Assessing the physical environment of older people’s residential care facilities: development of the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM)

Background There is emerging evidence that the physical environment is important for health, quality of life and care, but there is a lack of valid instruments to assess health care environments. The Sheffield Care Environment Assessment Matrix (SCEAM), developed in the United Kingdom, provides a comprehensive assessment of the physical environment of residential care facilities for older people. This paper reports on the translation and adaptation of SCEAM for use in Swedish residential care facilities for older people, including information on its validity and reliability. Methods SCEAM was translated into Swedish and back-translated into English, and assessed for its relevance by experts using content validity index (CVI) together with qualitative data. After modification, the validity assessments were repeated and followed by test-retest and inter-rater reliability tests in six units within a Swedish residential care facility that varied in terms of their environmental characteristics. Results Translation and back translation identified linguistic and semantic related issues. The results of the first content validity analysis showed that more than one third of the items had item-CVI (I-CVI) values less than the critical value of 0.78.  After modifying the instrument, the second content validation analysis resulted in I-CVI scores above 0.78, the suggested criteria for excellent content validity. Test-retest reliability showed high stability (96% and 95% for two independent raters respectively), and inter-rater reliability demonstrated high levels of agreement (95% and 94% on two separate rating occasions). Kappa values were very good for test-retest (κ= 0.903 and 0.869) and inter-rater reliability (κ= 0.851 and 0.832). Conclusions Adapting an instrument to a domestic context is a complex and time-consuming process, requiring an understanding of the culture where the instrument was developed and where it is to be used. A team, including the instrument’s developers, translators, and researchers is necessary to ensure a valid translation and adaption. This study showed preliminary validity and reliability evidence for the Swedish version (S-SCEAM) when used in a Swedish context. Further, we believe that the S-SCEAM has improved compared to the original instrument and suggest that it can be used as a foundation for future developments of the SCEAM model.

Automatic spiral analysis for objective assessment of motor symptoms in Parkinson's disease

A challenge for the clinical management of advanced Parkinson’s disease (PD) patients is the emergence of fluctuations in motor performance, which represents a significant source of disability during activities of daily living of the patients. There is a lack of objective measurement of treatment effects for in-clinic and at-home use that can provide an overview of the treatment response. The objective of this paper was to develop a method for objective quantification of advanced PD motor symptoms related to off episodes and peak dose dyskinesia, using spiral data gathered by a touch screen telemetry device. More specifically, the aim was to objectively characterize motor symptoms (bradykinesia and dyskinesia), to help in automating the process of visual interpretation of movement anomalies in spirals as rated by movement disorder specialists. Digitized upper limb movement data of 65 advanced PD patients and 10 healthy (HE) subjects were recorded as they performed spiral drawing tasks on a touch screen device in their home environment settings. Several spatiotemporal features were extracted from the time series and used as inputs to machine learning methods. The methods were validated against ratings on animated spirals scored by four movement disorder specialists who visually assessed a set of kinematic features and the motor symptom. The ability of the method to discriminate between PD patients and HE subjects and the test-retest reliability of the computed scores were also evaluated. Computed scores correlated well with mean visual ratings of individual kinematic features. The best performing classifier (Multilayer Perceptron) classified the motor symptom (bradykinesia or dyskinesia) with an accuracy of 84% and area under the receiver operating characteristics curve of 0.86 in relation to visual classifications of the raters. In addition, the method provided high discriminating power when distinguishing between PD patients and HE subjects as well as had good test-retest reliability. This study demonstrated the potential of using digital spiral analysis for objective quantification of PD-specific and/or treatment-induced motor symptoms.

