Are organ donation communication decisions reasoned or reactive? A test of the utility of an augmented Theory of Planned Behaviour with the Prototype/Willingness Model

Objectives: To explore whether people's organ donation consent decisions occur via a reasoned and/or social reaction pathway. --------- Design: We examined prospectively students' and community members' decisions to register consent on a donor register and discuss organ donation wishes with family. --------- Method: Participants completed items assessing theory of planned behaviour (TPB; attitude, subjective norm, perceived behavioural control (PBC)), prototype/willingness model (PWM; donor prototype favourability/similarity, past behaviour), and proposed additional influences (moral norm, self-identity, recipient prototypes) for registering (N=339) and discussing (N=315) intentions/willingness. Participants self-reported their registering (N=177) and discussing (N=166) behaviour 1 month later. The utility of the (1) TPB, (2) PWM, (3) augmented TPB with PWM, and (4) augmented TPB with PWM and extensions was tested using structural equation modelling for registering and discussing intentions/willingness, and logistic regression for behaviour. --------- Results: While the TPB proved a more parsimonious model, fit indices suggested that the other proposed models offered viable options, explaining greater variance in communication intentions/willingness. The TPB, augmented TPB with PWM, and extended augmented TPB with PWM best explained registering and discussing decisions. The proposed and revised PWM also proved an adequate fit for discussing decisions. Respondents with stronger intentions (and PBC for registering) had a higher likelihood of registering and discussing. --------- Conclusions: People's decisions to communicate donation wishes may be better explained via a reasoned pathway (especially for registering); however, discussing involves more reactive elements. The role of moral norm, self-identity, and prototypes as influences predicting communication decisions were highlighted also.

An evaluation of IS-impact utility and intuitiveness

This study is conducted within the IS-Impact Research Track at Queensland University of Technology (QUT). The goal of the IS-Impact Track is, "to develop the most widely employed model for benchmarking information systems in organizations for the joint benefit of both research and practice" (Gable et al, 2006). IS-Impact is defined as "a measure at a point in time, of the stream of net benefits from the IS [Information System], to date and anticipated, as perceived by all key-user-groups" (Gable Sedera and Chan, 2008). Track efforts have yielded the bicameral IS-Impact measurement model; the "impact" half includes Organizational-Impact and Individual-Impact dimensions; the "quality" half includes System-Quality and Information-Quality dimensions. The IS-Impact model, by design, is intended to be robust, simple and generalisable, to yield results that are comparable across time, stakeholders, different systems and system contexts. The model and measurement approach employs perceptual measures and an instrument that is relevant to key stakeholder groups, thereby enabling the combination or comparison of stakeholder perspectives. Such a validated and widely accepted IS-Impact measurement model has both academic and practical value. It facilitates systematic operationalisation of a main dependent variable in research (IS-Impact), which can also serve as an important independent variable. For IS management practice it provides a means to benchmark and track the performance of information systems in use. From examination of the literature, the study proposes that IS-Impact is an Analytic Theory. Gregor (2006) defines Analytic Theory simply as theory that ‘says what is’, base theory that is foundational to all other types of theory. The overarching research question thus is "Does IS-Impact positively manifest the attributes of Analytic Theory?" In order to address this question, we must first answer the question "What are the attributes of Analytic Theory?" The study identifies the main attributes of analytic theory as: (1) Completeness, (2) Mutual Exclusivity, (3) Parsimony, (4) Appropriate Hierarchy, (5) Utility, and (6) Intuitiveness. The value of empirical research in Information Systems is often assessed along the two main dimensions - rigor and relevance. Those Analytic Theory attributes associated with the ‘rigor’ of the IS-Impact model; namely, completeness, mutual exclusivity, parsimony and appropriate hierarchy, have been addressed in prior research (e.g. Gable et al, 2008). Though common tests of rigor are widely accepted and relatively uniformly applied (particularly in relation to positivist, quantitative research), attention to relevance has seldom been given the same systematic attention. This study assumes a mainly practice perspective, and emphasises the methodical evaluation of the Analytic Theory ‘relevance’ attributes represented by the Utility and Intuitiveness of the IS-Impact model. Thus, related research questions are: "Is the IS-Impact model intuitive to practitioners?" and "Is the IS-Impact model useful to practitioners?" March and Smith (1995), identify four outputs of Design Science: constructs, models, methods and instantiations (Design Science research may involve one or more of these). IS-Impact can be viewed as a design science model, composed of Design Science constructs (the four IS-Impact dimensions and the two model halves), and instantiations in the form of management information (IS-Impact data organised and presented for management decision making). In addition to methodically evaluating the Utility and Intuitiveness of the IS-Impact model and its constituent constructs, the study aims to also evaluate the derived management information. Thus, further research questions are: "Is the IS-Impact derived management information intuitive to practitioners?" and "Is the IS-Impact derived management information useful to practitioners? The study employs a longitudinal design entailing three surveys over 4 years (the 1st involving secondary data) of the Oracle-Financials application at QUT, interspersed with focus groups involving senior financial managers. The study too entails a survey of Financials at four other Australian Universities. The three focus groups respectively emphasise: (1) the IS-Impact model, (2) the 2nd survey at QUT (descriptive), and (3) comparison across surveys within QUT, and between QUT and the group of Universities. Aligned with the track goal of producing IS-Impact scores that are highly comparable, the study also addresses the more specific utility-related questions, "Is IS-Impact derived management information a useful comparator across time?" and "Is IS-Impact derived management information a useful comparator across universities?" The main contribution of the study is evidence of the utility and intuitiveness of IS-Impact to practice, thereby further substantiating the practical value of the IS-Impact approach; and also thereby motivating continuing and further research on the validity of IS-Impact, and research employing the ISImpact constructs in descriptive, predictive and explanatory studies. The study also has value methodologically as an example of relatively rigorous attention to relevance. A further key contribution is the clarification and instantiation of the full set of analytic theory attributes.

