Quality of child abuse information for measurement and surveillance : linking hospital and child welfare data

National estimates of the prevalence of child abuse-related injuries are obtained from a variety of sectors including welfare, justice, and health resulting in inconsistent estimates across sectors. The International Classification of Diseases (ICD) is used as the international standard for categorising health data and aggregating data for statistical purposes, though there has been limited validation of the quality, completeness or concordance of these data with other sectors. This research study examined the quality of documentation and coding of child abuse recorded in hospital records in Queensland and the concordance of these data with child welfare records. A retrospective medical record review was used to examine the clinical documentation of over 1000 hospitalised injured children from 20 hospitals in Queensland. A data linkage methodology was used to link these records with records in the child welfare database. Cases were sampled from three sub-groups according to the presence of target ICD codes: Definite abuse, Possible abuse, unintentional injury. Less than 2% of cases coded as being unintentional were recoded after review as being possible abuse, and only 5% of cases coded as possible abuse cases were reclassified as unintentional, though there was greater variation in the classification of cases as definite abuse compared to possible abuse. Concordance of health data with child welfare data varied across patient subgroups. This study will inform the development of strategies to improve the quality, consistency and concordance of information between health and welfare agencies to ensure adequate system responses to children at risk of abuse.

VO2max in overweight and obese adults

Purpose: The purpose of this study was to determine whether adiposity affects the attainment of VO2max. Methods: Sixty-seven male and 68 female overweight (body mass index (BMI) = 25-29.9 kg·m-2) and obese (BMI >= 30 kg·m-2) participants undertook a graded treadmill test to volitional exhaustion (phase 1) followed by a verification test (phase 2) to determine the proportion who could achieve a plateau in VO2 and other "maximal" markers (RER, lactate, HR, RPE). Results: At the end of phase 1, 46% of the participants reached a plateau in VO2, 83% increased HR to within 11 beats of age-predicted maximum, 89% reached an RER of >=1.15, 70% reached a blood lactate concentration of >=8 mmol·L-1, and 74% reached an RPE of >=18. No significant differences between genders and between BMI groups were found with the exception of blood lactate concentration (males = 84% vs females = 56%, P < 0.05). Neither gender nor fatness predicted the number of other markers attained, and attainment of other markers did not differentiate whether a VO2 plateau was achieved. The verification test (phase 2) revealed that an additional 52 individuals (39%) who did not exhibit a plateau in V·O2 in phase 1 had no further increase in VO2 in phase 2 despite an increase in workload. Conclusions: These findings indicate that the absence of a plateau in VO2 alone is not indicative of a failure to reach a true maximal VO2 and that individuals with excessive body fat are no less likely than "normal-weight" individuals to exhibit a plateau in VO2 provided that the protocol is appropriate and encouragement to exercise to maximal exertion is provided.

A comparative study of splint effectiveness in limiting forearm rotation

Study Design: Case Study Series.---------- Introduction: Restriction of forearm rotation may be required for effective management and rehabilitation of the upper limb after trauma.---------- Purpose of the Study: To compare the effectiveness of four splints in restricting forearm rotation.---------- Methods: Muenster, Sugartong, antipronation distal radioulnar joint (DRUJ), and standard wrist splints were fabricated for five healthy participants. Active range of motion (AROM) in forearm pronation and supination was measured with a goniometer for each splint, at the initial point of sensory feedback and during exertion of maximal force.---------- Results: Repeated-measures analysis of variance indicated significant differences between splints for all four AROM measures. Post hoc paired t-tests showed that the Sugartong splint was significantly more restrictive in pronation than the Muenster splint. The antipronation DRUJ splint provided significantly greater restriction in pronation than the standard wrist splint. No splints immobilized the forearm completely.---------- Conclusions: The Sugartong splint is recommended for maximal restriction in pronation, but individual patient characteristics require consideration in splint choice.