Acceptability of home-assessment post medical abortion and medical abortion in a low-resource setting in Rajasthan, India : Secondary outcome analysis of a non-inferiority randomized controlled trial

Background: Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education. Objective: To investigate women's acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India. Design: Secondary outcome of a randomised, controlled, non-inferiority trial. Setting Outpatient primary health care clinics in rural and urban Rajasthan, India. Population: Women were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin < 85mg/l and were below 18 years. Methods: Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1: 1) in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol), using opaque sealed envelopes. Blinding during outcome assessment was not possible. Main outcome measures: Women's acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups. Results: 731 women were randomized to the clinic follow-up group (n = 353) or home-assessment group (n = 378). 623 (85%) women were successfully followed up, of those 597 (96%) were satisfied and 592 (95%) found the abortion better or as expected, with no difference between study groups. The majority, 355 (57%) women, preferred home-assessment in the event of a future abortion. Significantly more women, 284 (82%), in the home-assessment group preferred home-assessment in the future, as compared with 188 (70%) of women in the clinic follow-up group, who preferred clinic follow-up in the future (p < 0.001). Conclusion: Home-assessment is highly acceptable among women in low-resource, and rural, settings. The choice to follow-up an early medical abortion according to women's preference should be offered to foster women's reproductive autonomy.

Self-assessment of the outcome of early medical abortion versus clinic follow-up in India : a randomised, controlled, non-inferiority trial

Background: The need for multiple clinical visits remains a barrier to women accessing safe legal medical abortion services. Alternatives to routine clinic follow-up visits have not been assessed in rural low-resource settings. We compared the effectiveness of standard clinic follow-up versus home assessment of outcome of medical abortion in a low-resource setting. Methods: This randomised, controlled, non-inferiority trial was done in six health centres (three rural, three urban) in Rajasthan, India. Women seeking early medical abortion up to 9 weeks of gestation were randomly assigned (1:1) to either routine clinic follow-up or self-assessment at home. Randomisation was done with a computer-generated randomisation sequence, with a block size of six. The study was not blinded. Women in the home-assessment group were advised to use a pictorial instruction sheet and take a low-sensitivity urine pregnancy test at home, 10-14 days after intake of mifepristone, and were contacted by a home visit or telephone call to record the outcome of the abortion. The primary (non-inferiority) outcome was complete abortion without continuing pregnancy or need for surgical evacuation or additional mifepristone and misoprostol. The non-inferiority margin for the risk difference was 5%. All participants with a reported primary outcome and who followed the clinical protocol were included in the analysis. This study is registered with ClinicalTrials.gov, number NCT01827995. Findings: Between April 23, 2013, and May 15, 2014, 731 women were recruited and assigned to clinic follow-up (n=366) or home assessment (n=365), of whom 700 were analysed for the main outcomes (n=336 and n=364, respectively). Complete abortion without continuing pregnancy, surgical intervention, or additional mifepristone and misoprostol was reported in 313 (93%) of 336 women in the clinic follow-up group and 347 (95%) of 364 women in the home-assessment group (difference -2.2%, 95% CI -5.9 to 1.6). One case of haemorrhage occurred in each group (rate of adverse events 0.3% in each group); no other adverse events were noted. Interpretation Home assessment of medical abortion outcome with a low-sensitivity urine pregnancy test is non-inferior to clinic follow-up, and could be introduced instead of a clinic follow-up visit in a low-resource setting.

Inadvertent doping through supplement use by athletes: assessment and management of the risk in Australia

Many athletes report using a wide range of special sports foods and supplements. In the present study of 77 elite Australian swimmers, 99% of those surveyed reported the use of these special preparations, with 94% of swimmers reporting the use of non-food supplements. The most popular dietary supplements were vitamin or mineral supplements (used by 94% of the group), herbal preparations (61%), and creatine (31%). Eighty-seven percent of swimmers reported using a sports drink or other energy-providing sports food. In total, 207 different products were reported in this survey. Sports supplements, particularly supplements presented as pills or other non-food form, are poorly regulated in most countries, with little assurance of quality control. The risk of an inadvertent "positive doping test" through the use of sports supplements or sports foods is a small but real problem facing athletes who compete in events governed by anti-doping rules. The elite swimmers in this survey reported that information about the "doping safety" of supplements was important and should be funded by supplement manufacturers. Although it is challenging to provide such information, we suggest a model to provide an accredited testing program suitable for the Australian situation, with targeted athlete education about the "sports safety" of sports supplements and foods.

