Defining the expert ICU nurse

This paper explores the concept of expertise in intensive care nursing practice from the perspective of its relationship to the current driving forces in healthcare. It discusses the potential barriers to acceptance of nursing expertise in a climate in which quantification of value and cost containment run high on agendas. It argues that nursing expertise which focuses on the provision of individualised, holistic care and which is based largely on intuitive decision-making cannot and should not be reduced to being articulated in positivist terms. The principles of abduction or fuzzy logic, derived from computer science, may be useful in assisting nurses to explain in terms, which others can comprehend, the value of nursing expertise.

Automated classification of limb fractures from free-text radiology reports using a clinician-informed gazetteer methodology

Background Timely diagnosis and reporting of patient symptoms in hospital emergency departments (ED) is a critical component of health services delivery. However, due to dispersed information resources and a vast amount of manual processing of unstructured information, accurate point-of-care diagnosis is often difficult. Aims The aim of this research is to report initial experimental evaluation of a clinician-informed automated method for the issue of initial misdiagnoses associated with delayed receipt of unstructured radiology reports. Method A method was developed that resembles clinical reasoning for identifying limb abnormalities. The method consists of a gazetteer of keywords related to radiological findings; the method classifies an X-ray report as abnormal if it contains evidence contained in the gazetteer. A set of 99 narrative reports of radiological findings was sourced from a tertiary hospital. Reports were manually assessed by two clinicians and discrepancies were validated by a third expert ED clinician; the final manual classification generated by the expert ED clinician was used as ground truth to empirically evaluate the approach. Results The automated method that attempts to individuate limb abnormalities by searching for keywords expressed by clinicians achieved an F-measure of 0.80 and an accuracy of 0.80. Conclusion While the automated clinician-driven method achieved promising performances, a number of avenues for improvement were identified using advanced natural language processing (NLP) and machine learning techniques.

Technoeconomic analysis of renewable aviation fuel from microalgae,Pongamia pinnata, and sugarcane

Technoeconomic analysis of renewable aviatin fuels has not been widely considered, despite the increasing global attention that the field has received. We present three process models for production of aviation fuel from microalgae, Pongamia pinnata, and sugarcane molasses. The models and assumptions have been deposited on a wiki (http://qsafi.aibn.uq.edu.au) and are open and accessible to the community. Based on currently available long-term reputable technological data, this analysis indicates that the biorefinieries processing the microalgae, Pongamia seeds, and sugarcane feedstocks would be competitive with crude oil at $1343, $374, and $301/bbl, respectively. Sensitivity analyses of the major economic drivers suggest technological and market developments that would bring the corresponding figures down to $385, $255, and $168/bbl. The dynamic nature of the freely accessible models will allow the community to track progress toward economic competitiveness of aviation fuels from these renewable feedstocks.

Trade, travel and disease : the role of law in pandemic preparedness

In 2009 the world experienced an influenza pandemic caused by the H1N1 virus. While the pandemic was milder then expected, it nonetheless provided the world with an opportunity to do real-time testing of pandemic preparedness. This paper examines the threats to human health posed by infectious diseases and the challenges for the global community in development of effective surveillance systems for emerging infectious diseases. In 2005 a new revised version of the International Health Regulations (IHR) was adopted. The requirements of the IHR (2005) are outlined and considered in light of the constraints facing resource-poor countries. Finally, the paper addresses the role of domestic law-making in supporting public health preparedness and articulates a number of ethical principles that should be considered when developing new public health laws.

From the editors : introduction and a compass for business process design

In this editorial letter, we provide the readers of Information Systems Management with a background on process design before we discuss the content of the special issue proper. By introducing and describing a so-called process design compass we aim to clarify what developments in the field are taking place and how the papers in this special issue expand on our current knowledge in this domain.