Women who miscarry : the effectiveness and clinical utility of the Kessler 10 questionnaire in screening for ongoing psychological distress

Background: Early pregnancy loss has been linked to enduring psychological morbidity. Aims: This study aimed to investigate the utility of the Kessler 10 (K10) questionnaire as a brief screening instrument to identify women at risk for the development of psychiatric diagnoses three months post-miscarriage. Method: Participants were 117 consecutive women presenting at a public hospital emergency department and receiving a diagnosis of miscarriage. Main outcome measures: K10 screen for psychological distress and the Structured Clinical Interview for DSM Disorders to determine psychiatric diagnoses. Results: A majority of women (81.2%) experienced elevated levels of distress initially, 24.8% in the very high range. They were not at increased risk of psychiatric diagnoses at three months compared with the general population; however, they were significantly more likely to report subsyndromal symptoms at this time compared with the general population. The baseline K10 score was the only significant predictor of distress at follow-up (r = 0.45, P < 0.001). The receiver operating characteristic curve shows that a cut-off of 14 on the K10 has suitable sensitivity (97%) and specificity (82%) for predicting ongoing psychological distress in women who miscarry. Conclusions: The K10 is effective in identifying women at risk for ensuring psychological symptoms following miscarriage.

Informed consent : the review of the law of negligence and the utility of reference to NHMRC guidelines

Although rarely referred to in litigation in the years that have followed the Ipp Review Report, there may well be some merit in more frequent judicial reference to the NHMRC guidelines for medical practitioners on providing information to patients 2004.

Asset renewal decision modelling with application to the water utility industry

Reliable infrastructure assets impact significantly on quality of life and provide a stable foundation for economic growth and competitiveness. Decisions about the way assets are managed are of utmost importance in achieving this. Timely renewal of infrastructure assets supports reliability and maximum utilisation of infrastructure and enables business and community to grow and prosper. This research initially examined a framework for asset management decisions and then focused on asset renewal optimisation and renewal engineering optimisation in depth. This study had four primary objectives. The first was to develop a new Asset Management Decision Framework (AMDF) for identifying and classifying asset management decisions. The AMDF was developed by applying multi-criteria decision theory, classical management theory and life cycle management. The AMDF is an original and innovative contribution to asset management in that: · it is the first framework to provide guidance for developing asset management decision criteria based on fundamental business objectives; · it is the first framework to provide a decision context identification and analysis process for asset management decisions; and · it is the only comprehensive listing of asset management decision types developed from first principles. The second objective of this research was to develop a novel multi-attribute Asset Renewal Decision Model (ARDM) that takes account of financial, customer service, health and safety, environmental and socio-economic objectives. The unique feature of this ARDM is that it is the only model to optimise timing of asset renewal with respect to fundamental business objectives. The third objective of this research was to develop a novel Renewal Engineering Decision Model (REDM) that uses multiple criteria to determine the optimal timing for renewal engineering. The unique features of this model are that: · it is a novel extension to existing real options valuation models in that it uses overall utility rather than present value of cash flows to model engineering value; and · it is the only REDM that optimises timing of renewal engineering with respect to fundamental business objectives; The final objective was to develop and validate an Asset Renewal Engineering Philosophy (AREP) consisting of three principles of asset renewal engineering. The principles were validated using a novel application of real options theory. The AREP is the only renewal engineering philosophy in existence. The original contributions of this research are expected to enrich the body of knowledge in asset management through effectively addressing the need for an asset management decision framework, asset renewal and renewal engineering optimisation based on fundamental business objectives and a novel renewal engineering philosophy.