Effect of a self-directed learning package on emergency nurses` knowledge of assessment of oxygenation and use of supplemental oxygen

Abstract Emergency nurses frequently and independently make decisions regarding supplemental oxygen. The importance of these decisions for patients is highlighted by the well documented association between respiratory dysfunction and adverse events. This study aimed to: (i) examine the effect of educational preparation on emergency nurses' knowledge of assessment of oxygenation, and the use of supplemental oxygen; (ii) explore the impact of existing knowledge on decisions related to the implementation of supplemental oxygen; and (iii) explore nurses' characteristics that were associated with effectiveness of the educational preparation. A pretest/post-test, controlled, quasi-experimental design was used in this study. Educational preparation was effective in increasing emergency nurses' knowledge. Baseline level of knowledge was predictive of reports of independent decisions regarding the implementation of oxygen. There was a significant positive relationship between postgraduate qualification in emergency nursing and the effect of education, and significant negative relationships between effect of education and baseline level of knowledge and daily decisions to implement supplemental oxygen.

The impact of computer-assisted learning on academic grades: an assessment of students' perceptions

This study examines student perceptions of the usefulness of Computer-Assisted Learning (CAL) packages in learning accounting concepts in terms of the influence on academic performance. Various additional factors  affecting academic performance [such as gender, prior studies of  accounting, and computer systems, together with entry background] are incorporated in the development of a multiple regression model, together with perceptions of CAL. The study uses a sample of 280 second-year undergraduate accounting students from an Australian university to test the model. In contrast to prior studies (e.g. Lane and Porch, 2002, Accounting Education: an international journal, 11(3), pp. 217-233), this study showed that positive perceptions of the usefulness of CAL significantly influenced performance. Additionally, it was found that international students, many of whom enter university at the second year level having obtained advanced standing credits, had significantly poorer performance than local students. The findings show that gender, prior studies of accounting and computing systems were not significant influences on academic performance. Overall, the results have implications for accounting educators utilising CAL in courses as a means of improving students' understanding of accounting concepts and academic performance.

Assessing adult adjustment to relationship separation : the Psychological Adjustment to Separation Test (PAST)

Relationship separation is associated with substantial adult adjustment problems. The Psychological Adjustment to Separation Test (PAST) was developed as a self-report measure of 3 key dimensions of separation adjustment problems: lonely negativity, ex-partner attachment and coparenting conflict. Two independent samples (n = 219 and n = 169, respectively) of recently separated adults, 60% of whom had children, completed the PAST and other measures of general adjustment. Exploratory and confirmatory factor analyses demonstrated a replicable 3-factor structure, with each factor showing satisfactory test–retest and internal reliability and good convergent and discriminant validity. The PAST meets initial criteria for a potentially useful new measure of adult separation adjustment.

Can written nursing practice standards improve documentation of initial assessment of ED patients?

Introduction: There is wide variation in emergency nursing practice in terms of initial patient assessment and the interventions implemented in response to these patient assessment findings. It is hypothesised that written ED nursing practice standards will reduce variability in documentation standards related to initial patient assessment.

Aim: This study aimed to examine the effect of written ED nursing practice standards augmented by an in-service education programme on the documentation of the initial nursing assessment.

Method: A pre-test/post-test design was used. Initial patient assessment was assessed using the Emergency Department Observation Chart. All adult patients (>18 years) who presented with chest pain and who were triaged to the general adult cubicles were eligible for inclusion in the study. Random sampling was used to select the patients for the pre-test (n = 78) and post-test groups (n = 74).

Results: There was significant improvement in documentation of all aspects of symptom assessment except quality and historical variables: pre-hospital care, cardiac risk factors, and past medical history. Improvements in documentation of elements of primary survey assessment were variable. There were significant increases in documentation of respiratory effort, chest auscultation findings, capillary refill and conscious state. There was a significant 18.3% decrease in the frequency of documentation of respiratory rate and no significant changes in documentation of oxygen saturation, heart rate or blood pressure.

