Change of perspective: a measurable and desired outcome of chronic disease self-management intervention programs that violates the premise of preintervention/postintervention assessment

Objective: To determine if participants in chronic disease self-management courses have a change of perspective of their health status (a response shift), and if this is measurable with a paper-based questionnaire.

Methods: Nine items were developed to measure potential benefits of self-management courses. These were based on the constructs of a previous questionnaire, the Health Education Impact Questionnaire (HEI-Q). Cognitive interviews elicited spontaneous statements about the reasons for paper-based answers. Sensitivity, specificity, and overall accuracy of items were calculated using the interview as a relative gold standard. Response shift can be negative (i.e., after the course, participants realize that, before the course, they were worse than they thought they were), positive (i.e., participants now realize they were better than they thought they were), or absent (no change).

Results: Interviews (n = 39) reflected that true response shift occurred in approximately half the replies to questionnaire items. Of these, 31% were negative response shift, 20% were positive response shift. Response shift was absent in 32% of replies. Presence or absence of response shift could not be determined in 17% of replies across items. Significant concordance between questionnaires and cognitive interviews (average overall accuracy 0.79) indicated that the HEI-Q Perspective questionnaire detects response shift in participants of self-management courses. The questionnaire revealed that 87% of participants had response shift in at least 1 item.

Conclusion: This study suggests that preintervention/postintervention assessments of interventions such as self-management courses are confounded by a change in perspective of a large proportion of respondents. It also indicates response shift is a valuable outcome of self-management courses that can be measured with a paper-based questionnaire.

Development of physiological discriminators for the Australasian triage scale

The Consistency of Triage in Victoria’s Emergency Departments Project (2001), funded by the Victorian Department of Human Services, aimed to improve the consistency of application of the Australasian (National) Triage Scale (ATS). One of the major objectives of the project was the development of an education strategy to promote a consistent approach to triage education, leading to the development of the Adult Physiological Discriminators (APDs) for the ATS and Paediatric Physiological Discriminators (PPDs) for the ATS. The guidelines and physiological discriminators were developed in consultation with the Emergency Nurses’ Association of Victoria (ENA Vic.) and clinical nurse educators, lecturers, nurse unit managers and clinicians from a wide variety of Emergency Departments (EDs) across Victoria. Numerous studies have identified varying degrees of inconsistency in the application of the ATS. A number of factors associated with inconsistency in the application of the ATS have also been alluded to in the literature. These range from the wide variation in the experiential and educational requirements of Victorian triage nurses to the specific clinical characteristics of the patient identified by the triage nurse. However, a consistent approach to triage education and uniform triage guidelines has been repeatedly identified as a key factor in improving the consistency of application of the ATS. Physiological data demonstrates the highest degree of objectivity and consistency and research has shown that physiological observations are useful and measurable indicators of clinical urgency and patient safety. This paper will discuss the development of these discriminators as part of the educational strategy including a critique of other approaches to triage decision-making and a review of the consultative processes used to facilitate consensus amongst triage nurses, ED Nurse Managers and ED Nurse Educators. The physiological discriminators developed by this project are also presented.

Objectively assessing "Walkability" of local communities: using GIS to identify the relevant environmental attributes.

Geographic Information Systems (GIS) may be used to measure objectively, those features of the built environment that may influence walking. Public health research on environmental determinants of physical activity in adults shows that different factors can influence walking for recreation, compared to walking for transport. Most studies have used perceived (self-report) rather than objective measures of potentially relevant environmental attributes. We describe how a previously-developed index of ‘walkability’ was operationalized in an Australian context, using available spatial data.               Attributes believed to be of relevance to walking for transport, that are measurable using GIS, are: Dwelling density (higher-density neighborhoods support greater retail and service variety, resulting in shorter, walkable distances between facilities; driving and parking are more difficult and time consuming). Connectivity (higher intersection densities provide people with a greater variety of potential routes, easier access to major roads where public transport is available and shorter times to get to destinations). Land use mix (the more varied the land use mix and built form, then the more conducive it is to walk to various destinations). Net retail area (there are more options for destinations where goods and services may be purchased and more local employment opportunities that can be reached by walking). The associations of these attributes with walking behaviors can be  examined separately, or in combination. Such GIS data are very helpful in fundamental studies of the environmental determinants of behavior, and also in applied policy research for cities, regions or local communities, to
address public health and environmental issues.

