Using Trauma Injury Severity Score (TRISS) variables to predict length of hospital stay following trauma in New Zealand

Aim – To develop and assess the predictive capabilities of a statistical model that relates routinely collected Trauma Injury Severity Score (TRISS) variables to length of hospital stay (LOS) in survivors of traumatic injury. Method – Retrospective cohort study of adults who sustained a serious traumatic injury, and who survived until discharge from Auckland City, Middlemore, Waikato, or North Shore Hospitals between 2002 and 2006. Cubic-root transformed LOS was analysed using two-level mixed-effects regression models. Results – 1498 eligible patients were identified, 1446 (97%) injured from a blunt mechanism and 52 (3%) from a penetrating mechanism. For blunt mechanism trauma, 1096 (76%) were male, average age was 37 years (range: 15-94 years), and LOS and TRISS score information was available for 1362 patients. Spearman’s correlation and the median absolute prediction error between LOS and the original TRISS model was ρ=0.31 and 10.8 days, respectively, and between LOS and the final multivariable two-level mixed-effects regression model was ρ=0.38 and 6.0 days, respectively. Insufficient data were available for the analysis of penetrating mechanism models. Conclusions – Neither the original TRISS model nor the refined model has sufficient ability to accurately or reliably predict LOS. Additional predictor variables for LOS and other indicators for morbidity need to be considered.

Using a longitudinal model to estimate the effect of methicillin-resistant staphylococcus aureus infection on length of stay in an intensive care unit

Healthcare-associated methicillin-resistant Staphylococcus aureus(MRSA) infection may cause increased hospital stay or, sometimes, death. Quantifying this effect is complicated because it is a time-dependent exposure: infection may prolong hospital stay, while longer stays increase the risk of infection. We overcome these problems by using a multinomial longitudinal model for estimating the daily probability of death and discharge. We then extend the basic model to estimate how the effect of MRSA infection varies over time, and to quantify the number of excess ICU days due to infection. We find that infection decreases the relative risk of discharge (relative risk ratio = 0.68, 95% credible interval: 0.54, 0.82), but is only indirectly associated with increased mortality. An infection on the first day of admission resulted in a mean extra stay of 0.3 days (95% CI: 0.1, 0.5) for a patient with an APACHE II score of 10, and 1.2 days (95% CI: 0.5, 2.0) for a patient with an APACHE II score of 30. The decrease in the relative risk of discharge remained fairly constant with day of MRSA infection, but was slightly stronger closer to the start of infection. These results confirm the importance of MRSA infection in increasing ICU stay, but suggest that previous work may have systematically overestimated the effect size.

Effect of female sex hormones on Chlamydia trachomatis growth and gene expression

Transmissible diseases are re-emerging as a global problem, with Sexually Transmitted Diseases (STDs) becoming endemic. Chlamydia trachomatis is the leading cause of bacterially-acquired STD worldwide, with the Australian cost of infection estimated at $90 - $160 million annually. Studies using animal models of genital tract Chlamydia infection suggested that the hormonal status of the genital tract epithelium at the time of exposure may influence the outcome of infection. Oral contraceptive use also increased the risk of contracting chlamydial infections compared to women not using contraception. Generally it was suggested that the outcome of chlamydial infection is determined in part by the hormonal status of the epithelium at the time of exposure. Using the human endolmetrial cell line ECC-1 this study investigated the effects of C. trachomatis serovar D infection, in conjunction with the female sex hormones, 17β-estradiol and progesterone, on chlamydial gene expression. While previous studies have examined the host response, this is the first study to examine C.trachomatis gene expression under different hormonal conditions. We have highlighted a basic model of C. trachomatis gene regulation in the presence of steroid hormones by identifying 60 genes that were regulated by addition of estradiol and/or progesterone. In addition, the third chapter of this thesis discussed and compared the significance of the current findings in the context of data from other research groups to improve our understanding of the molecular basis of chlamydial persistence under hormonal different conditions. In addition, this study analysed the effects of these female sex hormones and C. trachomatis Serovar D infection, on host susceptibility and bacterial growth. Our results clearly demonstrated that addition of steroid hormones not only had a great impact on the level of infectivity of epithelial cells with C.trachomatis serovar D, but also the morphology of chlamydial inclusions was affected by hormone supplementation.

