Multilevel competing risk models to evaluate the risk of nosocomial infection

Introduction Risk factor analyses for nosocomial infections (NIs) are complex. First, due to competing events for NI, the association between risk factors of NI as measured using hazard rates may not coincide with the association using cumulative probability (risk). Second, patients from the same intensive care unit (ICU) who share the same environmental exposure are likely to be more similar with regard to risk factors predisposing to a NI than patients from different ICUs. We aimed to develop an analytical approach to account for both features and to use it to evaluate associations between patient- and ICU-level characteristics with both rates of NI and competing risks and with the cumulative probability of infection. Methods We considered a multicenter database of 159 intensive care units containing 109,216 admissions (813,739 admission-days) from the Spanish HELICS-ENVIN ICU network. We analyzed the data using two models: an etiologic model (rate based) and a predictive model (risk based). In both models, random effects (shared frailties) were introduced to assess heterogeneity. Death and discharge without NI are treated as competing events for NI. Results There was a large heterogeneity across ICUs in NI hazard rates, which remained after accounting for multilevel risk factors, meaning that there are remaining unobserved ICU-specific factors that influence NI occurrence. Heterogeneity across ICUs in terms of cumulative probability of NI was even more pronounced. Several risk factors had markedly different associations in the rate-based and risk-based models. For some, the associations differed in magnitude. For example, high Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were associated with modest increases in the rate of nosocomial bacteremia, but large increases in the risk. Others differed in sign, for example respiratory vs cardiovascular diagnostic categories were associated with a reduced rate of nosocomial bacteremia, but an increased risk. Conclusions A combination of competing risks and multilevel models is required to understand direct and indirect risk factors for NI and distinguish patient-level from ICU-level factors.

Lifecycle optimization and tradeoff analysis among competing objectives for a road corridor

While the philosophical motivation behind Civil Infrastructure Management Systems is to achieve optimal level of service at a minimum cost, the allocation of scarce resources among competing alternatives is still a matter of debate. It appears to be widely accepted that results from tradeoff analysis can be measured by the degree of accomplishment of the objectives. Road management systems not only deal with different asset types but also with conflicting objectives. This paper presents a case study of lifecycle optimization with tradeoff analysis for a road corridor in New Brunswick. Objectives of the study included condition of bridge and roads and road safety. A road safety index was created based on potential for improvement. Road condition was based on roughness, rutting and cracking. Initial results show lack of sustainability in bridge performance. Therefore, bridges where broken by components: deck, superstructure and substructure. Visual inspections, in addition to construction age of each bridge, were combined to generate a surrogate apparent age. Two life cycle analysis were conducted; one aimed to minimize overall cost while achieving sustainable results and another one purely for optimization. -used to identify required levels of budget. Such analyses were used to identify the minimum required budget and to demonstrate that with the same amount of money it was possible to achieve better levels of performance. Dominance and performance driven criteria were combined to identify and select an optimal result. It was found that achievement of optimally sustained results is conditioned by the availability of treatments for all asset classes at across their life spans. For the case study a disaggregated bridge condition index was introduced to the original algorithm to attempt to achieve sustainability in all bridges components, however lack of early stage treatments for substructures produce declining trends for such a component.

The limits to public service : rural communities, professional families, and work mobility

Australia faces an ongoing challenge recruiting professionals to staff essential human services in rural and remote communities. This paper identifies the private limits to the implicit service contract between professions and such client populations. These become evident in how private solutions to competing priorities within professional families inform their selective mobility and thus create the public problem for such communities. The paper reports on a survey of doctors, nurses, teachers and police with responsibility for school-aged children in Queensland that plumbed the strength of neoliberal values in their educational strategy and their commitment to the public good in career decisions. The quantitative analysis suggested that neoliberal values are not necessarily opposed to a commitment to the public good. However, the qualitative analysis of responses to hypothetical career opportunities in rural and remote communities drew out the multiple intertwined spatial and temporal limits to such public service, highlighting the priority given to educational strategy in these families’ deliberations. This private/public nexus poses a policy problem on multiple institutional fronts.