Conclusion: Written ED nursing practice standards were effective in improving the documentation of some elements of initial nursing assessment for patients with chest pain. Active implementation strategies are important to ensure effective uptake of written practice standards and the relationship between nursing documentation and actual clinical practice warrants further consideration using a naturalistic approach in real practice settings.

Teacher and peer assessment of creativity in technology education

This study, part of a PhD thesis, investigates a number of aspects relating to technology education, creativity and the assessment of creativity and aesthetics. Following tuitional sessions, panels of upper primary school children were involved in assessing the creative and aesthetic characteristics of technological products made by other children. Teachers assessed a selection of student drawings for creativity and these results were compared against the corresponding products assessed by the panels of Year 5 children. Subjects were administered a test on their knowledge of technology and these scores were compared to product creativity scores. The results showed high correlations between the assessor ranks for both creativity and aesthetics although there was generally more consistency with creativity. While some subjects produced both creative drawings and products, others showed creativity in only one outcome. A further finding of the investigation identified the relationship between students' knowledge of technology and the creative product constructed by the older children in the study.

Objective assessment of pilling of nonwoven fabrics using the two dimensional discrete wavelet transform

Fabric pilling is a serious problem for the apparel industry, causing an unsightly appearance and premature wear. Woolen products are particularly prone to pilling. Recently, a process for production of woolen nonwoven apparel fabrics has been commercialized in Australia, and may lead to new markets for Australian wool. However, the success of such nonwoven fabrics will partly rely on their propensity to pill. A key element in the control of fabric pilling is the evaluation of resistance to pilling by testing. Resistance to pilling is normally tested in the laboratory by processes that simulate accelerated wear, followed by a manual assessment of the degree of pilling by an expert based on a visual comparison of the sample to a set of test images. To bring more objectivity into the pilling rating process, a number of automated systems based on image analysis have been developed. The authors previously proposed a new method of image analysis based on the two-dimensional discrete wavelet transform to objectively measure the pilling intensity for woven fabrics. This paper presents preliminary work in extending this method to nonwoven fabrics.

A comparison of four functional test in discriminating fallers from non-fallers in older people

Purpose : Which functional tests on mobility and balance can better screen older people at risk of falls is unclear. This study aims to compare the Berg Balance Scale (BBS), Tinetti Mobility Score (TMS), Elderly Mobility Scale (EMS) and Timed Up and Go test (TUG) in discriminating fallers from non-fallers in older people.
Method : This was a case-control study involving one rater who conducted a mobility and balance assessment on subjects using the four functional tests in random sequence. Subjects recruited included 17 and 22 older people with a history of single and multiple falls respectively from a public Falls Clinic, and 39 community-dwellers without fall history and whose age, sex and BMI matched those of the fallers. All subjects underwent the mobility and balance assessment within one day.
Results : Single fallers performed better than multiple fallers in all four functional tests but were worse than non-fallers in the BBS, TMS and TUG. The BBS demonstrated the best discriminating ability, with high sensitivity and specificity. The BBS item 'pick up an object from the floor' was the best at screening fallers.
Conclusion : BBS was the most powerful functional test of the four in discriminating fallers from non-faller.

Assessment in experiential learning : the case of a public policy internship

Assessment is a significant issue for learning in the workplace. In some professions there are key indicators of success shared by workplace and academic supervisors alike. Beyond specific professions, however, assessment becomes more diffuse in workplaces that do not have explicit criteria established to judge performance of students in experiential learning. Assessing learning in these workplaces may be associated with methods that rely more upon student self appraisal and workplace supervisor reports. This article reports on the approach used for assessment in a public policy internship program in one Australian university - Deakin University in Victoria. The article argues that assessment, rather than being an add-on or a test of pre-ordained information, is central to the process of learning itself. This means that before students embark upon a policy internship they need to build their critical thinking abilities; i.e. a process of purposeful, self- regulatory judgment. Secondly they need to discuss how to negotiate their tasks in different workplaces and how to produce the criteria to be used in their evaluation.