The ‘good’ parent in relation to early childhood literacy : symbolic terrain and lived practice

In this paper we consider the place of early childhood literacy in the discursive construction of the identity( ies) of ‘proper’ parents. Our analysis crosses between representations of parenting in texts produced by commercial and government/public institutional interests and the self-representations of individual parents in interviews with the researchers. The argument is made that there are commonalities and disjunctures in represented and lived parenting identities as they relate to early literacy. In commercial texts that advertise educational and other products, parents are largely absent from representations and the parent’s position is one of consumer on behalf of the child. In government-sanctioned texts, parents are very much present and are positioned as both learners about and important facilitators of early learning when they ‘interact’ with their children around language and books. The problem for which both, in their different ways, offer a solution is the ‘‘not-yet-ready’’ child precipitated into the evaluative environment of school without the initial competence seen as necessary to avoid falling behind right from the start. Both kinds of producers promise a smooth induction of children into mainstream literacy and learning practices if the ‘good parent’ plays her/his part. Finally, we use two parent cases to illustrate how parents’ lived practice involves multiple discursive practices and identities as they manage young children’s literacy and learning in family contexts in which they also need to negotiate relations with their partners and with paid and domestic work.

Control and protection of a microgrid connected to utility through back-to-back converters

This paper discusses the control and protection of a microgrid that is connected to utility through back-to-back converters. The back-to-back converter connection facilitates bidirectional power flow between the utility and the microgrid. These converters can operate in two different modes–one in which a fixed amount of power is drawn from the utility and the other in which the microgrid power shortfall is supplied by the utility. In the case of a fault in the utility or microgrid side, the protection system should act not only to clear the fault but also to block the back-to-back converters such that its dc bus voltage does not fall during fault. Furthermore, a converter internal mechanism prevents it from supplying high current during a fault and this complicates the operation of a protection system. To overcome this, an admittance based relay scheme is proposed, which has an inverse time characteristic based on measured admittance of the line. The proposed protection and control schemes are able to ensure reliable operation of the microgrid.

Characteristics of utility cyclists in Queensland, Australia : an examination of the associations between individual, social and environmental factors and utility cycling

Background: Initiatives to promote utility cycling in countries like Australia and the US, which have low rates of utility cycling, may be more effective if they first target recreational cyclists. This study aimed to describe patterns of utility cycling and examine its correlates, among cyclists in Queensland, Australia. Methods: An online survey was administered to adult members of a state-based cycling community and advocacy group (n=1813). The survey asked about demographic characteristics and cycling behavior, motivators and constraints. Utility cycling patterns were described, and logistic regression modeling was used to examine associations between utility cycling and other variables. Results: Forty-seven percent of respondents reported utility cycling: most did so to commute (86%). Most journeys (83%) were >5 km. Being male, younger, employed full-time, or university-educated increased the likelihood of utility cycling (p<0.05). Perceiving cycling to be a cheap or a convenient form of transport were associated with utility cycling (p<0.05). Conclusions: The moderate rate of utility cycling among recreational cyclists highlights a potential to promote utility cycling among this group. To increase utility cycling, strategies should target female and older recreational cyclists and focus on making cycling a cheap and convenient mode of transport.

IS-impact utility and intuitiveness : a rigorous approach to relevance

The study proposes to test the ‘IS-Impact’ index as Analytic Theory (AT). To (a) methodically evaluate the ‘relevance’ qualities of IS-Impact; namely, Utility & Intuitiveness. In so doing, to (b) document an exemplar of ‘a rigorous approach to relevance’, while (c) treating the overarching study as a higher-order case study having AT as the unit-of-analysis, and assessing adequacy of the 6 AT qualities, both for IS-Impact and for similar taxonomies. Also to (d) look beyond IS-Impact to other forms of Design Science, considering the generality of the AT qualities; and (e) further validating IS-Impact in new system organisation contexts taking account of contemporary understandings of construct theorisation, operationalization and validation.