Common values in assessing health outcomes from disease and injury: Disability weights measurement study for the Global Burden of Disease Study 2010

BACKGROUND Measurement of the global burden of disease with disability-adjusted life-years (DALYs) requires disability weights that quantify health losses for all non-fatal consequences of disease and injury. There has been extensive debate about a range of conceptual and methodological issues concerning the definition and measurement of these weights. Our primary objective was a comprehensive re-estimation of disability weights for the Global Burden of Disease Study 2010 through a large-scale empirical investigation in which judgments about health losses associated with many causes of disease and injury were elicited from the general public in diverse communities through a new, standardised approach. METHODS We surveyed respondents in two ways: household surveys of adults aged 18 years or older (face-to-face interviews in Bangladesh, Indonesia, Peru, and Tanzania; telephone interviews in the USA) between Oct 28, 2009, and June 23, 2010; and an open-access web-based survey between July 26, 2010, and May 16, 2011. The surveys used paired comparison questions, in which respondents considered two hypothetical individuals with different, randomly selected health states and indicated which person they regarded as healthier. The web survey added questions about population health equivalence, which compared the overall health benefits of different life-saving or disease-prevention programmes. We analysed paired comparison responses with probit regression analysis on all 220 unique states in the study. We used results from the population health equivalence responses to anchor the results from the paired comparisons on the disability weight scale from 0 (implying no loss of health) to 1 (implying a health loss equivalent to death). Additionally, we compared new disability weights with those used in WHO's most recent update of the Global Burden of Disease Study for 2004. FINDINGS 13,902 individuals participated in household surveys and 16,328 in the web survey. Analysis of paired comparison responses indicated a high degree of consistency across surveys: correlations between individual survey results and results from analysis of the pooled dataset were 0·9 or higher in all surveys except in Bangladesh (r=0·75). Most of the 220 disability weights were located on the mild end of the severity scale, with 58 (26%) having weights below 0·05. Five (11%) states had weights below 0·01, such as mild anaemia, mild hearing or vision loss, and secondary infertility. The health states with the highest disability weights were acute schizophrenia (0·76) and severe multiple sclerosis (0·71). We identified a broad pattern of agreement between the old and new weights (r=0·70), particularly in the moderate-to-severe range. However, in the mild range below 0·2, many states had significantly lower weights in our study than previously. INTERPRETATION This study represents the most extensive empirical effort as yet to measure disability weights. By contrast with the popular hypothesis that disability assessments vary widely across samples with different cultural environments, we have reported strong evidence of highly consistent results.

Using Bayesian Mixture Models That Combine Expert Knowledge and GIS Data to Define Ecoregions

Conservation planning and management programs typically assume relatively homogeneous ecological landscapes. Such “ecoregions” serve multiple purposes: they support assessments of competing environmental values, reveal priorities for allocating scarce resources, and guide effective on-ground actions such as the acquisition of a protected area and habitat restoration. Ecoregions have evolved from a history of organism–environment interactions, and are delineated at the scale or level of detail required to support planning. Depending on the delineation method, scale, or purpose, they have been described as provinces, zones, systems, land units, classes, facets, domains, subregions, and ecological, biological, biogeographical, or environmental regions. In each case, they are essential to the development of conservation strategies and are embedded in government policies at multiple scales.

Shared values : diverse perspectives – engaging engineering educators in integrating Indigenous engineering knowledge into current curricula

BACKGROUND Engineering is a problem-based practically oriented discipline, whose practitioners aim to find effective solutions to engineering challenges, technically and economically. Engineering educators operate within a mandate to ensure that graduate engineers understand the practicalities and realities of good engineering practice. While this is a vital goal for the discipline, emerging influences are challenging the focus on ‘hard practicalities’ and requiring recognition of the cultural and social aspects of engineering. Expecting graduate engineers to possess communication skills essential for negotiating satisfactory outcomes in contexts of complex social beliefs about the impact of their work can be an unsettling and challenging prospect for engineering educators. This project identifies and addresses Indigenous engineering practices and principles, and their relevance to future engineering practices. PURPOSE This Office of Learning and Teaching (OLT) project proposes that what is known/discoverable about indigenous engineering knowledge and practices must be integrated into engineering curricula. This is an important aspect of ensuring that engineering as a profession responds competently to increasing demands for socially and environmentally responsible activity across all aspects of engineering activity. DESIGN/METHOD The project addresses i) means for appropriate inclusion of Indigenous students into usual teaching activities ii) assuring engineering educators have access to knowledge of Indigenous practices and skills relevant to particular engineering courses and topics iii) means for preparing all students to negotiate their way through issues of indigenous relationships with the land where engineering projects are planned. The project is undertaking wide-ranging research to collate knowledge about indigenous engineering principles and practices and develop relevant resource materials. RESULTS It is common to hear that such social issues as ‘Indigenous concerns’ are only of concern to environmental engineers. We challenge that perspective, and make the case that Indigenous knowledge is an important issue for all engineering educators in relation to effective integration of indigenous students and preparation of all engineering graduates to engage with indigenous communities. At the time of first contact, a rich and varied, technically literate, Indigenous social framework possessed knowledge of the environment that is not yet fully acknowledged in Australian society. A core outcome of the work will be development of resources relating to Indigenous engineering practices for inclusion in engineering core curricula. CONCLUSIONS A large body of technical knowledge was needed to survive and sustain human society in the complex environment that was Australia before 1788. This project is developing resource materials, and supporting documentation, about that knowledge to enable engineering educators to more easily integrate it into current curricula. The project also aims to demonstrate the importance for graduating engineers to appreciate the existence of diverse perspectives on engineering tasks and learn how to value - and employ - multiple paths to possible solutions.

