A comparative analysis of risk stratification tools for emergency department patients with chest pain

Background: Appropriate disposition of emergency department (ED) patients with chest pain is dependent on clinical evaluation of risk. A number of chest pain risk stratification tools have been proposed. The aim of this study was to compare the predictive performance for major adverse cardiac events (MACE) using risk assessment tools from the National Heart Foundation of Australia (HFA), the Goldman risk score and the Thrombolysis in Myocardial Infarction risk score (TIMI RS). Methods: This prospective observational study evaluated ED patients aged ≥30 years with non-traumatic chest pain for which no definitive non-ischemic cause was found. Data collected included demographic and clinical information, investigation findings and occurrence of MACE by 30 days. The outcome of interest was the comparative predictive performance of the risk tools for MACE at 30 days, as analyzed by receiver operator curves (ROC). Results: Two hundred eighty-one patients were studied; the rate of MACE was 14.1%. Area under the curve (AUC) of the HFA, TIMI RS and Goldman tools for the endpoint of MACE was 0.54, 0.71 and 0.67, respectively, with the difference between the tools in predictive ability for MACE being highly significant [chi2 (3) = 67.21, N = 276, p < 0.0001]. Conclusion: The TIMI RS and Goldman tools performed better than the HFA in this undifferentiated ED chest pain population, but selection of cutoffs balancing sensitivity and specificity was problematic. There is an urgent need for validated risk stratification tools specific for the ED chest pain population.

Conflicting notions of risk : the chasm of conflict between institutions and the public

The trust and credibility gap between institutional regulators and the public is based on fundamental social and cultural differences related to power and authority. It is also associated with the 'distance' of a bureaucracies from those whom they serve. The nature of public concern about risk may be investigated by considering specific cognitive decision making 'rules' such as 'familiarity' of a hazard or 'voluntariness' of exposure. A more complete appreciation of the 'how' and 'why' of public response to danger from industrial hazards can be gained by appreciating these 'rules' within the broader context of mis-communication between 'elite' regulators and a highly diverse public. If the results of risk assessments are expressed in technical terms alone, it is unlikely that any real communication will occur. Further, if issues related to the 'remote' nature of much institutional decision making are not addressed, closure of the 'gap' may be difficult to bring about.

Free for all : a case study examining implementation factors of one-to-one device programs

Despite significant investment in school one-to-one device programs, little is known about which aspects of program implementation work and why. Through a comparison of two implementation models, adopter-diffusion and saturation, and using existing data from the One Laptop per Child Australia laptop program, we explored how factors of implementation may affect device diffusion, learning and educational outcomes, and program sustainability in schools. In this article we argue that more focused research into implementation of one-to-one device programs, moving beyond comparisons of “devices versus without devices,” is needed to provide reliable data to inform future program funding and advance this area of research.

Antecedent factors of knowledge sharing in research supervision

Today’s economy is a knowledge-based economy in which knowledge is a crucial facilitator to individuals, as well as being an instigator of success. Due to the impact of globalisation, universities face new challenges and opportunities. Accordingly, they ought to be more innovative and have their own competitive advantages. One of the most important goals of universities is the promotion of students as professional knowledge workers. Therefore, knowledge sharing and transfer at the tertiary level between students and supervisors is vital in universities, as it decreases the budget and provides an affordable way to do research. Knowledge-sharing impact factors can be categorised in three groups, namely: organisational, individual, and technical factors. Individual barriers to knowledge sharing include: the lack of time and trust and the lack of communication skills and social networks. IT systems such as elearning, blogs and portals can increase the knowledge-sharing capability. However, it must be stated that IT systems are only tools and not solutions. Individuals are still responsible for sharing information and knowledge. This paper proposes a new research model to examine the effect of individual factors, organisational factors (learning strategy, trust culture, supervisory support) and technological factors on knowledge sharing in the research supervision process.