The Medics - "Foundations"

The Medics “Foundations” is a full-length album of popular music completed over a 13-month period and released in 2012, with work taking place in Byron Bay’s 301 studios and Brisbane’s Airlock studios. “Foundations” contributes to studies in the field of music production, as well as furthering research into the place of Indigenous youth culture within contemporary rock music. The music draws on elements of folk, post rock and hardcore to create a dynamic and cinematic sound, framed by lyrics that focus on spirituality, nature and a connection to the land. Artists such as At the Drive In and Mars Volta were referenced in the production of the record. Scholars such as Joe Bennett have argued that the relationship between songwriting practice and song product is an under-explored area in popular musicology, and, by using a practice-led research methodology, the production of “Foundations” extends these creative inquiries. “Foundations” was produced with the assistance of a competitive grant, the Cultural Minister’s Council Breakthrough initiative, which assists emerging Indigenous contemporary musicians. The album was well received and positively reviewed, resulting in the band signing a record deal with Warner Music and a publishing deal with Albert’s Music. It was album of the week on Triple J and several singles were placed on high rotation. A review on Themusic.com.au highlighted the production work: “Producer Yanto Browning has captured the impassioned live intent the band have built their reputation on and bottled it into 11 impeccable tracks, the album maintaining their onstage vigour while polishing it just enough to allow it to burn brightly through the speakers.” As a result of the record, The Medics were invited to play Splendour in the Grass, the national Big Day Out tour and a series of shows in South America.

Orientation dependence of spatial memory acquired from auditory experience

The present study investigated whether memory for a room-sized spatial layout learned through auditory localization of sounds exhibits orientation dependence similar to that observed for spatial memory acquired from stationary viewing of the environment. Participants learned spatial layouts by viewing objects or localizing sounds and then performed judgments of relative direction among remembered locations. The results showed that direction judgments following auditory learning were performed most accurately at a particular orientation in the same way as were those following visual learning, indicating that auditorily encoded spatial memory is orientation dependent. In combination with previous findings that spatial memories derived from haptic and proprioceptive experiences are also orientation dependent, the present finding suggests that orientation dependence is a general functional property of human spatial memory independent of learning modality.

Thoracoscopic scoliosis surgery – a cheaper option? A cost analysis of 189 consecutive cases

INTRODUCTION: Increasing health care costs, limited resources and increased demand makes cost effective and cost-efficient delivery of Adolescent Idiopathic Scoliosis (AIS) management paramount. Rising implant costs in deformity correction surgery have prompted analysis of whether high implant densities are justified. The objective of this study was to analyse the costs of thoracoscopic scoliosis surgery, comparing initial learning curve costs with those of the established technique and to the costs involved in posterior instrumented fusion from the literature. METHODS: 189 consecutive cases from April 2000 to July 2011 were assessed with a minimum of 2 years follow-up. Information was gathered from a prospective database covering perioperative factors, clinical and radiological outcomes, complications and patient reported outcomes. The patients were divided into three groups to allow comparison; 1. A learning curve cohort, 2. An intermediate cohort and 3. A third cohort of patients, using our established technique. Hospital finance records and implant manufacturer figures were corrected to 2013 costs. A literature review of AIS management costs and implant density in similar curve types was performed. RESULTS: The mean pre-op Cobb angle was 53°(95%CI 0.4) and was corrected postop to mean 22.9°(CI 0.4). The overall complication rate was 20.6%, primarily in the first cohort, with a rate of 5.6% in the third cohort. The average total costs were $46,732, operating room costs of $10,301 (22.0%) and ICU costs of $4620 (9.8%). The mean number of screws placed was 7.1 (CI 0.04) with a single rod used for each case giving average implant costs of $14,004 (29.9%). Comparison of the three groups revealed higher implant costs as the technique evolved to that in use today, from $13,049 in Group 1 to $14577 in Group 3 (P<0.001). Conversely operating room costs reduced from $10,621 in Group 1 to $7573 (P<0.001) in Group 3. ICU stay was reduced from an average of 1.2 to 0 days. In-patient stay was significantly (P=0.006) lower in Groups 2 and 3 (5.4 days) than Group 1 (5.9 days) (i.e. a reduction in cost of approximately $6,140). CONCLUSIONS: The evolution of our thoracoscopic anterior scoliosis correction has resulted in an increase in the number of levels fused and reduction in complication rate. Implant costs have risen as a result, however, there has been a concurrent decrease in those costs generated by operating room use, ICU and in-patient stay with increasing experience. Literature review of equivalent curve types treated posteriorly shows similar perioperative factors but higher implant density, 69-83% compared to the 50% in this study. Thoracoscopic Scoliosis surgery presents a low density, reliable, efficient and effective option for selected curves. A cost analysis of Thoracoscopic Scoliosis Surgery using financial records and a prospectively collected database of all patients since 2000, demonstrating a clear cost advantage compared to equivalent posterior instrumentation and fusion.