Sustainability: meaning and measurement with application to agriculture

Sustainability refers to having the ability to meet present needs without impacting on future generations to meet their needs. It incorporates social, economic and environmental aspects, and as a measure of sustainability, a range of sustainability indicators at the economy, regional, and individual level, have been suggested. However, given the complex and multidisciplinary nature of the concept, an interdisciplinary approach is necessary. Sustainability is not something that is easily measurable, and the aim of this paper is to present a conceptual framework for quantifying sustainability on the basis of social economic efficiency. According to neoclassical economic theory, economic activity will only be sustained by the private sector as long as it is profitable. However, private economic decisions do not always ensure long-term sustainability of environmental resources or production. The approach suggested here is to derive a measure of social economic efficiency as a measure of sustainability. For dairy farmers, increased productivity has been emphasized, while recognizing the need to reduce greenhouse emissions, pests and disease, nutrient run-off into the environment and degradation of the soil structure. By incorporating environmental and economic impacts, a fuller measure of efficiency, social economic efficiency, and sustainability of the farming practice can be developed.

A morphological model for sexing nestling peregrine falcons (Falco Peregrinus Macropus) verified through genetic analysis

Adult peregrine falcons (Falco peregrinus macropus) have monotypic plumage and display strong reversed sexual dimorphism, with females significantly larger than males. Reversed sexual dimorphism is measurable among nestlings in the latter stages of their development and can therefore be used to differentiate between sexes. In the early stages of development, however, nestlings cannot be sexed with any degree of certainty because morphological differentiation between the sexes is not well developed. During this study we developed a model for sexing younger nestlings based on genetic analysis and morphometric data collected as part of a long-term banding study of this species. A discriminant function model based on morphological characteristics was developed for determining the sex of nestlings (n = 150) in the field and was shown to be 96.0% accurate. This predictive model was further tested against an independent morphometric dataset taken from a second group of nestlings (n = 131). The model correctly allocated sex to 96.2% of this second group of nestlings. Sex can reliably be determined (98.6% accurate) for nestlings that have a wing length of at least 9 cm using this model. Application of this model, therefore, allows the banding of younger nestlings and, as such, significantly increases the period of time over which banding can occur. Another important implication of this model is that by banding nestlings earlier, they are less likely to jump from the nest, therefore reducing the risk of injury to both the brood and the bander.

Simulation of dynamic recrystallization using random grid cellular automata

Computer simulation is a powerful tool to predict microstructure and its evolution in dynamic and post-dynamic recrystallization. CAFE proposed as an appropriate approach by combining finite element (FE) method and cellular automata (CA) for recrystallization simulation. In the current study, a random grid cellular automaton (CA), as micro-scale model, based on finite element (FE), as macro-scale method, has been used to study initial and evolving microstructural features; including nuclei densities, dislocation densities, grain size and grain boundary movement during dynamic recrystallization in a C-Mn steel. An optimized relation has been established between mechanical variables and evolving microstructure features during recrystallization and grain growth. In this model, the microstructure is defined as cells located within grains and grain boundaries while dislocations are randomly dispersed throughout microstructure. Changes of dislocation density during deformation are described considering hardening, recovery and recrystallization. Recrystallization is assumed to initiate near grain boundaries and nucleation rate was considered constant (site-saturated condition). The model produced a mathematical formulation which captured the initial and evolving microstructural entities and linked their effects to measurable macroscopic variables (e.g. stress).

