Radiographic imaging for traumatic ankle injuries : a demand profile and investigation of radiological reporting timeframes from an Australian tertiary facility

Background Radiographic examinations of the ankle are important in the clinical management of ankle injuries in hospital emergency departments. National (Australian) Emergency Access Targets (NEAT) stipulate that 90 percent of presentations should leave the emergency department within 4 hours. For a radiological report to have clinical usefulness and relevance to clinical teams treating patients with ankle injuries in emergency departments, the report would need to be prepared and available to the clinical team within the NEAT 4 hour timeframe; before the patient has left the emergency department. However, little is known about the demand profile of ankle injuries requiring radiographic examination or time until radiological reports are available for this clinical group in Australian public hospital emergency settings. Methods This study utilised a prospective cohort of consecutive cases of ankle examinations from patients (n=437) with suspected traumatic ankle injuries presenting to the emergency department of a tertiary hospital facility. Time stamps from the hospital Picture Archiving and Communication System were used to record the timing of three processing milestones for each patient's radiographic examination; the time of image acquisition, time of a provisional radiological report being made available for viewing by referring clinical teams, and time of final verification of radiological report. Results Radiological reports and all three time stamps were available for 431 (98.6%) cases and were included in analysis. The total time between image acquisition and final radiological report verification exceeded 4?hours for 404 (92.5%) cases. The peak demand for radiographic examination of ankles was on weekend days, and in the afternoon and evening. The majority of examinations were provisionally reported and verified during weekday daytime shift hours. Conclusions Provisional or final radiological reports were frequently not available within 4 hours of image acquisition among this sample. Effective and cost-efficient strategies to improve the support provided to referring clinical teams from medical imaging departments may enhance emergency care interventions for people presenting to emergency departments with ankle injuries; particularly those with imaging findings that may be challenging for junior clinical staff to interpret without a definitive radiological report.

Setting the research agenda in IHRM

Firstly, on behalf of the secretariat that has coordinated these meetings every two years since 1985, our thanks to the organising committee here at the University of Economics in Cracow, Poland, for hosting this conference. I was asked to offer comment on the research agenda. There are many famous names to refer to. Two Australian colleagues here today are Peter Dowling and Helen De Cieri, longtime stalwarts of the field of IHRM. I acknowledge their contributions over many years, along with Randy Schuler and Denise Welch, and Dennis Briscoe. Other names such as Rosalie Tung, Pawan Bhudwhar, Michael Morley, Paul Sparrow and Wayne Cascio are known to us all. Their books have become classics. One example is the 700 page benchmark 2012 work by Chris Brewster and Wolfgang Mayrhofer, Handbook of Research on Comparative Human Resource Management (Brewster & Mayrhofer, 2012). More recently, in a book published by Cambridge University press in 2014, Mustafa Özbilgin, Dimitria Groutsis and William Harvey offer students a very accessible overview of the basics in IHRM (Ozbilgin, Groutsis, & Harvey, 2014). As for a research agenda, there are excellent literature reviews to which I would refer you, such as those by people who over the years have been frequent participants at this conference (Tarique & Schuler, 2010), (Farndale, Scullion, & Sparrow, 2010), and (Scullion & Collings, 2011).

Keynote address : aligning HR with a changing business landscape

"Firstly, I thank you sincerely for your kind invitation and warm welcome to Sri Lanka and to this national HR conference, I particularly acknowledge the initiative of Chairman of the Technical Committee, Dr Asoka Jinadasa in making it possible for me to be here, and to offer this contribution to your conference. I congratulate you on assembling such an impressive array of talent to aid your discussions. I hope I can add usefully to your conversations. In particular I congratulate you on developing such a good definition of HRM: “A strategic and integrated approach in acquisition, development and engagement of talent using relevant tools, with proper policies, products and processes in creating a conducive climate towards achieving organizational excellence and societal well-being” To me, that means that HR has to add value to the organisation, through an integrated set of tools, competencies, and policies, which are all consistent with the business model..."

Creating quality cross-media experiences

There are many ways to create a cross-media project, but there are approaches which facilitate a quality implementation. The crucial starting point with any creative project is a great story or game. However, because the cross-media artform is still emerging and many practitioners are new to the area, just how to produce a quality cross-media project is not well known. Based on my work on both small- and large-scale projects, I outline ten approaches that will aid in facilitating a quality cross-media project.