Semantic search and inferencing in health informatics

Consider a person searching electronic health records, a search for the term ‘cracked skull’ should return documents that contain the term ‘cranium fracture’. A information retrieval systems is required that matches concepts, not just keywords. Further more, determining relevance of a query to a document requires inference – its not simply matching concepts. For example a document containing ‘dialysis machine’ should align with a query for ‘kidney disease’. Collectively we describe this problem as the ‘semantic gap’ – the difference between the raw medical data and the way a human interprets it. This paper presents an approach to semantic search of health records by combining two previous approaches: an ontological approach using the SNOMED CT medical ontology; and a distributional approach using semantic space vector space models. Our approach will be applied to a specific problem in health informatics: the matching of electronic patient records to clinical trials.

Manifolds, patterns and transitions in a creative life

Using sculpture and drawing as my primary methods of investigation, this research explores ways of shifting the emphasis of my creative visual arts practice from object to process whilst still maintaining a primacy of material outcomes. My motivation was to locate ways of developing a sustained practice shaped as much by new works, as by a creative flow between works. I imagined a practice where a logic of structure within discrete forms and a logic of the broader practice might be developed as mutually informed processes. Using basic structural components of multiple wooden curves and linear modes of deployment – in both sculptures and drawings – I have identified both emergence theory and the image of rhizomic growth (Deleuze and Guattari, 1987) as theoretically integral to this imagining of a creative practice, both in terms of critiquing and developing works. Whilst I adopt a formalist approach for this exegesis, the emergence and rhizome models allow it to work as a critique of movement, of becoming and changing, rather than merely a formalism of static structure. In these models, therefore, I have identified a formal approach that can be applied not only to objects, but to practice over time. The thorough reading and application of these ontological models (emergence and rhizome) to visual arts practice, in terms of processes, objects and changes, is the primary contribution of this thesis. The works that form the major component of the research develop, reflect and embody these notions of movement and change.

Network

Network has emerged from a contempory worldwide phenomenon, culturally manifested as a consequence of globalization and the knowledge economy. It is in this context that the internet revolution has prompted a radical re-ordering of social and institutional relations and the associated structures, processes and places which support them. Within the duality of virtual space and the augmentation of traditional notions of physical place, the organizational structures pose new challenges for the design professions. Technological developments increasingly permit communication anytime and anywhere, and provide the opportunity for both synchronous and asynchronous collaboration. The resultant ecology formed through the network enterprise has resulted in an often convolted and complex world wherein designers are forced to consider the relevance and meaning of this new context. The role of technology and that of space are thus interwined in the relation between the network and the individual workplace. This paper explores a way to inform the interior desgn process for contemporary workplace environments. It reports on both theoretical and practical outcomes through an Australia-wide case study of three collaborating, yet independent business entities. It further suggests the link between workplace design and successful business innovation being realized between partnering organizations in Great Britain. Evidence presented indicates that, for architects and interior designers, the scope of the problem has widened, the depth of knowledge required to provide solutions has increased, and the rules of engagement are required to change. The ontological and epistemological positions adopted in the study enabled the spatial dimensions to be examined from both within and beyond the confines of a traditional design only viewpoint. Importantly it highlights the significance of a trans-disiplinary collaboration in dealing with the multiple layers and complexity of the contemporary social and business world, from both a research and practice perspective.

Age, muscle fatigue, and walking endurance in pre-menopausal women

Aging is associated with loss of endurance; however, aging is also associated with decreased fatigue during maximal isometric contractions. The aims of this study were to examine the relationship between age and walking endurance (WE) and maximal isometric fatigue (MIF) and to determine which metabolic/fitness components explain the expected age effects on WE and MIF. Subjects were 96 pre-menopausal women. Oxygen uptake (walking economy) was assessed during a 3-mph walk; aerobic capacity and WE by progressive treadmill test; knee extension strength by isometric contractions, MIF during a 90-s isometric plantar flexion (muscle metabolism measured by 31P MRS). Age was related to increased walking economy (low VO2, r = −0.19, P < 0.03) and muscle metabolic economy (force/ATP, 0.34, P = 0.01), and reduced MIF (−0.26, P < 0.03). However, age was associated with reduced WE (−0.28, P < 0.01). Multiple regression showed that muscle metabolic economy explained the age-related decrease in MIF (partial r for MIF and age −0.13, P = 0.35) whereas walking economy did not explain the age-related decrease in WE (partial r for WE and age −0.25, P < 0.02). Inclusion of VO2max and knee endurance strength accounted for the age-related decreased WE (partial r for WE and age = 0.03, P > 0.80). In premenopausal women, age is related to WE and MIF. In addition, these results support the hypothesis that age-related increases in metabolic economy may decrease MIF. However, decreased muscle strength and oxidative capacity are related to WE.

