Post-discharge surveillance : can patients reliably diagnose surgical wound infections?

Post-discharge surgical wound infection surveillance is an important part of many infection control programs. It is frequently undertaken by patient self-assessment, prompted either by a telephone or postal questionnaire. To assess the reliability of this method, 290 patients were followed for six weeks postoperatively. Their wounds were photographed and also covertly assessed for signs of infection by two experienced infection control nurses (ICNs). Patients also responded to a postal questionnaire seeking evidence of infection at both week four and week six post-surgery. Correlation between the patient's assessment of their wound and the ICNs diagnosis was poor (r=0.37) with a low positive predictive value (28.7%), although negative predictive value was high (98.2%). Assessment of photos for signs of infection by two experienced clinicians also correlated poorly with the ICNs diagnosis of infection (r=0.54). The patient's recall of prescription of an antibiotic by their general practitioner (GP) for wound infection during the postoperative period correlated best with the ICNs diagnosis (r=0.76). This latter measure, particularly when confirmed by the GP in those patients reporting an infection, appears to provide the most valid and resource efficient marker of post-discharge surgical wound infection.

A critical regionalist approach to housing design in Vietnam : socio-environmental organisation of living spaces in pre- and post-reform houses

Vietnam has a unique culture which is revealed in the way that people have built and designed their traditional housing. Vietnamese dwellings reflect occupants’ activities in their everyday lives, while adapting to tropical climatic conditions impacted by seasoning monsoons. It is said that these characteristics of Vietnamese dwellings have remained unchanged until the economic reform in 1986, when Vietnam experienced an accelerated development based on the market-oriented economy. New housing types, including modern shop-houses, detached houses, and apartments, have been designed in many places, especially satisfying dwellers’ new lifestyles in Vietnamese cities. The contemporary housing, which has been mostly designed by architects, has reflected rules of spatial organisation so that occupants’ social activities are carried out. However, contemporary housing spaces seem unsustainable in relation to socio-cultural values because they has been influenced by globalism that advocates the use of homogeneous spatial patterns, modern technologies, materials and construction methods. This study investigates the rules of spaces in Vietnamese houses that were built before and after the reform to define the socio-cultural implications in Vietnamese housing design. Firstly, it describes occupants’ views of their current dwellings in terms of indoor comfort conditions and social activities in spaces. Then, it examines the use of spaces in pre-reform Vietnamese housing through occupants’ activities and material applications. Finally, it discusses the organisation of spaces in both pre- and post-reform housing to understand how Vietnamese housing has been designed for occupants to live, act, work, and conduct traditional activities. Understanding spatial organisation is a way to identify characteristics of the lived spaces of the occupants created from the conceived space, which is designed by designers. The characteristics of the housing spaces will inform the designers the way to design future Vietnamese housing in response to cultural contexts. The study applied an abductive approach for the investigation of housing spaces. It used a conceptual framework in relation to Henri Lefebvre’s (1991) theory to understand space as the main factor constituting the language of design, and the principles of semiotics to examine spatial structure in housing as a language used in the everyday life. The study involved a door-knocking survey to 350 households in four regional cities of Vietnam for interpretation of occupancy conditions and levels of occupants’ comfort. A statistical analysis was applied to interpret the survey data. The study also required a process of data selection and collection of fourteen cases of housing in three main climatic regions of the country for analysing spatial organisation and housing characteristics. The study found that there has been a shift in the relationship of spaces from the pre- to post-reform Vietnamese housing. It also indentified that the space for guest welcoming and family activity has been the central space of the Vietnamese housing. Based on the relationships of the central space with the others, theoretical models were proposed for three types of contemporary Vietnamese housing. The models will be significant in adapting to Vietnamese conditions to achieve socioenvironmental characteristics for housing design because it was developed from the occupants’ requirements for their social activities. Another contribution of the study is the use of methodological concepts to understand the language of living spaces. Further work will be needed to test future Vietnamese housing designs from the applications of the models.