Effects of inoculating dose on the kinetics of Chlamydia muridarum genital infection in female mice

Chlamydia trachomatis infections have been implicated in problems such as pelvic inflammatory disease and infertility in females. Although there are some studies examining the kinetics of ascending infection, there is limited information on the kinetics of pathology development and cellular infiltrate into the reproductive tissues in relation to the effects of inoculating dose, and a better understanding of these is needed. The murine model of female genital tract Chlamydia muridarum infection is frequently used as a model of human C. trachomatis reproductive tract infection. To investigate the kinetics of ascending genital infection and associated pathology development, female BALB/c mice were intravaginally infected with C. muridarum at doses ranging from 5102 to 2.6106 inclusion forming units. We found that the inoculating dose affects the course of infection and the ascension of bacteria, with the highest dose ascending rapidly to the oviducts. By comparison, the lowest dose resulted in the greatest bacterial load in the lower reproductive tract. Interestingly, we found that the dose did not significantly affect inflammatory cell infiltrate in the various regions. Overall, this data show the effects of infectious dose on the kinetics of ascending chlamydial infection and associated inflammatory infiltration in BALB/c mice.

Fasting and the female body : from the ascetic to the pathological

This paper will examine the literature on ‘anorexia nervosa’, and argue that it is underpinned by three fundamental assumptions. First, ‘anorexia nervosa’ is a reflection of the mismatch between true ‘inner self’ and the external ‘false self’, the latter self being the distorted product of a male dominated society. Second, the explanation for the severe fasting practices constitutive of ‘anorexia nervosa’ (a new social problem) is to be found within the binary opposition of resistance/conformity to contemporary cultural expectations. Finally, ‘anorexia nervosa’ is a problem which exists in nature (i.e., independently of analysis). It was eventually discovered, named and explained. This paper will problematise each of these assumptions in turn, and in doing so, it will propose an alternative way of understanding contemporary fasting practices.

Between flagged borders, across gendered lands : the voiceless female space in contemporary representations of Australian beach

International and national representations of the beach perpetuate normative female concepts by maintaining dominant masculine myths, such as that of the heroic lifesaver and tanned sunbaker. Female experiences on the beach are traditionally associated with rhetorics of danger and peril, contrasted to the welcomed and protective gaze of the beach male. Conventional understandings of the gaze promote male surveillance of women, and although some resistance exists, the beach primarily remains a place to observe the female form. This article attempts to explore currents of resistance at the beach through a self-reflexive examination of Schoolies. Although the event is fixed within patriarchal codes and structures, small eddies of resistance exist amongst female participants in light of increasing awareness of masculine hegemony. The Australian beach remains a contested site of multiple constructs of gender and national identity. This article reveals the changing tides of resistance.

Leadership construction : an exploratory case study of two exemplary female principals in urban primary schools in mainland China

Worldwide, education systems have undergone unprecedented change due to a variety of economic, social, and political forces (Limerick, Cunnington & Crowther, 2002). The People’s Republic of China (PRC) is no exception. Continuous educational reform at primary and secondary levels in Mainland China has created new challenges and accountabilities for school principals. The important role of principals in primary and secondary schools has been acknowledged in both policy documents and the broader literature (Central Committee of the Chinese Communist Party, 1985; F. Chen, 2005; Chu, 2003; W. Huang, 2005; T. Wang, 2003). Yet, most of the literature on primary and secondary school principals in Mainland China is prescriptive in nature, identifying from the perspectives of researchers and academics what principals should do and how they should enact leadership. Lacking in this research is an awareness of the daily practices and lived experiences of principals. Furthermore, within the small body of writing on primary and secondary school principals in Mainland China, gender is seldom given any attention. To date, only a small number of empirical studies have focused on female principals as a specific category of research (Zen, 2004; Zhong, 2004). This study aimed to explore the professional lives of two female exemplary school principals in urban primary schools in Mainland China. A qualitative exploratory case study was used. Semi-structured interviews with each individual female principal, with six teachers in each of the school sites and with the superintendent of each principal were conducted. Field observations and document analysis were also undertaken to obtain multiple insights about their leadership practices. The conceptual framework was based largely on the theory of Gronn (1999) and incorporated five core leadership practices (vision building, ethical considerations, teaching and learning, power utilisation, and dealing with risks and challenges) taken from the wider literature. The key findings of this study were twofold. Firstly, while the five leadership practices were evident in the leadership of the two principals, this study identified some subtle differences in the way they approached each of them. Secondly, contextual factors such as Chinese traditional culture, the contemporary societal context, and the school organisational context, in addition to the biographical experiences of each principal were significant factors in shaping the way in which they exercised their leadership practices in the schools.

Minimising speaker verification utterance length through confidence based early verification decisions

This paper presents a novel approach of estimating the confidence interval of speaker verification scores. This approach is utilised to minimise the utterance lengths required in order to produce a confident verification decision. The confidence estimation method is also extended to address both the problem of high correlation in consecutive frame scores, and robustness with very limited training samples. The proposed technique achieves a drastic reduction in the typical data requirements for producing confident decisions in an automatic speaker verification system. When evaluated on the NIST 2005 SRE, the early verification decision method demonstrates that an average of 5–10 seconds of speech is sufficient to produce verification rates approaching those achieved previously using an average in excess of 100 seconds of speech.