Content and functionality of alcohol and other drug websites : results of an online survey

Background: There is a growing trend for individuals to seek health information from online sources. Alcohol and other drug (AOD) use is a significant health problem worldwide, but access and use of AOD websites is poorly understood. ----- ----- Objective: To investigate content and functionality preferences for AOD and other health websites. Methods: An anonymous online survey examined general Internet and AOD-specific usage and search behaviors, valued features of AOD and health-related websites (general and interactive website features), indicators of website trustworthiness, valued AOD website tools or functions, and treatment modality preferences. ----- ----- Results: Surveys were obtained from 1214 drug (n = 766) and alcohol website users (n = 448) (mean age 26.2 years, range 16-70). There were no significant differences between alcohol and drug groups on demographic variables, Internet usage, indicators of website trustworthiness, or on preferences for AOD website functionality. A robust website design/navigation, open access, and validated content provision were highly valued by both groups. While attractiveness and pictures or graphics were also valued, high-cost features (videos, animations, games) were minority preferences. Almost half of respondents in both groups were unable to readily access the information they sought. Alcohol website users placed greater importance on several AOD website tools and functions than did those accessing other drug websites: online screening tools (χ²2 = 15.8, P < .001, n = 985); prevention programs (χ²2 = 27.5, P < .001, n = 981); tracking functions (χ²2 = 11.5, P = .003, n = 983); self help treatment programs (χ²2 = 8.3, P = .02, n = 984); downloadable fact sheets for friends (χ²2 = 11.6, P = .003, n = 981); or family (χ²2 = 12.7, P = .002, n = 983). The most preferred online treatment option for both the user groups was an Internet site with email therapist support. Explorations of demographic differences were also performed. While gender did not affect survey responses, younger respondents were more likely to value interactive and social networking features, whereas downloading of credible information was most highly valued by older respondents. ----- ----- Conclusions: Significant deficiencies in the provision of accessible information on AOD websites were identified, an important problem since information seeking was the most common reason for accessing these websites, and, therefore, may be a key avenue for engaging website users in behaviour change. The few differences between AOD website users suggested that both types of websites may have similar features, although alcohol website users may more readily be engaged in screening, prevention and self-help programs, tracking change, and may value fact sheets more highly. While the sociodemographic differences require replication and clarification, these differences support the notion that the design and features of AOD websites should target specific audiences to have maximal impact.

The role of assisted self-help in services for alcohol-related disorders

Potentially harmful substance use is common, but many affected people do not receive treatment. Brief face-to-face treatments show impact, as do strategies to assist self-help remotely, by using bibliotherapies, computers or mobile phones. Remotely delivered treatments offer more sustained and multifaceted support than brief interventions, and they show a substantial cost advantage as users increase in number. They may also build skills, confidence and treatment fidelity in providers who use them in sessions. Engagement and retention remain challenges, but electronic treatments show promise in engaging younger populations. Recruitment may be assisted by integration with community campaigns or brief opportunistic interventions. However, routine use of assisted self-help by standard services faces significant challenges. Strategies to optimize adoption are discussed. ----- ----- Research Highlights: ► Many people with risky or problematic drinking do not currently receive treatment. ► Assisted self-help has a significant impact and can be delivered at low cost. ► Maximal effects from assisted self-help require engagement of potential users. ► Marketing campaigns and integration into existing service models may assist.