A comparison of new and existing mild traumatic brain injury vignettes : recommendations for research into post-concussion syndrome

OBJECTIVE: To review and compare the mild traumatic brain injury (mTBI) vignettes used in postconcussion syndrome (PCS) research, and to develop 3 new vignettes. METHOD: The new vignettes were devised using World Health Organization (WHO) mTBI diagnostic criteria [1]. Each vignette depicted a very mild (VM), mild (M), or severe (S) brain injury. Expert review (N = 27) and readability analysis was used to validate the new vignettes and compare them to 5 existing vignettes. RESULTS: The response rate was 44%. The M vignette and existing vignettes were rated as depicting a mTBI; however, the fit-to-criteria of these vignettes differed significantly. The fit-to-criteria of the M vignette was as good as that of 3 existing vignettes and significantly better than 2 other vignettes. As expected, the VM and S vignettes were a poor fit-to-criteria. CONCLUSIONS: These new vignettes will assist PCS researchers to test the limits of important etiology factors by varying the severity of depicted injuries.

Systematic variation of the severity of motor vehicle accident-related traumatic brain injury vignettes produces different post-concussion symptom reports

This study investigated the specificity of the post-concussion syndrome (PCS) expectation-as-etiology hypothesis. Undergraduate students (n = 551) were randomly allocated to one of three vignette conditions. Vignettes depicted either a very mild (VMI), mild (MI), or moderate-to-severe (MSI) motor vehicle-related traumatic brain injury (TBI). Participants reported the PCS and PTSD symptoms that they imagined the depicted injury would produce. Secondary outcomes (knowledge of mild TBI, and the perceived undesirability of TBI) were also assessed. After data screening, the distribution of participants by condition was: VMI (n = 100), MI (n = 96), and MSI (n = 71). There was a significant effect of condition on PCS symptomatology, F(2, 264) = 16.55, p < .001. Significantly greater PCS symptomatology was expected in the MSI condition compared to the other conditions (MSI > VMI; medium effect, r = .33; MSI > MI; small-to-medium effect, r = .22). The same pattern of group differences was found for PTSD symptoms, F(2, 264) = 17.12, p < .001. Knowledge of mild TBI was not related to differences in expected PCS symptoms by condition; and the perceived undesirability of TBI was only associated with reported PCS symptomatology in the MSI condition. Systematic variation in the severity of a depicted TBI produces different PCS and PTSD symptom expectations. Even a very mild TBI vignette can elicit expectations of PCS symptoms.

Prosecutorial discretion in assisted dying in Canada : a proposal for charging guidelines

An Expert Panel of the Royal Society of Canada and a Select Committee of the Québec National Assembly both recently recommended the issuance of permissive guidelines for the exercise of prosecutorial discretion on voluntary euthanasia and assisted suicide and “medical aid in dying” respectively. It seems timely, therefore, to propose a set of offence-specific guidelines for how prosecutorial discretion should be exercised in cases of voluntary euthanasia and assisted suicide in Canadian provinces and territories. We take as our starting point the only existing guidelines of this sort currently in force in the world (i.e. the British Columbia Guidelines, and the England and Wales Guidelines). In light of certain concerns we have with these guidelines, we outline an approach to constructing guidelines for Canadian jurisdictions that begins with identifying three guiding principles we argue are appropriate for this purpose (respect for autonomy, the need for high-quality prosecutorial decision making, and the importance of public confidence in that decision making), and ends with a concrete and detailed set of proposed guidelines. The paper is consistent with, but also extends, the work of the Royal Society of Canada Expert Panel on End of Life Decision Making. Un panel d’expert de la Société Royale du Canada et une Commission spéciale de l’Assemblée nationale du Québec ont tous les deux récemment recommandé que soit émises des directives permettant exercice d’un pouvoir de poursuite discrétionnaire concernant l’euthanasie et le suicide assisté et « l’assistance médicale pour mourir », respectivement. Il semble donc à propos de proposer une série de directives spécifiques aux offenses sur la façon dont le pouvoir de poursuite discrétionnaire dans les territoires et provinces canadiennes serait appliqué dans les cas d’euthanasie et de suicide assisté. Nous avons pris comme point de départ les seules directives de la sorte existant déjà (c’est-à-dire celle de la Colombie-Britannique et de l’Angleterre et du Pays de Galles). Par contre, compte tenu de certaines de nos réserves concernant ces directives, nous avons ensuite établi les grandes lignes d’une approche permettant de mettre sur pied des directives pour les juridictions canadiennes, qui débute par l’identification de trois principes de base qui sont selon nous appropriées à cette fin (respect de l’autonomie, besoin pour une grande qualité de prise de prise de décision du poursuivant et la confiance du public envers cette prise de décision) pour se terminer par une série de directives concrètes et détaillées. Le présent document est compatible avec le travail de la Société royale du Canada tout en en augmentant la portée.