The social foundations of risk

Ulrich Beck's argument about risk society emphasises, among other things, the pervasiveness of risk. As a feature of the human condition in the contemporary, globalised, world that distinguishes the present from the past, risk is widespread across society and affects all social strata. While Beck has gestured towards the irregular distribution of contemporary risks, nonetheless he has suggested that traditional structural entities – class and wealth – no longer provide the key interpretive frameworks for the calculation of susceptibility. In short, the tentacles of risk are long and almost no one is out of reach. Yet, while the risk society thesis has generated a large theoretical literature, there is very little in the way of research that marries theorising to original data collection. This paper represents an attempt to address this gap by using empirical data to investigate whether risk is more textured than Beck's account suggests. Focusing on health as a domain of risk, the paper uses data from a national sample survey of the Australian electorate to investigate the extent to which social divisions structure perceptions of risk within the general population. The findings suggest that various aspects of social stratification, such as income, occupation and education, do indeed play a role in shaping perceptions of risk.

Analysis of risk management disclosures by Australian publicly listed companies

In the aftermath of the global financial crisis, effective risk management (RM) and its communication to stakeholders are now considered essential components in corporate governance. However, despite the importance of RM communication, it is still unclear how and to what extent disclosures in financial reports can achieve effective communication of RM activities. The situation is hampered by the paucity of international RM Research that captures institution differences in corporate governance standards. The Australian setting provides an ideal environment in which to examine RM communication because the Australian Securities Exchange (ASX) has since 2007 recommended RM disclosures under its principle-based governance rules. The recommendations are contained in Principle 7 of the Corporate Governance Principles and recommendations (ASX CGPR). Accordingly, to assess the effectiveness of the AXS's RM governance principle, this study examines the nature and extent of RM disclosures reported by major ASX-listed firms. Using a mixed method approach (thematic content analysis and a series of regression analysis) we find widespread divergence in disclosure practices and low conformance with the Principle 7 recommendations. Certain corporate governance mechanisms appear to influence some categories of RM dislcosure but equity risk has surprisingly little explanatory power. These results suggest that the RM disclosures practices observed in the Australian setting may not be meeting the objectives of regulators and the needs of stakeholders.

Medical negligence, causation and liability for non-disclosure of risk : a post-wallace framework and critique

Through an examination of Wallace v Kam, this article considers and evaluates the law of causation in the specific context of a medical practitioner’s duty to provide information to patients concerning material risks of treatment. To supply a contextual background for the analysis which follows, Part II summarises the basic principles of causation law, while Part III provides an overview of the case and the reasoning adopted in the decisions at first instance and on appeal. With particular emphasis upon the reasoning in the courts of appeal, Part IV then examines the implications of the case in the context of other jurisprudence in this field and, in so doing, provides a framework for a structured consideration of causation issues in future non-disclosure cases under the Australian civil liability legislation. As will become clear, Wallace was fundamentally decided on the basis of policy reasoning centred upon the purpose behind the legal duty violated. Although the plurality in Rogers v Whitaker rejected the utility of expressions such as ‘the patient’s right of self-determination’ in this context, some Australian jurisprudence may be thought to frame the practitioner’s duty to warn in terms of promoting a patient’s autonomy, or right to decide whether to submit to treatment proposed. Accordingly, the impact of Wallace upon the protection of this right, and the interrelation between it and the duty to warn’s purpose, is investigated. The analysis in Part IV also evaluates the courts’ reasoning in Wallace by questioning the extent to which Wallace’s approach to liability and causal connection in non-disclosure of risk cases: depends upon the nature and classification of the risk(s) in question; and can be reconciled with the way in which patients make decisions. Finally, Part V adopts a comparative approach by considering whether the same decision might be reached if Wallace was determined according to English law.

Success factors of engaging higher education students and staff with e-learning tools within Learning Management Systems

This thesis explored the state of the use of e-learning tools within Learning Management Systems in higher education and developed a distinct framework to explain the factors influencing users' engagement with these tools. The study revealed that the Learning Management System design, preferences for other tools, availability of time, lack of adequate knowledge about tools, pedagogical practices, and social influences affect the uptake of Learning Management System tools. Semi structured interviews with 74 students and lecturers of a major Australian university were used as a source of data. The applied thematic analysis method was used to analyse the collected data.