Non-market use and non-use values for preserving ecosystem services over time : a choice experiment application to coral reef ecosystems in New Caledonia

Non-use values (i.e. economic values assigned by individuals to ecosystem goods and services unrelated to current or future uses) provide one of the most compelling incentives for the preservation of ecosystems and biodiversity. Assessing the non-use values of non-users is relatively straightforward using stated preference methods, but the standard approaches for estimating non-use values of users (stated decomposition) have substantial shortcomings which undermine the robustness of their results. In this paper, we propose a pragmatic interpretation of non-use values to derive estimates that capture their main dimensions, based on the identification of a willingness to pay for ecosystem protection beyond one's expected life. We empirically test our approach using a choice experiment conducted on coral reef ecosystem protection in two coastal areas in New Caledonia with different institutional, cultural, environmental and socio-economic contexts. We compute individual willingness to pay estimates, and derive individual non-use value estimates using our interpretation. We find that, a minima, estimates of non-use values may comprise between 25 and 40% of the mean willingness to pay for ecosystem preservation, less than has been found in most studies.

Subtropical values and principles of subtropical design for the South East Queensland region : a report for the Office of Urban Management Queensland Government

The Office of Urban Management recognises that the values which characterise the SEQ region as 'subtropical' are important determinants of form in urban and regional planning. Subtropical values are those qualities on which our regional identity depends. A built environment which responds positively to these values is a critical ingredient for achieving a desirable future for the region. The Centre for Subtropical Design has undertaken this study to identify the particular set of values which characterises SEQ, and to translate theses values into design principals that will maintain and reinforce the value set. The principles not only apply to the overall balance between the natural environment and the built environment, but can be applied by local government authorities to guide local planning schemes and help shape specific built for outcomes.

How long does stigma impact property values

Purpose - The purpose of this paper is to determine the impact stigma has on property values and how long the stigma remains after the Not in My Back Yard (NIMBY) structure has been removed. Design/methodology/approach - A quantitative analysis was undertaken, using a high voltage overhead transmission line (HVOTL) case study, to determine the effect on property values prior and post removal of the NIMBY structure. A repeat sales index in conjunction with the regression analysis determined the length of time, the stigma remained after removal of the NIMBY structure. Findings - The results show that while the NIMBY is in place the impact on value is confined to those properties in close proximity. This is in contradiction to the findings, where on removal of the NIMBY the property values of the whole neighbourhood improve with the stigma remaining for 3 to 4 years. Research Implications - The implication of this research is that property Valuers need to change the way they take into account the presence of NIMBYs when valuing property with more emphasis, being placed on the neighbourhood rather than just the properties in close proximity. While the HVOTL was in place, only properties in close proximity were negatively affected, but on removal of the HVOTL the whole neighbourhood increased in value. Originality/value - Results expand on current knowledge by demonstrating the length of time the market takes to adjust to the removal of a NIMBY structure.

Historical intake and elimination of polychlorinated biphenyls and organochlorine pesticides by the Australian population reconstructed from biomonitoring data

Quantifying the competing rates of intake and elimination of persistent organic pollutants (POPs) in the human body is necessary to understand the levels and trends of POPs at a population level. In this paper we reconstruct the historical intake and elimination of ten polychlorinated biphenyls (PCBs) and five organochlorine pesticides (OCPs) from Australian biomonitoring data by fitting a population-level pharmacokinetic (PK) model. Our analysis exploits two sets of cross-sectional biomonitoring data for PCBs and OCPs in pooled blood serum samples from the Australian population that were collected in 2003 and 2009. The modeled adult reference intakes in 1975 for PCB congeners ranged from 0.89 to 24.5 ng/kg bw/day, lower than the daily intakes of OCPs ranging from 73 to 970 ng/kg bw/day. Modeled intake rates are declining with half-times from 1.1 to 1.3 years for PCB congeners and 0.83 to 0.97 years for OCPs. The shortest modeled intrinsic human elimination half-life among the compounds studied here is 6.4 years for hexachlorobenzene, and the longest is 30 years for PCB-74. Our results indicate that it is feasible to reconstruct intakes and to estimate intrinsic human elimination half-lives using the population-level PK model and biomonitoring data only. Our modeled intrinsic human elimination half-lives are in good agreement with values from a similar study carried out for the population of the United Kingdom, and are generally longer than reported values from other industrialized countries in the Northern Hemisphere.