Inside the pleasure dome : cultural tourism on Australia’s Gold Coast

The City of the Gold Coast in Queensland, Australia, will host the Commonwealth Games in 2018. In advance of the Games, the City is beginning to reposition the traditional marketing programs that were based around the four S’s- ‘sun, sand, surf and sex.’ There is a new emphasis on urban sophistication, sport, science, education and the environment. At the same time, local communities are asking for renewed attention to residential issues, particularly relating to recognising the importance of culture to the region. In this paper I explore the development of integrated computer technologies (ICTs) as a way of linking tourism, culture and place in the experience economy of the Gold Coast. The discussion is framed by theories of the post-tourist, contemporary cultural tourism and the role of mobile technologies, and the figure of the ‘referential tourist.’ An examination of stakeholder responses to changing business and social frameworks on the Gold Coast shows how discussions about a range of issues coalesce around cultural tourism. Local communities have the opportunity to engage with the new tourist as they move quickly between leisure and cultural experiences, at once connected to tourist expectations but increasingly self-directed. The Surfers Paradise Nights campaign, which is based around social media, is a case in point. This campaign aims to interest visitors in becoming a part of a familiar third place, an online space, but one that will sustain an emotive connection to the physical location and events. The paper also draws on research carried out in Brisbane, Queensland, in relation to building connections between place and culture on designated, self-directed journeys via iPhone technology. Participant responses indicate the importance of narrative to developing cultural frameworks.

Sustainability in post disaster road infrastructure recovery projects in Queensland, Australia

between mid 2010 and early 2011, Queensland road related infrastructures were devastated by flood and cyclone related natural disasters. Responding to these recent events and in preparing for more regular and intense climate-change induced events in future, the Queensland Government is now reviewing how post-disaster road infrastructure recovery projects are planned and delivered. In particular, there is awareness that rebuilding such infrastructure need sustainable strategies across economic, environmental and social dimensions. A comprehensive sustainability assessment framework for pre and post disaster situations can minimize negative impact on our communities, economy and environment. This research is underway to develop a comprehensive sustainability element frame work for post disaster management in road infrastructures in Queensland, Australia. Analyzing the implications of disruption to transport network and associated services is an important part of preparing local and regional responses to the impacts of natural disasters. This research can contribute to strategic planning, management leading to safe, efficient and integrated transport system that supports sustainable economic, social and environmental outcomes in Queensland. Within this context, this paper provides an overview of the qualitative mixed-method research approach involving literature reviews and case studies to explore and evaluate a number of sustainability elements with a view to develop operational strategies for disaster recovery road projects.

A review of "The Peace In Between : Post-war violence and peacebuilding", edited by Astri Suhrke and Mats Berdal, Routledge, 2012

The term post-war violence has been with us for much of the twentieth century but the issue itself has existed for centuries. The study of violence in post-war societies has been explored by philosophers (Erasmus), statesmen (Sir Thomas More) and sociologists (Emile Durkheim). In many cases the cessation of war and the signing of peace accords do not always mean an end to the violence. This book examines in considerable detail the causes and purposes of post-conflict violence and argues that features which constrain or encourage violence accumulate in such a manner as to create distinct and different types of post-war environments...