Equity-focused health impact assessment framework

Background to the Development of the Equity-Focused HIA Framework
The equity focused health impact assessment (EFHIA) framework arises out of a two year research project funded for the most part by the Australian Government’s Public Health Education Research Program (PHERP) Innovations Grants (Round 2) scheme. This project had as its primary objective the development of a framework for health inequalities impact assessment, subsequently renamed equity focused health impact assessment. A partnership between the University of Newcastle, Deakin University and the University of New South Wales (the Project Management Steering Committee) received the funding and the Australasian Collaboration for Health Equity Impact Assessment (ACHEIA) was formed to undertake appropriate background research and to develop, pilot test, modify and disseminate the framework. The work commenced in September 2002 and concluded in October 2004. Part of the funding included a capacity building workshop in August 2004. ACT Health and the Division of Medicine at the John Hunter Hospital, Newcastle, also provided financial support for the project. The August 2004 Workshop was supported by NSW Health. All participants and organisations involved in the project gave extensive in-kind support.
The aims of the workshop were to bring together an international collaboration of multidisciplinary investigators, public health experts, and key senior health managers working in national, state and local settings, to inform the further development of the framework and to provide training in its application. The initial goals of the project were to work collaboratively to develop a strategic framework to assess the health inequalities of public health-related policies, plans, strategies, decisions, programs and services. The EFHIA framework as presented at the August workshop was developed through:
1. an extensive review of the relevant literature
2. formal and informal consultation with members of ACHEIA (the international
reference group), members of the Project Management Steering Committee and
other relevant experts; and
3. testing of the draft EFHIA framework with the 5 case study partners – who applied the draft framework in a range of health settings (see
Acknowledgements).
The result of this work has been the development of an equity focused health impact assessment framework that can be used to determine the unanticipated and systemic health inequities that may exist within the decision making processes or activities of a range of organisations and sectors. The EFHIA framework provides one approach that can be used to assist decision makers to put equity and health on their agenda in a more obvious and systematic way. The framework represents a ‘moment in time’ rather than a definitive statement or ‘toolkit’ on the best way to proceed. Further practice, refinement and adjustment will be needed over many years to consolidate both HIA and EFHIA. As well as this guide to the framework, additional outputs from the project team include:
- A literature review
- A position paper
- A report on the five case studies
- An evaluation report.
With the consent of the Australian Government, a monograph will be made available to workshop participants at the end of October which contains the framework and the appropriate background papers.

Assessment of physical activity among primary school aged children: the Children's Leisure Activities Study (CLASS)

Overweight and obesity rates among children in Australia have increased twofold in the last decade. Physical activity is thought to play an important role in the prevention and treatment of childhood obesity. Children's physical activity data in Australia are incomplete and mainly based on parental proxy reports. One of the reasons for the lack of children's physical activity prevalence data in Australia is the difficulties of measurement. The aim of this study was to develop and examine a reliable, valid and feasible method for assessing physical activity among primary school aged children. A total of 112 grade 5 and 6 children and their parents were recruited from four state primary schools in the eastern and western suburbs of Melbourne. The test-retest reliability of a parental proxy physical activity questionnaire and a children's self report physical activity questionnaire was assessed. The criterion validity of the questionnaires was assessed using accelerometry. Findings suggest that the self report and proxy report questionnaires provided reliable measures of the type, frequency and duration of children's physical activity behaviour. Overall, the criterion validity of the questionnaires was poor. Although accelerometry as an objective measure shows promise, it does not provide the important physical activity behavioural and contextual information that is critical for the development of strategies to promote physical activity among children. We recommend that a combination of self report or proxy and objective measurement (using accelerometry or even pedometry) appears to be the current 'best buy' in the assessment of children's physical activity behaviour.