Child-feeding practices of Indian and Australian-Indian mothers

Aims Child-feeding practices may be modifiable risk factors for childhood obesity; however investigation of feeding practices in non-Western populations is scarce. This cross-sectional study examines feeding practices of affluent Indian mothers with children aged 1-5 years residing in Australia and Mumbai, India. The secondary aim was to study the association between maternal and child characteristics and feeding practices. Methods In Australia 230 and in Mumbai 301 mothers completed either a hardcopy or online questionnaire. Self-reported maternal feeding practices (restriction, monitoring, pressure to eat, passive and responsive feeding) were measured using established scales and culturally-specific items. Results Mothers in both samples were equally likely to use non-responsive feeding practices, namely dietary restriction, pressure and passive feeding. Similarly, at least 50% of mothers in both samples did not feed their child responsively (mother decides what and the child decides how much to eat). The only difference observed after controlling for covariates (mothers’ age, BMI, religion, education, questionnaire type, child’s age, birth place, gender, number of siblings, and weight-for-age (WAZ) scores) was that mothers in the Australian sample used higher levels of dietary monitoring (β= 0.2, P= 0.006). Mothers with a higher BMI (OR: 0.84, CI: 0.89-0.99, p=0.03) and following Hinduism (OR: 0.50, CI: 0.33-0.83, p=0.008) were less likely to feed responsively. Conclusions These results suggest that Indian mothers in both the samples may benefit from interventions that promote responsive child-feeding practices.

Nitrous oxide emissions from fertilized, irrigated cotton (Gossypium hirsutum L.) in the Aral Sea Basin, Uzbekistan : influence of nitrogen applications and irrigation practices

Nitrous oxide emissions were monitored at three sites over a 2-year period in irrigated cotton fields in Khorezm, Uzbekistan, a region located in the arid deserts of the Aral Sea Basin. The fields were managed using different fertilizer management strategies and irrigation water regimes. N2O emissions varied widely between years, within 1 year throughout the vegetation season, and between the sites. The amount of irrigation water applied, the amount and type of N fertilizer used, and topsoil temperature had the greatest effect on these emissions. Very high N2O emissions of up to 3000 μg N2O-N m−2 h−1 were measured in periods following N-fertilizer application in combination with irrigation events. These “emission pulses” accounted for 80–95% of the total N2O emissions between April and September and varied from 0.9 to 6.5 kg N2O-N ha−1.. Emission factors (EF), uncorrected for background emission, ranged from 0.4% to 2.6% of total N applied, corresponding to an average EF of 1.48% of applied N fertilizer lost as N2O-N. This is in line with the default global average value of 1.25% of applied N used in calculations of N2O emissions by the Intergovernmental Panel on Climate Change. During the emission pulses, which were triggered by high soil moisture and high availability of mineral N, a clear diurnal pattern of N2O emissions was observed, driven by daily changes in topsoil temperature. For these periods, air sampling from 8:00 to 10:00 and from 18:00 to 20:00 was found to best represent the mean daily N2O flux rates. The wet topsoil conditions caused by irrigation favored the production of N2O from NO3− fertilizers, but not from NH4+ fertilizers, thus indicating that denitrification was the main process causing N2O emissions. It is therefore argued that there is scope for reducing N2O emission from irrigated cotton production; i.e. through the exclusive use of NH4+ fertilizers. Advanced application and irrigation techniques such as subsurface fertilizer application, drip irrigation and fertigation may also minimize N2O emission from this regionally dominant agro-ecosystem.