Post-orogenic Mesozoic basins and magmatism

This chapter describes the later Mesozoic history of Queensland, when the broad epicratonic basins that underlie most of the state west of the Great Dividing Range received the greater part of their sediment infill after ~210 Ma(middle Norian). The final major orogenic event—the Hunter Bowen Orogeny—had abated in the Tasmanides. These basins preserve relatively thin sedimentary successions that extend over about two-thirds of the area of the state...

Walk@Work : an automated intervention to increase walking in university employees not achieving 10,000 daily steps

This study assessed the workday step counts of lower active (<10,000 daily steps) university employees using an automated, web-based walking intervention (Walk@Work). METHODS: Academic and administrative staff (n=390; 45.6±10.8years; BMI 27.2±5.5kg/m2; 290 women) at five campuses (Australia [x2], Canada, Northern Ireland and the United States), were given a pedometer, access to the website program (2010-11) and tasked with increasing workday walking by 1000 daily steps above baseline, every two weeks, over a six week period. Step count changes at four weeks post intervention were evaluated relative to campus and baseline walking. RESULTS: Across the sample, step counts significantly increased from baseline to post-intervention (1477 daily steps; p=0.001). Variations in increases were evident between campuses (largest difference of 870 daily steps; p=0.04) and for baseline activity status. Those least active at baseline (<5000 daily steps; n=125) increased step counts the most (1837 daily steps; p=0.001), whereas those most active (7500-9999 daily steps; n=79) increased the least (929 daily steps; p=0.001). CONCLUSIONS: Walk@Work increased workday walking by 25% in this sample overall. Increases occurred through an automated program, at campuses in different countries, and were most evident for those most in need of intervention.

Factors influencing funding decisions by elected politicians at the state/provincial level : a case study of public libraries in Canada

The purpose of this study was to determine factors (internal and external) that influenced Canadian provincial (state) politicians when making funding decisions about public libraries. Using the case study methodology, Canadian provincial/state level funding for public libraries in the 2009-10 fiscal year was examined. After reviewing funding levels across the country, three jurisdictions were chosen for the case: British Columbia's budget revealed dramatically decreased funding, Alberta's budget showed dramatically increased funding, and Ontario's budget was unchanged from the previous year. The primary source of data for the case was a series of semi-structured interviews with elected officials and senior bureaucrats from the three jurisdictions. An examination of primary and secondary documents was also undertaken to help set the political and economic context as well as to provide triangulation for the case interviews. The data were analysed to determine whether Cialdini's theory of influence (2001) and specifically any of the six tactics of influence (i.e, commitment and consistency, authority, liking, social proof, scarcity and reciprocity) were instrumental in these budget processes. Findings show the principles of "authority", "consistency and commitment" and "liking" were relevant, and that "liking" were especially important to these decisions. When these decision makers were considering funding for public libraries, they most often used three distinct lenses: the consistency lens (what are my values? what would my party do?), the authority lens (is someone with hierarchical power telling me to do this? are the requests legitimate?), and most importantly, the liking lens (how much do I like and know about the requester?). These findings are consistent with Cialdini's theory, which suggests the quality of some relationships is one of six factors that can most influence a decision maker. The small number of prior research studies exploring the reasons for increases or decreases in public library funding allocation decisions have given little insight into the factors that motivate those politicians involved in the process and the variables that contribute to these decisions. No prior studies have examined the construct of influence in decision making about funding for Canadian public libraries at any level of government. Additionally, no prior studies have examined the construct of influence in decision making within the context of Canadian provincial politics. While many public libraries are facing difficult decisions in the face of uncertain funding futures, the ability of the sector to obtain favourable responses to requests for increases may require a less simplistic approach than previously thought. The ability to create meaningful connections with individuals in many communities and across all levels of government should be emphasised as a key factor in influencing funding decisions.

