolkit that defines the operators, measures and modifiers necessary for the manipulation of fuzzy sets and relations is developed. The toolkit contains a detailed set of laws that demonstrate the properties of the definitions when applied to partial set membership. It also provides a set of laws that establishes an isomorphism between the toolkit notation and that of conventional Z when applied to boolean sets and relations. The thesis also illustrates how the fuzzy logic toolkit can be applied in the problem domains of interest. Several examples are presented and discussed including the representation of imprecise concepts as fuzzy sets and relations, system requirements as a series of linguistically quantified propositions, the modelling of conflict and agreement in terms of fuzzy sets and the partial specification of a fuzzy expert system. The thesis concludes with a consideration of potential areas for future research arising from the work presented here.

Ethical practice in sex offender assessment : consideration of actuarial and polygraph methods

The current generation of community protection laws represents a shift in priorities that may see the individual rights of sex offenders compromised for the goal of public safety. At the center of many judicial decisions under these laws are the risk assessment reports provided by mental health practitioners. The widespread enactment of laws allowing for additional sanctions for sex offenders, and a burgeoning research literature regarding the methods used to assess risk have served to heighten rather than resolve the ethical concerns associated with professional practice in this area. This article examines ethical issues inherent in the use of two assessment methods commonly used with sex offenders in the correctional context, focusing on actuarial measures and polygraph tests. Properly conducted and adequately reported actuarial findings are considered to provide useful information of sufficient accuracy to inform rather than mislead judicial decision makers, although careful consideration must be given to the limitations of current measures in each individual case. Despite its increasing use, polygraph testing is considered controversial, with little consensus regarding its accuracy or appropriate applications. On the basis of the current state of the professional literature regarding the polygraph, its use with sex offenders raises unresolved ethical concerns.

Damage identification of steel beams using local and global methods

Structural condition monitoring methods can be generally classified as local and global. While the global method needs only a small number of sensors to measure the low-frequency structural vibration properties, the acquired information is often not sufficiently sensitive to minor damages in a structure. Local methods, on the other hand, could be very sensitive to minor damages but their detection range is usually small. To overcome the drawbacks and take advantage of both methods, an integrated condition monitoring system has been recently developed for structural damage detection, which combines guided wave and structural vibration tests. This study aims at finding a viable damage identification method for steel structures by using this system. First, a spectral element modelling method is developed, which can simulate both wave propagation and structural vibration properties. Then the model is used in updating analysis to identify crack damage. Extensive numerical simulations and model updating works are conducted. The experimental and numerical results suggest that simply combining the objective functions cannot provide better structural damage identification. A two-stage damage identification scheme is more suitable for identifying damage in steel beams.

Diabetes MILES - Australia (Management and Impact for Long-Term Empowerment and Success) : methods and sample characteristics of a national survey of the psychological aspects of living with type 1 or type 2 diabetes in Australian adults

Background Successful management of diabetes requires attention to the behavioural, psychological and social aspects of this progressive condition. The Diabetes MILES (Management and Impact for Long-term Empowerment and Success) Study is an international collaborative. Diabetes MILES-Australia, the first Diabetes MILES initiative to be undertaken, was a national survey of adults living with type 1 or type 2 diabetes in Australia. The aim of this study was to gather data that will provide insights into how Australians manage their diabetes, the support they receive and the impact of diabetes on their lives, as well as to use the data to validate new diabetes outcome measures.

Methods The survey was designed to include a core set of self-report measures, as well as modules specific to diabetes type or management regimens. Other measures or items were included in only half of the surveys. Cognitive debriefing interviews with 20 participants ensured the survey content was relevant and easily understood. In July 2011, the survey was posted to 15,000 adults (aged 18-70 years) with type 1 or type 2 diabetes selected randomly from the National Diabetes Services Scheme (NDSS) database. An online version of the survey was advertised nationally. A total of 3,338 eligible Australians took part; most (70.4%) completed the postal survey. Respondents of both diabetes types and genders, and of all ages, were adequately represented in both the postal and online survey sub-samples. More people with type 2 diabetes than type 1 diabetes took part in Diabetes MILES-Australia (58.8% versus 41.2%). Most respondents spoke English as their main language, were married/in a de facto relationship, had at least a high school education, were occupied in paid work, had an annual household income > $AUS40,000, and lived in metropolitan areas.

Discussion A potential limitation of the study is the under-representation of respondents from culturally and linguistically diverse backgrounds (including Aboriginal and Torres Strait Islander origin). Diabetes MILES-Australia represents a major achievement in the study of diabetes in Australia, where for the first time, the focus is on psychosocial and behavioural aspects of this condition at a national level.

Determining binding constants from 1H NMR titration data using global and local methods : a case study using [n]polynorbornane-based anion hosts

From data generated using 1H NMR titrations, different methodologies to calculate binding constants are compared. The ‘local’ analysis method that uses only a single isotherm (only one H-bond donor) is compared against the ‘global’ method (that includes many or all H-bond donors). The results indicate that for simple systems both methods are suitable, however, the global approach consistently provides a K a value with uncertainties up to 30% smaller. For more complex binding, the global analysis method gives much more robust results than the local methods. This study also highlights the need to explore several different modes when data do not fit well to a simple 1:1 complexation model and illustrates the need for better methods to estimate uncertainties in supramolecular binding experiments.

Construct validity and reliability of the single checking administration of medications scale

Research indicates that single checking of medications is as safe as double checking; however, many nurses are averse to independently checking medications. To assist with the introduction and use of single checking, a measure of nurses' attitudes, the thirteen-item Single Checking Administration of Medications Scale (SCAMS) was developed. We examined the psychometric properties of the SCAMS. Secondary analyses were conducted on data collected from 503 nurses across a large Australian health-care service. Analyses using exploratory and confirmatory factor analyses supported by structural equation modelling resulted in a valid twelve-item SCAMS containing two reliable subscales, the nine-item Attitudes towards single checking and three-item Advantages of single checking subscales. The SCAMS is recommended as a valid and reliable measure for monitoring nurses' attitudes to single checking prior to introducing single checking medications and after its implementation.

Developing and validating an overall international marketing performance scale

The purpose of this chapter is to develop and validate a scale of the overall international marketing performance. Based on a review of the existing literature, the scale constructed to measure international marketing performance used in this study included three factors; namely, finance, strategic and brand performance.

A total of 315 Australian firms involved in international marketing were surveyed. Exploratory and confirmatory factor analyses were undertaken to validate the scale.

Findings support the conceptualization that the overall international marketing construct consists of three factors.

The present study contributes to the understanding of the measurement of the overall international marketing performance by empirically testing the dimensionality of this construct.