Technoeconomic analysis of an integrated microalgae photobioreactor, biodiesel and biogas production facility

As fossil fuel prices increase and environmental concerns gain prominence, the development of alternative fuels from biomass has become more important. Biodiesel produced from microalgae is becoming an attractive alternative to share the role of petroleum. Currently it appears that the production of microalgal biodiesel is not economically viable in current environment because it costs more than conventional fuels. Therefore, a new concept is introduced in this article as an option to reduce the total production cost of microalgal biodiesel. The integration of biodiesel production system with methane production via anaerobic digestion is proved in improving the economics and sustainability of overall biodiesel stages. Anaerobic digestion of microalgae produces methane and further be converted to generate electricity. The generated electricity can surrogate the consumption of energy that require in microalgal cultivation, dewatering, extraction and transesterification process. From theoretical calculations, the electricity generated from methane is able to power all of the biodiesel production stages and will substantially reduce the cost of biodiesel production (33% reduction). The carbon emissions of biodiesel production systems are also reduced by approximately 75% when utilizing biogas electricity compared to when the electricity is otherwise purchased from the Victorian grid. The overall findings from this study indicate that the approach of digesting microalgal waste to produce biogas will make the production of biodiesel from algae more viable by reducing the overall cost of production per unit of biodiesel and hence enable biodiesel to be more competitive with existing fuels.

Composing an email : social interaction in a preschool classroom

The chapter contributes understandings of digitally mediated interactions in early childhood classrooms. Ethnomethodological and conversation analysis approaches are used to analyse a video-recorded episode of children and teacher composing an email in a preschool classroom. In their talk we find how the teacher directs the children to what counts procedurally, such as the components of an email, and the teacher’s moral work in producing a culturally correct way form of personal communication. Such considerations of situated examples can encourage investigations of digital practices that extend beyond operational skills to broader understandings of digital practices as cultural and situated activities.

Playing with Technology: Young Children Making Sense of Technology as Part of Their Everyday Social Worlds

Games and activities, often involving aspects of pretence and fantasy play, are an essential aspect of everyday preschool life for many young children. Young children’s spontaneous play activities can be understood as social life in action. Increasingly, young children’s games and activities involve their engagement in pretence using play props to represent computers, laptops and other pieces of technology equipment. In this way, pretend play becomes a context for engaging with matters from the real world. There are a number of studies investigating school-aged children engaging in gaming and other online activities, but less is known about what young children are doing with online technologies. Drawing on Australian Research Council funded research of children engaging with technologies at home and school, this chapter investigates how young children use technologies in everyday life by showing how they draw on props, both real or imaginary, to support their play activities. An ethnomethodological approach using conversation analysis is used to explore how children’s gestures, gaze and talk work to introduce ideas and activities. This chapter contributes to understandings of how children’s play intersects with technologies and pretend play.

Creative work environments and employee engagement: Exploring potential links and possibilities

Companies that perform well are often identified as either possessing creative work environments and (or) having high levels of employee engagement. Creative work environments are largely not well defined, although research alludes to contributing factors. On the other hand employee engagement is defined as the multiple emotional, rational and behavioural dimensions of an employee's consistent level of effort, commitment and connection to their job. Some authors including Saks (2006) and Shuck and Wollard (2010) call for more scholarly research to increase our understanding of the drivers of employee engagement and the actions that organisations can take to improve engagement. There are references made in the literature to the existence of a relationship between a creative work environment and engaged employees (Isaksen & Ekvall 2010), but there is a lack of empirical evidence providing support for the direct relationship between the two. This study aims to explore the relationship, addressing the question of how a creative work environment impacts on employee engagement. Exploratory research to investigate this relationship will use a qualitative methodology with semi-structured interviews, field observations and document analysis. Key themes will be analysed at both the individual and team level reflecting the multi-level nature of the constructs.