Personal values and political activism: A cross-national study

Using data from 28 countries in four continents, the present research addresses the question of how basic values may account for political activism. Study 1 (N = 35,116) analyses data from representative samples in 20 countries that responded to the 21-item version of the Portrait Values Questionnaire (PVQ-21) in the European Social Survey. Study 2 (N = 7,773) analyses data from adult samples in six of the same countries (Finland, Germany, Greece, Israel, Poland, and United Kingdom) and eight other countries (Australia, Brazil, Chile, Italy, Slovakia, Turkey, Ukraine, and United States) that completed the full 40-item PVQ. Across both studies, political activism relates positively to self-transcendence and openness to change values, especially to universalism and autonomy of thought, a subtype of self-direction. Political activism relates negatively to conservation values, especially to conformity and personal security. National differences in the strength of the associations between individual values and political activism are linked to level of democratization.

Basic personal values underlie and give coherence to political values: A cross national study in 15 countries

Do the political values of the general public form a coherent system? What might be the source of coherence? We view political values as expressions, in the political domain, of more basic personal values. Basic personal values (e.g., security, achievement, benevolence, hedonism) are organized on a circular continuum that reflects their conflicting and compatible motivations. We theorize that this circular motivational structure also gives coherence to political values. We assess this theorizing with data from 15 countries, using eight core political values (e.g., free enterprise, law and order) and ten basic personal values. We specify the underlying basic values expected to promote or oppose each political value. We offer different hypotheses for the 12 non-communist and three post-communist countries studied, where the political context suggests different meanings of a basic or political value. Correlation and regression analyses support almost all hypotheses. Moreover, basic values account for substantially more variance in political values than age, gender, education, and income. Multidimensional scaling analyses demonstrate graphically how the circular motivational continuum of basic personal values structures relations among core political values. This study strengthens the assumption that individual differences in basic personal values play a critical role in political thought.

Culture in Business Process Management: How cultural values determine BPM success

There is consensus among practitioners and academics that culture is a critical factor that is able to determine success or failure of BPM initiatives. Yet, culture is a topic that seems difficult to grasp and manage. This may be the reason for the overall lack of guidance on how to address this topic in practice. We have conducted in-depth research for more than three years to examine why and how culture is relevant to BPM. In this chapter, we introduce a framework that explains the role of culture in BPM. We also present the relevant cultural values that compose a BPM culture, and we introduce a tool to examine the supportiveness of organizational cultures for BPM. Our research results provide the basis for further empirical analyses on the topic and support practitioners in the management of culture as an important factor in BPM initiatives.

Conceptual beliefs about human values and their implications: Human nature beliefs predict value importance, value trade-offs, and responses to value-laden rhetoric

Beliefs that may underlie the importance of human values were investigated in 4 studies, drawing on research that distinguishes natural-kind (natural), nominal-kind (conventional), and artifact (functional) beliefs. Values were best characterized by artifact and nominal-kind beliefs, as well as a natural-kind belief specific to the social domain, “human nature” (Studies 1 and 2). The extent to which values were considered central to human nature was associated with value importance in both Australia and Japan (Study 2), and experimentally manipulating human nature beliefs influenced value importance (Study 3). Beyond their association with importance, human nature beliefs predicted participants’ reactions to value trade-offs (Study 1) and to value-laden rhetorical statements (Study 4). Human nature beliefs therefore play a central role in the psychology of values.

Which values?: Matching Schwartz's ten values constructs with the Nine Values for Australian Schooling

This study set out to determine which values are represented in the National Framework for Values Education in Australian Schools by matching Schwartz's ten values constructs to the Nine Values for Australian Schooling and examining the values orientations of contemporary young people, specifically Grade 8 girls from one State High School in South East Queensland. This was achieved by using the Schwartz Portrait Values Questionnaire (PVQ) as well as thematic analysis. Key findings were that there was a match between the Grade 8 girls values and some of the Nine Values however not others. Also, that not all of Schwartz's values are represented in the Nine Values for Australian Schooling, and certain values could be said to be omitted from the Framework and certain privileged.