Queer Youth Research/ers: A reflexive account of risk and intimacy in an ethical (mine)field

In contemporary Western societies, the years between childhood and young adulthood are commonly understood to be (trans)formative in the reflexive project of sexual self-making (Russell et al. 2012). As sexual subjects in the making, youthful bodies, desires and sexual activities are often perceived as both volatile and vulnerable, thus subjected to instruction and discipline, protection and surveillance. Accordingly, young people’s sexual proximities are closely monitored by social institutions and ‘(hetero)normalising regimes’ (Warner 1999) for any signs that may compromise the end goal of development—a ‘normal’ reproductive heterosexual monogamous adult.

Incidence factors of the tracking systems used in parabolic-cylindrical concentrators

Several orientation and tracking systems employed in parabolic-cylindrical concentrators for focusing the direct solar radiation on the absorber tubes are analyzed from the technical and economic points of view. Case one, where the incidence factor was a function of declination and hour angle, showed that the maximum variations of incident factor from morning to noon was 0.5 at zero angle of declination. Case two, where the incidence factor was a function of declination, hour angle and latitude, showed the maximum variation of the incidence factor to be 0.128, which occurred during noon at the latitude of 30 degrees, corresponding to a change of declination from 0 to 23.5 degrees. In case three, the incidence factor, a function of declination only, showed that the maximum variation of the incidence factor corresponding to the change in declination from 0 to 23.5 degree was 0.0758. It is concluded that system three is the most efficient from the technical and economic point of view.

Pathophysiological factors of irritable bowel syndrome, and the effects of probiotic supplementation

Gastrointestinal symptoms and impaired quality of life caused by irritable bowel syndrome (IBS) affect up to 20% of the adult population worldwide. The exact aetiology and pathophysiology of IBS are incompletely understood. Clinical studies suggest that supplementation with certain probiotics may be beneficial in IBS, but there is not enough evidence to make general recommendations. The aim of this thesis was to investigate microbiota- and mucosa-associated pathophysiological factors of IBS, and to evaluate the long-term effects of multispecies probiotic supplementation on symptoms, quality of life, intestinal microbiota and systemic inflammatory markers in IBS. The intestinal microbiota composition in IBS patients and healthy control subjects was analysed by quantitative polymerase chain reaction (qPCR). Significantly lower counts for the Clostridium coccoides and the Bifidobacterium catenulatum groups were found in IBS compared to controls. Quantitative differences also appeared in subgroup analysis based on the predominant bowel habit: diarrhoea patients harboured significantly lower numbers of Lactobacillus spp. than the constipation-predominant patients, while higher counts for Veillonella spp. were detected in constipation-predominant patients compared to healthy controls. Analysis of mucosal biopsies by a metabolomic approach revealed multiple differences between patients and controls. The most prominent finding was an upregulation of specific lipid species, principally lysophosphatidylcholines and ceramides, in IBS. The effects of multispecies probiotic supplementation with Lactobacillus rhamnosus GG, Lactobacillus rhamnosus Lc705, Propionibacterium freudenreichii subsp. shermanii JS, and Bifidobacterium breve Bb99 or Bifidobacterium animalis subsp. lactis Bb12 was evaluated in two, randomised, double-blind, placebo-controlled trials. Compared to placebo, the probiotic supplementation significantly reduced the total symptoms of IBS. No effects on bowel habit were seen. Health-related quality of life (HRQOL) is reduced in patients with IBS in comparison with the Finnish population on the whole. The probiotic supplementation improved one IBS-specific domain of quality of life (bowel symptoms), whereas no other effects on HRQOL were seen. The probiotics had no major effects on the predominant microbiota as measured by qPCR, but a microarray-based analysis suggested that the probiotic consumption stabilised the microbiota. No effects on serum sensitive-CRP or cytokines were detected. In conclusion, alterations in the microbiota composition and in the mucosal metabolite profile are potential pathophysiological factors of IBS. Multispecies probiotic supplementation alleviates the gastrointestinal symptoms of IBS, and improves the bowel symptoms domain of HRQOL. Probiotic supplementation in IBS is associated with a stabilisation of microbiota, but it does not influence systemic inflammatory markers.