Doing the right thing at the right time: Assessing responses to patient deterioration in electronic simulation scenarios using course-of-action analysis

International studies indicate that the recognition and management of deteriorating patients in hospitals are poor and that patient assessment is often inadequate. Face-to-face simulation programs have been shown to have an impact on educational and clinical outcomes; however, little is known about performance in contemporary healthcare e-simulation approaches. Using data from an open-access Web-based patient deterioration program (FIRSTACTWeb), the performance of 367 Australian nursing students in identification of treatment priorities and clinical actions was analyzed using a military model of Course of Action Simulation Analysis. Participants' performance in the whole program demonstrated a significant improvement in knowledge and skills (P ≤ .001) with high levels of participant satisfaction. Course of Action Simulation Analysis modeling identified three key participant groupings within which only 18% took the "best course of action" (the right actions and timing), with most (70%) completing the right actions but in the wrong order. The remaining 12% produced incomplete assessments and actions in an incorrect sequence. Contemporary approaches such as e-simulation do enhance educational outcomes. Measurement of performance when combined with Course of Action Simulation Analysis becomes a useful tool in the description of outcomes, an understanding of decision making, and the prediction of future events.

Finding line of action of the force exerted on erect spine based on lateral bending test in personalization of scoliotic spine models

In multi-body models of scoliotic spine, personalization of mechanical properties of joints significantly improves reconstruction of the spine shape. In personalization methods based on lateral bending test, simulation of bending positions is an essential step. To simulate, a force is exerted on the spine model in the erect position. The line of action of the force affects the moment of the force about the joints and thus, if not correctly identified, causes over/underestimation of mechanical properties. Therefore, we aimed to identify the line of action, which has got little attention in previous studies. An in-depth analysis was performed on the scoliotic spine movement from the erect to four spine positions in the frontal plane by using pre-operative X-rays of 18 adolescent idiopathic scoliosis (AIS) patients. To study the movement, the spine curvature was considered as a 2D chain of micro-scale motion segments (MMSs) comprising rigid links and 1-degree-of-freedom (DOF) rotary joints. It was found that two MMSs representing the inflection points of the erect spine had almost no rotation (0.0028° ± 0.0021°) in the movement. The small rotation can be justified by weak moment of the force about these MMSs due to very small moment arm. Therefore, in the frontal plane, the line of action of the force to simulate the left/right bending position was defined as the line that passes through these MMSs in the left/right bending position. Through personalization of a 3D spine model for our patients, we demonstrated that our line of action could result in good estimates of the spine shape in the bending positions and other positions not included in the personalization, supporting our proposed line of action.

Visual perception of action categories and the "bowl-throw" decision in cricket.

Cricket umpires, cricket bowlers, and physical education students (who were knowledgeable about the rules of cricket), were shown 72 videotaped point-light displays of cricket deliveries with varying extents of elbow flexion such that they ranged from highly “bowl-like” to highly “throw-like”. The observers made a bowl-throw decision about each display, and the umpires and bowlers reported their confidence on a 5-point scale. The percentage of displays reported as a “bowl” was 59, 40, and 44 for the umpires, bowlers, and students respectively. Umpires made significantly more bowl decisions than both the bowlers and students, but there was no difference between the latter groups. Umpires were significantly more confident than the bowlers in both their bowl and throw decisions. Thus, in an experimental setting, with no apparent costs or benefits associated with their decision-makin, umpires “called” a bowler significantly less frequently for throwing than other knowledgeable observers. The procedures devised for this experiment demonstrate that psychophysical methods can be applied to the problem of discrete action-category nominations in sport (e.g., bowl or throw, walk or run).

Visual perception of movement kinematics and the acquisition of "action prototypes"

Recognizing a class of movements as belonging to a "nominal" action category, such as walking, running, or throwing, is a fundamental human ability. Three experiments were undertaken to test the hypothesis that common ("prototypical") features of moving displays could be learned by observation. Participants viewed moving stick-figure displays resembling forearm flexion movements in the saggital plane. Four displays (presentation displays) were first presented in which one or more movement dimensions were combined with 2 respective cues: direction (up, down), speed (fast, slow), and extent (long, short). Eight test displays were then shown, and the observer indicated whether each test display was like or unlike those previously seen. The results showed that without corrective feedback, a single cue (e.g., up or down) could be correctly recognized, on average, with the proportion correct between .66 and .87. When two cues were manipulated (e.g., up and slow), recognition accuracy remained high, ranging between .72 and .89. Three-cue displays were also easily identified. These results provide the first empirical demonstration of action-prototype learning for categories of human action and show how apparently complex kinematic patterns can be categorized in terms of common features or cues. It was also shown that probability of correct recognition of kinematic properties was reduced when the set of 4 presentation displays were more variable with respect to their shared kinematic property, such as speed or amplitude. Finally, while not conclusive, the results (from 2 of the 3 experiments) did suggest that similarity (or "likeness") with respect to a common kinematic property (or properties) is more easily recognized than dissimilarity.

RE Kevin and the right of transsexual persons to marry in Australia

This article considers the decision of the Family Court of Australia in Re Kevin (Validity of Marriage of a Transsexual) [2001] FamCA 1074, which was upheld by the Full Court of the Family Court of Australia in February 2003. Re Kevin was the first case in Australia to deal directly with the question of whether a transsexual person could marry under Australian law. In the past, Australia had adhered to the judgement of Ormrod J in Corbett v Corbett [1971] P. 83, which set the benchmark for what is ‘male’ and what is ‘female’ under the common law. Prior to Re Kevin the question of what is a man and what is a woman for the purposes of marriage in Australia mirrored the strict biological test established in Corbett. In other words, the Australian courts relied upon biological factors, as espoused by Ormrod J, when determining a person's true sex. In Re Kevin, Chisholm J examined in detail what it is to be a man or woman, but unlike Ormrod J considered ‘brain sex’ to have a significant impact on a person's view of their own innate sexual identity. The Full Court of the Family Court agreed with the powerful and well-reasoned judgement of Chisholm J at first instance.