Biceps brachii muscle oxygenation in electrical muscle stimulation

The purpose of this study was to compare between electrical muscle stimulation (EMS) and maximal voluntary (VOL) isometric contractions of the elbow flexors for changes in biceps brachii muscle oxygenation (tissue oxygenation index, TOI) and haemodynamics (total haemoglobin volume, tHb = oxygenated-Hb + deoxygenated-Hb) determined by near-infrared spectroscopy (NIRS). The biceps brachii muscle of 10 healthy men (23–39 years) was electrically stimulated at high frequency (75 Hz) via surface electrodes to evoke 50 intermittent (4-s contraction, 15-s relaxation) isometric contractions at maximum tolerated current level (EMS session). The contralateral arm performed 50 intermittent (4-s contraction, 15-s relaxation) maximal voluntary isometric contractions (VOL session) in a counterbalanced order separated by 2–3 weeks. Results indicated that although the torque produced during EMS was approximately 50% of VOL (P<0Æ05), there was no significant difference in the changes in TOI amplitude or TOI slope between EMS and VOL over the 50 contractions. However, the TOI amplitude divided by peak torque was approximately 50% lower for EMS than VOL (P<0Æ05), which indicates EMS was less efficient than VOL. This seems likely because of the difference in the muscles involved in the force production between conditions. Mean decrease in tHb amplitude during the contraction phases was significantly (P<0Æ05) greater for EMS than VOL from the 10th contraction onwards, suggesting that the muscle blood volume was lower in EMS than VOL. It is concluded that local oxygen demand of the biceps brachii sampled by NIRS is similar between VOL and EMS.

Postural balance under normal and altered sensory conditions in normal-weight and overweight children

Background Little or no research has been done in the overweight child on the relative contribution of multisensory information to maintain postural stability. Therefore, the purpose of this study was to investigate postural balance control under normal and experimentally altered sensory conditions in normal-weight versus overweight children. Methods Sixty children were stratified into a younger (7–9 yr) and an older age group (10–12 yr). Participants were also classified as normal-weight (n = 22) or overweight (n = 38), according to the international BMI cut-off points for children. Postural stability was assessed during quiet bilateral stance in four sensory conditions (eyes open or closed, normal or reduced plantar sensation), using a Kistler force plate to quantify COP dynamics. Coefficients of variation were calculated as well to describe intra-individual variability. Findings Removal of vision resulted in systematically higher amounts of postural sway, but no significant BMI group differences were demonstrated across sensory conditions. However, under normal conditions lower plantar cutaneous sensation was associated with higher COP velocities and maximal excursion of the COP in the medial-lateral direction for the overweight group. Regardless of condition, higher variability was shown in the overweight children within the 7–9 yr old subgroup for postural sway velocity, and more specifically medial–lateral velocity. Interpretation In spite of these subtle differences, results did not establish any clear underlying sensory organization impairments that may affect standing balance performance in overweight children compared to normal-weight peers. Consequently, it is believed that other factors account for overweight children's functional balance deficiencies.

The influence of underreported crashes on hotspot identification

Hot spot identification (HSID) plays a significant role in improving the safety of transportation networks. Numerous HSID methods have been proposed, developed, and evaluated in the literature. The vast majority of HSID methods reported and evaluated in the literature assume that crash data are complete, reliable, and accurate. Crash under-reporting, however, has long been recognized as a threat to the accuracy and completeness of historical traffic crash records. As a natural continuation of prior studies, the paper evaluates the influence that under-reported crashes exert on HSID methods. To conduct the evaluation, five groups of data gathered from Arizona Department of Transportation (ADOT) over the course of three years are adjusted to account for fifteen different assumed levels of under-reporting. Three identification methods are evaluated: simple ranking (SR), empirical Bayes (EB) and full Bayes (FB). Various threshold levels for establishing hotspots are explored. Finally, two evaluation criteria are compared across HSID methods. The results illustrate that the identification bias—the ability to correctly identify at risk sites--under-reporting is influenced by the degree of under-reporting. Comparatively speaking, crash under-reporting has the largest influence on the FB method and the least influence on the SR method. Additionally, the impact is positively related to the percentage of the under-reported PDO crashes and inversely related to the percentage of the under-reported injury crashes. This finding is significant because it reveals that despite PDO crashes being least severe and costly, they have the most significant influence on the accuracy of HSID.