The Dystopian Mirror and the Female Body

Women’s experience of the change room mirror is not a particularly affirmative one. The pleasure in looking at the self is dissipated by the ideal feminine ‘I’ that hovers in the shadows of their image of self and others constructing dystopian surveillance and entrapment. This article considers the responses of a number of women bloggers who describe their negative experiences in front of change room mirrors. It also argues that the mirror has been used in positive and creative ways by women artists to assert a self that is not subject to a critical gaze.

A comparison of different methods to determine diffusion length in dye-sensitized solar cells

A new steady state method for determination of the electron diffusion length in dye-sensitized solar cells (DSCs) is described and illustrated with data obtained using cells containing three different types of electrolyte. The method is based on using near-IR absorbance methods to establish pairs of illumination intensity for which the total number of trapped electrons is the same at open circuit (where all electrons are lost by interfacial electron transfer) as at short circuit (where the majority of electrons are collected at the contact). Electron diffusion length values obtained by this method are compared with values derived by intensity modulated methods and by impedance measurements under illumination. The results indicate that the values of electron diffusion length derived from the steady state measurements are consistently lower than the values obtained by the non steady-state methods. For all three electrolytes used in the study, the electron diffusion length was sufficiently high to guarantee electron collection efficiencies greater than 90%. Measurement of the trap distributions by near-IR absorption confirmed earlier observations of much higher electron trap densities for electrolytes containing Li+ ions. It is suggested that the electron trap distributions may not be intrinsic properties of the TiO2 nanoparticles, but may be associated with electron-ion interactions.

Does feminism spoil girls? Explanations for official rises in female delinquency

Official rates of female delinquency have been rising steadily in countries such as Australia, England, Canada and the United States since the 1960s. They have also generally been rising at a rate faster than that for boys. As yet there is little consensus about the reasons for these rises or even whether such rate rises reflect any real increase in female delinquency at all. Against this backdrop of rising official crimes rates for young women, this article revisits the various criminological explanations for these trends.

A cross cultural examination of consumer behaviour and GM food products : results from Australian and South Korean female consumers

The call for the cross cultural examination and validation of commonly accepted relationships within consumer behaviour is strengthening. Consequently, this paper seeks to address this call by examining consumer risk perceptions, reliance on country of origin information and willingness to buy Genetically Modified (GM) food products on Australian and South Korean consumers. Findings indicate a number of cross cultural similarities and differences that have both theoretical and practical implications.

An exploration of two female principals’ leadership in mainland China

Purpose: The purpose of this paper is to explore two dimensions of leadership practices (i.e. teaching and learning and sources of power) used by two exemplary principals in mainland China against a background of education reform and to identify how broader contextual factors have shaped these two dimensions of their leadership.--------- Design/methodology/approach: An exploratory case study was used that drew upon semi-structured interviews, observations and document analysis. Interviews were conducted with two principals, six teachers from each of the two schools and a superintendent who was the supervisor of the two principals.---------- Findings: The findings reveal that there are some common elements in both of the leaders’ practices but also some subtle differences. Both leaders emphasise teaching and learning. One sees herself as curriculum expert; the other delegate teaching responsibilities. While both uses a top down approach, one principal uses an adversarial approach and the other a more facilitative approach.---------- Research limitations/implications: The study used a small sample size. It explored the leaders’ practices in the light of broader contextual factors rather than personal factors or gender-based factors Originality/value – Given the limited empirical research conducted on female principals in mainland China, this qualitative study provides insights into two dimensions of leadership used by two exemplary principals and explains their practices in the light of critical contextual factors such as contemporary and traditional Chinese culture and the school’s organisational context.

Is length of experience an appropriate criterion to identify level of expertise?

Clinical experience plays an important role in the development of expertise, particularly when coupled with reflection on practice. There is debate, however, regarding the amount of clinical experience that is required to become an expert. Various lengths of practice have been suggested as suitable for determining expertise, ranging from five years to 15 years. This study aimed to investigate the association between length of experience and therapists’ level of expertise in the field of cerebral palsy with upper limb hypertonicity using an empirical procedure named Cochrane–Weiss–Shanteau (CWS). The methodology involved re-analysis of quantitative data collected in two previous studies. In Study 1, 18 experienced occupational therapists made hypothetical clinical decisions related to 110 case vignettes, while in Study 2, 29 therapists considered 60 case vignettes drawn randomly from those used in Study 1. A CWS index was calculated for each participant's case decisions. Then, in each study, Spearman's rho was calculated to identify the correlations between the duration of experience and level of expertise. There was no significant association between these two variables in both studies. These analyses corroborated previous findings of no association between length of experience and judgemental performance. Therefore, length of experience may not be an appropriate criterion for determining level of expertise in relation to cerebral palsy practice.