Critical Factors for Sustainable Post Natural Disaster Reconstruction : Chinese Data

While scientists continue to explore the level of climate change impact to new weather patterns and our environment in general, there have been some devastating natural disasters worldwide in the last two decades. Indeed natural disasters are becoming a major concern in our society. Yet in many previous examples, our reconstruction efforts only focused on providing short-term necessities. How to develop resilience in the long run is now a highlight for research and industry practice. This paper introduces a research project aimed at exploring the relationship between resilience building and sustainability in order to identify key factors during reconstruction efforts. From extensive literature study, the authors considered the inherent linkage between the two issues as evidenced from past research. They found that sustainability considerations can improve the level of resilience but are not currently given due attention. Reconstruction efforts need to focus on resilience factors but as part of urban development, they must also respond to the sustainability challenge. Sustainability issues in reconstruction projects need to be amplified, identified, processed, and managed properly. On-going research through empirical study aims to establish critical factors (CFs) for stakeholders in disaster prone areas to plan for and develop new building infrastructure through holistic considerations and balanced approaches to sustainability. A questionnaire survey examined a range of potential factors and the subsequent data analysis revealed six critical factors for sustainable Post Natural Disaster Reconstruction that include: considerable building materials and construction methods, good governance, multilateral coordination, appropriate land-use planning and policies, consideration of different social needs, and balanced combination of long-term and short-term needs. Findings from this study should have an influence on policy development towards Post Natural Disaster Reconstruction and help with the achievement of sustainable objectives.

Oropharyngeal dysphagia in an elderly post-operative hip fracture population : a prospective cohort study

Background: normal ageing processes impact on oropharyngeal swallowing function placing older adults at risk of developing oropharyngeal dysphagia (OD). Anecdotal clinical experience has observed that older patients recovering from hip fracture surgery commonly develop OD post-operatively. Objective: to document the presence of OD following hip fracture surgery, and the factors associated with OD. Methods: one hundred and eighty-one patients with a mean age of 83 years (range: 65–103) admitted to a specialised orthogeriatric unit were assessed for OD post-surgery for hip fracture. Pre-admission, intra-operative and post-operative factors were examined to determine their relationship with the presence of OD. Results: OD was found to be present post-operatively in 34% (n = 61) of the current population. Multivariate logistic regression analyses revealed the presence of pre-existing neurological and respiratory medical co-morbidities, presence of post-operative delirium, age and living in a residential aged care facility prior to hospital admission to be associated with the post-operative OD. Conclusion: these results highlight that OD is present in a large number of the older hip fracture population. Early identification of OD has important implications for the provision of timely dysphagia management that may prevent secondary complications and potentially reduce the hospital length of stay.

Anisotropic damage mechanics as a novel approach to improve pre-and post-failure borehole stability analysis

Anisotropic damage distribution and evolution have a profound effect on borehole stress concentrations. Damage evolution is an irreversible process that is not adequately described within classical equilibrium thermodynamics. Therefore, we propose a constitutive model, based on non-equilibrium thermodynamics, that accounts for anisotropic damage distribution, anisotropic damage threshold and anisotropic damage evolution. We implemented this constitutive model numerically, using the finite element method, to calculate stress–strain curves and borehole stresses. The resulting stress–strain curves are distinctively different from linear elastic-brittle and linear elastic-ideal plastic constitutive models and realistically model experimental responses of brittle rocks. We show that the onset of damage evolution leads to an inhomogeneous redistribution of material properties and stresses along the borehole wall. The classical linear elastic-brittle approach to borehole stability analysis systematically overestimates the stress concentrations on the borehole wall, because dissipative strain-softening is underestimated. The proposed damage mechanics approach explicitly models dissipative behaviour and leads to non-conservative mud window estimations. Furthermore, anisotropic rocks with preferential planes of failure, like shales, can be addressed with our model.