Towards a model for the analysis and description of mathematical knowledge and understanding

Mathematics education literature has called for an abandonment of ontological and epistemological ideologies that have often divided theory-based practice. Instead, a consilience of theories has been sought which would leverage the strengths of each learning theory and so positively impact upon contemporary educational practice. This research activity is based upon Popper’s notion of three knowledge worlds which differentiates the knowledge shared in a community from the personal knowledge of the individual, and Bereiter’s characterisation of understanding as the individual’s relationship to tool-like knowledge. Using these notions, a re-conceptualisation of knowledge and understanding and a subsequent re-consideration of learning theories are proposed as a way to address the challenge set by literature. Referred to as the alternative theoretical framework, the proposed theory accounts for the scaffolded transformation of each individual’s unique understanding, whilst acknowledging the existence of a body of domain knowledge shared amongst participants in a scientific community of practice. The alternative theoretical framework is embodied within an operational model that is accompanied by a visual nomenclature with which to describe consensually developed shared knowledge and personal understanding. This research activity has sought to iteratively evaluate this proposed theory through the practical application of the operational model and visual nomenclature to the domain of early-number counting, addition and subtraction. This domain of mathematical knowledge has been comprehensively analysed and described. Through this process, the viability of the proposed theory as a tool with which to discuss and thus improve the knowledge and understanding with the domain of mathematics has been validated. Putting of the proposed theory into practice has lead to the theory’s refinement and the subsequent achievement of a solid theoretical base for the future development of educational tools to support teaching and learning practice, including computer-mediated learning environments. Such future activity, using the proposed theory, will advance contemporary mathematics educational practice by bringing together the strengths of cognitivist, constructivist and post-constructivist learning theories.

A Personalized Ontology Model for Web Information Gathering

As a model for knowledge description and formalization, ontologies are widely used to represent user profiles in personalized web information gathering. However, when representing user profiles, many models have utilized only knowledge from either a global knowledge base or a user local information. In this paper, a personalized ontology model is proposed for knowledge representation and reasoning over user profiles. This model learns ontological user profiles from both a world knowledge base and user local instance repositories. The ontology model is evaluated by comparing it against benchmark models in web information gathering. The results show that this ontology model is successful.

The 'nurdle to leg' and other ways of winning cricket matches

The emergence of Twenty20 cricket at the elite level has been marketed on the excitement of the big hitter, where it seems that winning is a result of the muscular batter hitting boundaries at will. This version of the game has captured the imagination of many young players who all want to score runs with “big hits”. However, in junior cricket, boundary hitting is often more difficult due to size limitations of children and games played on outfields where the ball does not travel quickly. As a result, winning is often achieved via a less spectacular route – by scoring more singles than your opponents. However, most standard coaching texts only describe how to play boundary scoring shots (e.g. the drives, pulls, cuts and sweeps) and defensive shots to protect the wicket. Learning to bat appears to have been reduced to extremes of force production, i.e. maximal force production to hit boundaries or minimal force production to stop the ball from hitting the wicket. Initially, this is not a problem because the typical innings of a young player (<12 years) would be based on the concept of “block” or “bash” – they “block” the good balls and “bash” the short balls. This approach works because there are many opportunities to hit boundaries off the numerous inaccurate deliveries of novice bowlers. Most runs are scored behind the wicket by using the pace of the bowler’s delivery to re-direct the ball, because the intrinsic dynamics (i.e. lack of strength) of most children means that they can only create sufficient power by playing shots where the whole body can contribute to force production. This method works well until the novice player comes up against more accurate bowling when they find they have no way of scoring runs. Once batters begin to face “good” bowlers, batters have to learn to score runs via singles. In cricket coaching manuals (e.g. ECB, n.d), running between the wickets is treated as a separate task to batting, and the “basics” of running, such as how to “back- up”, carry the bat, calling and turning and sliding the bat into the crease are “drilled” into players. This task decomposition strategy focussing on techniques is a common approach to skill acquisition in many highly traditional sports, typified in cricket by activities where players hit balls off tees and receive “throw-downs” from coaches. However, the relative usefulness of these approaches in the acquisition of sporting skills is increasingly being questioned (Pinder, Renshaw & Davids, 2009). We will discuss why this is the case in the next section.