River pilots for time`s flow: identifying factors to guide on-line distance education students in the use of their learning time

This research draws on recent studies of student time perception and use.
Case studies are used contrast the time use experiences of tertiary distance
education (on-line) students with tertiary students studying in traditional faceto-face classes with an online component. Previous studies and experience highlight a mismatch between the measurable and hence ”real” amount of time students spend at their computer and online, with the perceived” (and resented) time spent in online learning. This study uses investigates the recognition and application of factors affecting student perception of time spent in studying and learning online. It also compares the effectiveness of these factors when applied to distance education based wholly online classes, and face-to-face classes with an online component.
Some of the factors were measurably successful in reducing students’
perceptions of time “wasted” online, while others produced considerable
insight into face-to-face students perceptions of time used in study. The
factors included much greater focus on the person who was a student and
their expectations and time/life experiences while learning; the support and
use of alternative technologies such as mobile phones as learning and
communication too; a higher level of administrative and academic technical
support for the students; convergence of delivery methods; and strategic
involvement of teaching staff in design and delivery of learner management
systems.

Categorisation of knowledge management processes in the development of sustainable enterprises

Sustainable development is a growing area of interest in organisations. Particularly those that have large energy demands for processing, use dwindling raw materials or produce a great deal of waste through production. Knowing those processes that can contribute to making an organisation more sustainable provides a great advantage both in terms of project implementation success and in measurable Triple Bottom Line returns.

In previous research we identified that many of the Information Technology processes used to assist organisations in developing sustainable practices were more clearly suited as Knowledge Management processes (Van Der Meer and Sinnappan, 2008), however less empirical study has been done to categorise them meaningfully.

In this study we have taken these Knowledge Management processes and categorised them according to the sustainable development practice where we identify they can be of service based on Waage et al (2003). Through this we are hoping to develop a framework for organisations to determine what Knowledge Management processes are needed to achieve the particular sustainable development. We may also be able to judge what steps an organisation needs to take to develop further sustainable practices in other areas.

Development of a framework for knowledge management tools in sustainable development would assist industries in determining the best processes for these sustainable projects. This framework also contributes to the body of knowledge on sustainable development and Information Technology.

Modelling multi-criteria decision analysis for benchmarking management practices in project management

The link between management practices and worker’s motivations impacting construction productivity is being considered as significant among the research community. This research aimed to identify and analyse the underlying attributes impacting construction productivity from the site management perspective. This research presents a framework designed to analyse and quantify the relative relevance of different drivers in the determination of productivity levels and the degree of effectiveness of potential opportunities for improving performance of overall projects. Owing to the complexity of construction projects and underlying conflicting drivers influencing higher worker’s productivity, the Analytical Hierarchy Process (AHP) is employed to deal with interdependent relationships within a multi-criteria decision-making model. In the analytical approach, the large unstructured decision parameters are identified first and then are broken down into the manageable and measurable components using a top down hierarchical structure. This paper demonstrates an example to illustrate how to empirically analyse and prioritise a set of influencing parameters as selection criteria in devising appropriate management practices to ensure higher productivity vis-à-vis optimum performance of projects.

Wireless estimation of canine pose for search and rescue

In this paper we discuss the use of accelerometers and Bluetooth to monitor canine pose in the context of common poses observed in urban search and rescue dogs. We discuss the use of the canine pose system in a disaster environment, and propose techniques for determining canine pose. In addition we discuss the challenges with this approach in such environments. The paper presents the experimental results obtained from the heavy urban search and rescue disaster simulation, where experiments were conducted using multiple canines, which show that angles can be derived from acceleration readings. Our experiments show that similar angles were measured for each of the poses, even when measured on multiple USAR canines of varying size. We also found measurable and consistent differences between each of the poses, making them clearly distinguishable from one another, again even when comparing with different USAR canines.