Secondary user relations in emerging mobile computing environments

Mobile technologies are enabling access to information in diverse environ.ments, and are exposing a wider group of individuals to said technology. Therefore, this paper proposes that a wider view of user relations than is usually considered in information systems research is required. Specifically, we examine the potential effects of emerging mobile technologies on end-­‐user relations with a focus on the ‘secondary user’, those who are not intended to interact directly with the technology but are intended consumers of the technology’s output. For illustration, we draw on a study of a U.K. regional Fire and Rescue Service and deconstruct mobile technology use at Fire Service incidents. Our findings provide insights, which suggest that, because of the nature of mobile technologies and their context of use, secondary user relations in such emerging mobile environments are important and need further exploration.

Surviving (thriving) in academia : feminist support networks and women ECRs

In this paper, we reflect upon our experiences and those of our peers as doctoral students and early career researchers in an Australian political science department. We seek to explain and understand the diverse ways that participating in an unofficial Feminist Reading Group in our department affected our experiences. We contend that informal peer support networks like reading groups do more than is conventionally assumed, and may provide important avenues for sustaining feminist research in times of austerity, as well as supporting and enabling women and emerging feminist scholars in academia. Participating in the group created a community of belonging and resistance, providing women with personal validation, information and material support, as well as intellectual and political resources to understand and resist our position within the often hostile spaces of the University. While these experiences are specific to our context, time and location, they signal that peer networks may offer critical political resources for responding to the ways that women’s bodies and concerns are marginalised in increasingly competitive and corporatised university environments.

Marx as a Critical Discourse Analyst : The Genesis of a Critical Method and its Relevance to the Critique of Global Capital (with Phil Graham)

In this paper we identify elements in Marx’s economic and political writings that are relevant to contemporary critical discourse analysis (CDA). We argue that Marx can be seen to be engaging in a form of discourse analysis. We identify the elements in Marx’s historical materialist method that support such a perspective, and exemplify these in longitudinal comparison of Marx’s texts.

Implications of differences in technical efficiency of fishing boats for capacity measurement and reduction

Capacity measurement and reduction is a major international issue to emerge in the new millennium. However, there has been limited assessment of the success of capacity reduction schemes (CRS). In this paper, the success of a CRS is assessed for a European fishery characterised by differences in efficiency levels of individual boats. In such a fishery, given it is assumed that the least efficient producers are the first to exit through a CRS, the reduction in harvesting capacity is less than the nominal reduction in physical fleet capacity. Further, there is potential for harvesting capacity to increase if remaining vessels improve their efficiency.

Common hazards and their mitigating measures in work zones : a qualitative study of worker perceptions

Road construction and maintenance activities present challenges for ensuring the safety of workers and the traveling public alike. Hazards in work zones are typically studied using historical crash records but the current study took a qualitative approach by interviewing 66 workers from various work zones in Queensland, Australia. This supplemented and enhanced the limited available data regarding the frequency and nature of work zone crashes in Australia, provided worker insights into contributing factors, and assessed their opinions on the likely effectiveness of current or future approaches to hazard mitigation. Workers may not be aware of objective data regarding effectiveness, but their attitudes and consequent levels of compliance can influence both the likelihood of implementation and the outcomes of safety measures. Despite the potential importance of worker perceptions, they have not been studied comprehensively to date, and thus this study fills a significant gap in the literature. Excessive vehicle speeds, driver distraction and aggression towards roadworkers, working in wet weather, at night and close to traffic stream were among the most common hazards noted by workers. The safety measures perceived to be most effective included police presence, active enforcement, and improving driver awareness and education about work zones. Worker perceptions differed according to their level of exposure to hazards.