Utility of routine data sources for feedback on the quality of cancer care: an assessment based on clinical practice guidelines

Background Not all cancer patients receive state-of-the-art care and providing regular feedback to clinicians might reduce this problem. The purpose of this study was to assess the utility of various data sources in providing feedback on the quality of cancer care. Methods Published clinical practice guidelines were used to obtain a list of processes-of-care of interest to clinicians. These were assigned to one of four data categories according to their availability and the marginal cost of using them for feedback. Results Only 8 (3%) of 243 processes-of-care could be measured using population-based registry or administrative inpatient data (lowest cost). A further 119 (49%) could be measured using a core clinical registry, which contains information on important prognostic factors (e.g., clinical stage, physiological reserve, hormone-receptor status). Another 88 (36%) required an expanded clinical registry or medical record review; mainly because they concerned long-term management of disease progression (recurrences and metastases) and 28 (11.5%) required patient interview or audio-taping of consultations because they involved information sharing between clinician and patient. Conclusion The advantages of population-based cancer registries and administrative inpatient data are wide coverage and low cost. The disadvantage is that they currently contain information on only a few processes-of-care. In most jurisdictions, clinical cancer registries, which can be used to report on many more processes-of-care, do not cover smaller hospitals. If we are to provide feedback about all patients, not just those in larger academic hospitals with the most developed data systems, then we need to develop sustainable population-based data systems that capture information on prognostic factors at the time of initial diagnosis and information on management of disease progression.

Symbolic number : the integration of magnitude and spatial representations in children aged 6 to 8 years

The process of learning symbolic Arabic digits in early childhood requires that magnitude and spatial information integrates with the concept of symbolic digits. Previous research has separately investigated the development of automatic access to magnitude and spatial information from symbolic digits. However, developmental trajectories of symbolic number knowledge cannot be fully understood when considering components in isolation. In view of this, we have synthesized the existing lines of research and tested the use of both magnitude and spatial information with the same sample of British children in Years 1, 2 and 3 (6-8 years of age). The physical judgment task of the numerical Stroop paradigm (NSP) demonstrated that automatic access to magnitude was present from Year 1 and the distance effect signaled that a refined processing of numerical information had developed. Additionally, a parity judgment task showed that the onset of the Spatial-Numerical Association of Response Codes (SNARC) effect occurs in Year 2. These findings uncover the developmental timeline of how magnitude and spatial representations integrate with symbolic number knowledge during early learning of Arabic digits and resolve inconsistencies between previous developmental and experimental research lines.

Assessment of function and clinical utility of alcohol and other drug web sites : an observational, qualitative study

Background The increasing popularity and use of the internet makes it an attractive option for providing health information and treatment, including alcohol/other drug use. There is limited research examining how people identify and access information about alcohol or other drug (AOD) use online, or how they assess the usefulness of the information presented. This study examined the strategies that individuals used to identify and navigate a range of AOD websites, along with the attitudes concerning presentation and content. Methods Members of the general community in Brisbane and Roma (Queensland, Australia) were invited to participate in a 30-minute search of the internet for sites related to AOD use, followed by a focus group discussion. Fifty one subjects participated in the study across nine focus groups. Results Participants spent a maximum of 6.5 minutes on any one website, and less if the user was under 25 years of age. Time spent was as little as 2 minutes if the website was not the first accessed. Participants recommended that AOD-related websites should have an engaging home or index page, which quickly and accurately portrayed the site’s objectives, and provided clear site navigation options. Website content should clearly match the title and description of the site that is used by internet search engines. Participants supported the development of a portal for AOD websites, suggesting that it would greatly facilitate access and navigation. Treatment programs delivered online were initially viewed with caution. This appeared to be due to limited understanding of what constituted online treatment, including its potential efficacy. Conclusions A range of recommendations arise from this study regarding the design and development of websites, particularly those related to AOD use. These include prudent use of text and information on any one webpage, the use of graphics and colours, and clear, uncluttered navigation options. Implications for future website development are discussed.

Clinical utility of mental state screening as a predictor of intellectual outcomes 6 months after diagnosis of type 1 diabetes

Background Screening tests of basic cognitive status or ‘mental state’ have been shown to predict mortality and functional outcomes in adults. This study examined the relationship between mental state and outcomes in children with type 1 diabetes. Objective We aimed to determine whether mental state at diagnosis predicts longer term cognitive function of children with a new diagnosis of type 1 diabetes. Methods Mental state of 87 patients presenting with newly diagnosed type 1 diabetes was assessed using the School-Years Screening Test for the Evaluation of Mental Status. Cognitive abilities were assessed 1 wk and 6 months postdiagnosis using standardized tests of attention, memory, and intelligence. Results Thirty-seven children (42.5%) had reduced mental state at diagnosis. Children with impaired mental state had poorer attention and memory in the week following diagnosis, and, after controlling for possible confounding factors, significantly lower IQ at 6 months compared to those with unimpaired mental state (p < 0.05). Conclusions Cognition is impaired acutely in a significant number of children presenting with newly diagnosed type 1 diabetes. Mental state screening is an effective method of identifying children at risk of ongoing cognitive difficulties in the days and months following diagnosis. Clinicians may consider mental state screening for all newly diagnosed diabetic children to identify those at risk of cognitive sequelae.