Intervening to improve health indicators among Australian farm families

The Sustainable Farm Families project (http://www.sustainablefarmfamilies.org.au/) was a 3-year demonstration and education project designed to influence farmer behavior with respect to family health and well-being among cropping and grazing farmers in Victoria, New South Wales, and South Australia, Australia. The project was conducted by the Western District Health Service, Hamilton, Australia, in partnership with farmers; Farm Management 500 (peer discussion group); the Victorian Farmers Federation; Royal Melbourne Institute of Technology; and Land Connect. During the 3 years of the project, 128 farmers—men (70) and women (58)—were enrolled. The project utilized a combination of small group workshops, individualized health action plans, and health education opportunities to encourage farm safety and health behavior changes and to elicit sustained improvements in the following health indicators: body mass index (BMI), total cholesterol, fasting blood glucose, and blood pressure. Mean changes in these health indicators were analyzed using repeated measures analysis of variance (ANOVA) and McNemar's test compared the proportion of individuals with elevated indicators. Among participants with elevated values at baseline, the following average reductions were observed: BMI 0.44 kg/m2 (p = .0034), total cholesterol 48.7 mg/dl (p < .0001), blood glucose 10.1 mg/dl (p = .0016), systolic blood pressure 12.5 mm Hg (p < .0001), and diastolic blood pressure 5.0 mm Hg (p = .0007). The proportion of participants with elevated total cholesterol at baseline decreased after 24 months (p < .001). Such findings suggest that proactive intervention by farmer associations, rural health services, and government agencies may be an effective vehicle for promoting voluntary farm safety and health behavior change while empowering farm families to achieve measurable reductions in important health risk factors.

Comorbidites of overweight/obesity experienced in adolescence : longitudinal study

Objectives: Adolescent obesity is linked to measurable, asymptomatic metabolic and cardiovascular precursors, but its associations with adolescents’ experienced health and morbidity is less clear. The objective of this paper was to determine (1) Prevalence of comorbidities experienced by overweight/obese adolescents; (2) Associations between timing of overweight/obesity and morbidity.

Methods: Data were drawn from the three waves (1997, 2000, 2005) of the Health of Young Victorians Study (HOYVS), an Australian school-based longitudinal study. The main outcome measures were blood pressure; self- and parent-proxy reported health status (PedsQL, global health); self-reported mental health (SDQ), psychological distress (K-10), physical symptoms, sleep, asthma, and dieting; parent-reported health care needs (CSHCN screener) and visits. Regression methods, adjusted for sociodemographic factors, were used to assess associations with (1) Body mass index (BMI) status (non-overweight, overweight or obese) and (2) Timing of overweight/obesity ( never , childhood only , adolescence only , ‘persistent ).

Results: Of the 923 adolescents (20.2% overweight, 6.1% obese), 63.5% were categorised as ‘never’ overweight/obese, 8.5% as ‘childhood only’, 7.3% as ‘adolescence only’, and 20.8% as ‘persistent’. Current BMI status was strongly associated with poorer physical and global health, hypertension and dieting behaviours. Associations were weaker for emotional morbidity, and there was no clear evidence of association with any other variable. Other than dieting, adolescent morbidity was not associated with resolved childhood overweight/obesity.

Conclusions: Despite poorer overall health, overweight/obese adolescents were not more likely to report specific problems that might prompt health intervention. Morbidity was mainly associated with concurrent, rather than earlier, overweight/obesity.

Spatial ability is impaired and mineralcorticoid receptor mRNA expression in zebra finches (Taeniopygia guttata) selected for acute high corticosterone response to stress

In mammals, stress hormones have profound influences on spatial learning and memory. Here, we investigated whether glucocorticoids influence cognitive abilities in birds by testing a line of zebra finches selectively bred to respond to an acute stressor with high plasma corticosterone (CORT) levels. Cognitive performance was assessed by spatial and visual one-trial associative memory tasks. Task performance in the high CORT birds was compared with that of the random-bred birds from a control breeding line. The birds selected for high CORT in response to an acute stressor performed less well than the controls in the spatial task, but there were no significant differences between the lines in performance during the visual task. The birds from the two lines did not differ in their plasma CORT levels immediately after the performance of the memory tasks; nevertheless, there were significant differences in peak plasma CORT between the lines. The high CORT birds also had significantly lower mineralocorticoid receptor mRNA expression in the hippocampus than the control birds. There was no measurable difference between the lines in glucocorticoid receptor mRNA density in either the hippocampus or the paraventricular nucleus. Together, these findings provide evidence to suggest that stress hormones have important regulatory roles in avian spatial cognition.