A tale of action, suspense and drama : Village Roadshow’s buy-back scheme

The experience of Village Roadshow, in its two failed attempts to have a share buy-back scheme approved by the Supreme Court, sounds a warning to companies and their legal advisers about the pitfalls in presentation of such schemes to shareholders.

Arsenic, mode of action at biologically plausible low doses : what are the implications for low dose cancer risk?

Arsenic is an established human carcinogen. However, there has been much controversy about the shape of the arsenic response curve, particularly at low doses. This controversy has been exacerbated by the fact that the  mechanism(s) of arsenic carcinogenesis are still unclear and because there are few satisfactory animal models for arsenic-induced carcinogenesis. Recent epidemiological studies have shown that the relative risk for cancer among populations exposed to ≤60 ppb As in their drinking water is often lower than the risk for the unexposed control population. We have found that treatment of human keratinocyte and fibroblast cells with 0.1 to 1 μM arsenite (As^III) also produces a low dose protective effect against oxidative stress and DNA damage. This response includes increased transcription, protein levels and enzyme activity of several base excision repair genes, including DNA polymerase β and DNA ligase I. At higher concentrations (> 10 μM), As induces down-regulation of DNA repair, oxidative DNA damage and apoptosis. This low dose adaptive (protective) response by a toxic agent is known as hormesis and is characteristic of many agents that induce oxidative stress. A mechanistic model for arsenic carcinogenesis based on these data would predict that the low dose risk for carcinogenesis should be sub-linear. The threshold dose where toxicity outweighs protection is hard to predict based on in vitro dose response data, but might be estimated if one could determine the form (metabolite) and concentration of arsenic responsible for changes in gene regulation in the target tissues.

Preventative detention and the right of personal liberty and security under the International Covenant on Civil and Political Rights, 1966

Preventive detention enables a person to be deprived of liberty, by executive determination, for the purposes of safeguarding national security or public order without that person being charged or brought to trial. This paper examines Article 9(1) of the International Covenant on Civil and Political Rights, 1966 to assess whether preventive detention is prohibited by the phrase 'arbitrary arrest and detention '. To analyse this Article, this paper uses a textual and structural analysis of the Article, as well as reference to the travaux preparatoires and case law of the Human Rights Committee. This paper argues that preventive detention is not explicitly prohibited by Article 9(1) ofthe International Covenant on Civil and Political Rights 1966. If preventive detention is 'arbitrary', within the wide interpretation of that term as argued in this paper, it will be a permissible deprivation of personal liberty under Article 9(1) of the International Covenant on Civil and Political Rights, 1966. Preventive detention will, however, always be considered 'arbitrary' if sajeguards for those arrested and detained are not complied with, in particular the right to judicial review of the lawfulness of detention.

G-CSF: function and modes of action (Review)

Since the observations in the 1960s that granulocyte-colony stimulating factor (G-CSF) stimulated the proliferation of granulocytic cells in semisolid cultures of bone marrow cells, G-CSF has established itself as a useful clinical agent for increasing levels of neutrophilic granulocytes. However, these early findings did not firmly establish whether G-CSF is a genuine regulator of granulocyte formation under normal physiological conditions or rather acts as an emergency regulator, playing an important role only under stress conditions. The advent of <gene-knockout technology> has allowed us to evaluate these questions in a physiological setting through analysis of mice with a targeted mutation of G-CSF or its receptor, while the development of relevant cell models has enabled us to dissect the molecular basis of G-CSF action. This review discusses our current state of knowledge regarding the role of G-CSF in granulopoiesis.

Critical analysis of action research-based inservice teacher education : four case histories

Changing the nature of institutionalised education is the central theme of the thesis. The potential for radical changes to classroom teaching and to inservice teacher education is considered through four curriculum and teaching reform projects structured by action -research. The problems explored through the thesis are at the levels of teaching, institutional and research practices. It is argued that the professional activity of teachers, administrators, consultants, teacher educators and researchers can be understood to be tightly bound and determined by rules for acceptable professional ways of acting which are often unquestioned and unexamined by educators themselves. It is further argued that institutionalised education is dominated by ways of thinking and acting that are inherently individualistic. The thesis analyses the ideological character of this 'individualistic1 structuring of educational practice, identifying belief systems that hold the lived reality of educators and students in place. The thesis endeavours to show that the bureaucratic character of institutionalised education primarily serves and maintains the interests of dominant groups. The thesis examines the possibilities for radical reform in classroom teaching, the support teachers need when embarking on curriculum and teaching change processes, and the possible outcomes of such reform. The thesis also examines the interaction between the institutional practices of schools, universities and regional offices in the Ministry of Education in Victoria, Australia on these reform processes in classrooms. Finally, the thesis examines the potential of action research as a research and educative process in the professional development of educators who are both critically aware of the ideological nature of institutionalised education and committed to collective social action. From the analyses of the four action research projects the thesis concludes that action research has the potential to transform institutionalised education when its own practice is firstly, developed as a liberating pedagogy and not as research projects structured by individualistic and paternalistic interests; secondly, is driven by a commitment to the political struggle for equity and social justice; and thirdly, is itself an expression of communitarian work. The thesis concludes that the transformative processes associated with action research under these conditions hold the promise of democratising the 'individualistic' character of institutional education.