Association of STAT3 and TNFRSF1A with ankylosing spondylitis in Han Chinese

Objectives: Recent association studies by the Australo-Anglo-American Spondyloarthritis Consortium (TASC) in Caucasian European populations from Australia, North America and the UK have identified a number of genes as being associated with ankylosing spondylitis (AS). A candidate gene study in a Han Chinese population was performed based on these findings to identify associated genes in this population. Methods: A case-control study was performed in a Han Chinese population of patients with AS (n=775) and controls (n=1587) from Shanghai and Nanjing. All patients met the modified New York criteria for AS. The cases and controls were genotyped for 115 single nucleotide polymorphisms (SNPs) tagging IL23R, ERAP1, STAT3, JAK2, TNFRSF1A and TRADD, as well as other confirmation SNPs from the TASC study, using the Sequenom iPlex and the ABI OpenArray platforms. Statistical analysis of genotyped SNPs was performed using the Cochran - Armitage test for trend and meta-analysis was performed using METAL. SNPs in AS-associated genes in this study were then imputed using MaCH, and association with AS tested by logistic regression. Results: SNPs in TNFRSF1A (rs4149577, p=8.2×10-4), STAT3 (rs2293152, p=0.0015; rs1053005, p=0.017) and ERAP1 (rs27038, p=0.0091; rs27037, p=0.0092) were significantly associated with AS in Han Chinese. Association was also observed between AS and the intergenic region 2p15 (rs10865331, p=0.023). The lack of association between AS and IL23R in Han Chinese was confirmed (all SNPs p>0.1). Conclusions: The study results demonstrate for the first time that genetic polymorphisms in STAT3, TNFRSF1A and 2p15 are associated with AS in Han Chinese, suggesting common pathogenic mechanisms for the disease in Chinese and Caucasian European populations. Furthermore, previous findings demonstrating that ERAP1, but not IL23R, is associated with AS in Chinese patients were confirmed.

High-throughput sequencing of IL23R reveals a low-frequency, nonsynonymous single-nucleotide polymorphism that is associated with ankylosing spondylitis in a Han Chinese population

Objective Ankylosing spondylitis (AS) is a highly heritable common inflammatory arthritis that targets the spine and sacroiliac joints of the pelvis, causing pain and stiffness and leading eventually to joint fusion. Although previous studies have shown a strong association of IL23R with AS in white Europeans, similar studies in East Asian populations have shown no association with common variants of IL23R, suggesting either that IL23R variants have no role or that rare genetic variants contribute. The present study was undertaken to screen IL23R to identify rare variants associated with AS in Han Chinese. Methods A 170-kb region containing IL23R and its flanking regions was sequenced in 50 patients with AS and 50 ethnically matched healthy control subjects from a Han Chinese population. In addition, the 30-kb region of peak association in white Europeans was sequenced in 650 patients with AS and 1,300 healthy controls. Validation genotyping was undertaken in 846 patients with AS and 1,308 healthy controls. Results We identified 1,047 variants, of which 729 were not found in the dbSNP genomic build 130. Several potentially functional rare variants in IL23R were identified, including one nonsynonomous single-nucleotide polymorphism (nsSNP), Gly149Arg (position 67421184 GA on chromosome 1). Validation genotyping showed that the Gly149Arg variant was associated with AS (odds ratio 0.61, P = 0.0054). Conclusion This is the first study to implicate rare IL23R variants in the pathogenesis of AS. The results identified a low-frequency nsSNP with predicted loss-of-function effects that was protectively associated with AS in Han Chinese, suggesting that decreased function of the interleukin-23 (IL-23) receptor protects against AS. These findings further support the notion that IL-23 signaling has an important role in the pathogenesis of AS.

Association of ERAP1, but not IL23R, with ankylosing spondylitis in a Han Chinese population

Objective The results of a recent genome-wide association study have shown that ERAP1 and IL23R are associated with ankylosing spondylitis (AS) in Caucasian populations from North America and the UK. Based on these findings, we undertook the current study to investigate whether single-nucleotide polymorphisms (SNPs) covering the genes ERAP1 and IL23R are associated with AS in a Han Chinese population. Methods A case-control study was performed in Han Chinese patients with AS (n = 527) and controls (n = 945) from Shanghai and Nanjing. All patients met the modified New York criteria for AS. The Sequenom iPlex platform was used to genotype cases and controls for 21 tag SNPs covering IL23R and 38 tag SNPs covering ERAP1. Statistical analysis was performed using the Cochran-Armitage test for trend. Results Multiple SNPs in ERAP1 were significantly associated with AS (for rs27980, P = 0.0048; for rs7711564, P = 0.0081). However, no association was observed between IL23R and AS (for all SNPs, P > 0.1). The nonsynonymous SNP in IL23R, rs11209026, widely thought to be the primary AS-associated SNP in IL23R in Europeans, was found not to be polymorphic in Chinese. Conclusion Our results demonstrate that genetic polymorphisms in ERAP1 are associated with AS in Han Chinese, suggesting a common pathogenic mechanism for the disease in Chinese and Caucasian populations, and that IL23R is not associated with AS in Chinese, indicating a difference in the mechanism of disease pathogenesis between Chinese and Caucasian populations. This may result from the fact that rs11209026, the nonsynonymous SNP in IL23R, is not polymorphic in Chinese patients, providing further evidence that rs11209026 is the key polymorphism associated with AS (and likely inflammatory bowel disease and psoriasis) in this gene.

Enrichment of circulating interleukin-17-secreting interleukin-23 receptor-positive γ/δ T cells in patients with active ankylosing spondylitis

Objective Ankylosing spondylitis (AS) is a common inflammatory arthritis affecting primarily the axial skeleton. IL23R is genetically associated with AS. This study was undertaken to investigate and characterize the role of interleukin-23 (IL-23) signaling in AS pathogenesis. Methods The study population consisted of patients with active AS (n = 17), patients with psoriatic arthritis (n = 8), patients with rheumatoid arthritis, (n = 9), and healthy subjects (n = 20). IL-23 receptor (IL-23R) expression in T cells was determined in each subject group, and expression levels were compared. Results The proportion of IL-23R-expressing T cells in the periphery was 2-fold higher in AS patients than in healthy controls, specifically driven by a 3-fold increase in IL-23R-positive γ/δ T cells in AS patients. The proportions of CD4+ and CD8+ cells that were positive for IL-17 were unchanged. This increased IL-23R expression on γ/δ T cells was also associated with enhanced IL-17 secretion, with no observable IL-17 production from IL-23R-negative γ/δ T cells in AS patients. Furthermore, γ/δ T cells from AS patients were heavily skewed toward IL-17 production in response to stimulation with IL-23 and/or anti-CD3/CD28. Conclusion Recently, mouse models have shown IL-17-secreting γ/δ T cells to be pathogenic in infection and autoimmunity. Our data provide the first description of a potentially pathogenic role of these cells in a human autoimmune disease. Since IL-23 is a maturation and growth factor for IL-17-producing cells, increased IL-23R expression may regulate the function of this putative pathogenic γ/δ T cell population.

Mosaic PPM1D mutations are associated with predisposition to breast and ovarian cancer

Improved sequencing technologies offer unprecedented opportunities for investigating the role of rare genetic variation in common disease. However, there are considerable challenges with respect to study design, data analysis and replication. Using pooled next-generation sequencing of 507 genes implicated in the repair of DNA in 1,150 samples, an analytical strategy focused on protein-truncating variants (PTVs) and a large-scale sequencing case-control replication experiment in 13,642 individuals, here we show that rare PTVs in the p53-inducible protein phosphatase PPM1D are associated with predisposition to breast cancer and ovarian cancer. PPM1D PTV mutations were present in 25 out of 7,781 cases versus 1 out of 5,861 controls (P = 1.12 × 10-5), including 18 mutations in 6,912 individuals with breast cancer (P = 2.42 × 10-4) and 12 mutations in 1,121 individuals with ovarian cancer (P = 3.10 × 10-9). Notably, all of the identified PPM1D PTVs were mosaic in lymphocyte DNA and clustered within a 370-base-pair region in the final exon of the gene, carboxy-terminal to the phosphatase catalytic domain. Functional studies demonstrate that the mutations result in enhanced suppression of p53 in response to ionizing radiation exposure, suggesting that the mutant alleles encode hyperactive PPM1D isoforms. Thus, although the mutations cause premature protein truncation, they do not result in the simple loss-of-function effect typically associated with this class of variant, but instead probably have a gain-of-function effect. Our results have implications for the detection and management of breast and ovarian cancer risk. More generally, these data provide new insights into the role of rare and of mosaic genetic variants in common conditions, and the use of sequencing in their identification.