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.

Contemporary New Zealand coefficients for the Trauma Injury Severity Score: TRISS(NZ)

Aims – To develop local contemporary coefficients for the Trauma Injury Severity Score in New Zealand, TRISS(NZ), and to evaluate their performance at predicting survival against the original TRISS coefficients. Methods – Retrospective cohort study of adults who sustained a serious traumatic injury, and who survived until presentation at Auckland City, Middlemore, Waikato, or North Shore Hospitals between 2002 and 2006. Coefficients were estimated using ordinary and multilevel mixed-effects logistic regression models. Results – 1735 eligible patients were identified, 1672 (96%) injured from a blunt mechanism and 63 (4%) from a penetrating mechanism. For blunt mechanism trauma, 1250 (75%) were male and average age was 38 years (range: 15-94 years). TRISS information was available for 1565 patients of whom 204 (13%) died. Area under the Receiver Operating Characteristic (ROC) curves was 0.901 (95%CI: 0.879-0.923) for the TRISS(NZ) model and 0.890 (95% CI: 0.866-0.913) for TRISS (P<0.001). Insufficient data were available to determine coefficients for penetrating mechanism TRISS(NZ) models. Conclusions – Both TRISS models accurately predicted survival for blunt mechanism trauma. However, TRISS(NZ) coefficients were statistically superior to TRISS coefficients. A strong case exists for replacing TRISS coefficients in the New Zealand benchmarking software with these updated TRISS(NZ) estimates.

Green a city grow a wall

As Brisbane grows, it is rapidly becoming akin to any other city in the world with its typical stark grey concrete buildings rather than being characterized by its subtropical element of abundant green vegetation. Living Walls can play a vital role in restoring the loss of this distinct local element of a subtropical city. This paper will start by giving an overview of the traditional methods of greening subtropical cities with the use of urban parks and street trees. Then, by examining a recent heat imaging map of Brisbane, the effect of green cover with the built environment will be shown. With this information from a macro level, this paper will proceed to examine a typical urban block within the Central Business District (CBD) to demonstrate urban densification in relation to greenery in the city. Then, this paper will introduce the new technology where Living Walls have the untapped potential of effectively greening a city where land is scarce and given over to high density development. Living Walls incorporated into building design does not only enhance the subtropical lifestyle that is being lost in modern cities but is also an effective means for addressing climate change. This paper will serve as a preliminary investigation into the effects of incorporating Living Walls into cities. By growing a Living Wall onto buildings, we can be part of an effective design solution for countering global warming and at the same time, Living Walls can return local character to subtropical cities, thereby greening the city as well.

Developing a rural land investment performance index for New Zealand

Agricultural production is one of the major industries in New Zealand and accounts for over 60% of all export trade. The farming industry comprises 70,000 entities ranging in size from small individual run farms to large corporate operations. The reliance of the New Zealand economy to the international rural sector has seen considerable volatility in the rural land markets over the past four decades, with significant shifts in rural land prices based on location, land use and underlying international rural commodity prices. With the increasing attention being paid to the rural sector, especially in relation to food production and bio-fuels, there has been an increasing corporate interest in rural land ownership in relatively low subsidised agricultural producing countries such as New Zealand and Australia. A factor that has limited this participation of institutional investors previously has been a lack of reliable and up-to-date investment performance data for this asset class. This paper is the initial starting phase in the development of a New Zealand South Island rural land investment performance index and covers the period 1990-2007. The research in this paper analyses all rural sales transactions in the South Island and develops a capital return index for rural property based on major rural property land use. Additional work on this index will cover both total return performance and geographic location.

Increase in Body Mass Index decreases body satisfaction of their abdominal, arm and thigh regions in young Japanese women [in Japanese]

The aim of the present study was to examine body concern and satisfactions in 191 female university students and their relationships with measured body composition and circumferences of selected body parts. Body composition and circumference measurements of participants were conducted after obtaining their consent. Body concern and satisfaction were determined using the Body Shape Questionnaire (BSQ) and the Body parts and General subscales from the Body Satisfaction Scales (BSS). Increase in body composition and circumferences were associated with decrease in body concern and satisfaction. Increase in body size, including circumferences did not decrease whole body satisfaction but increased dissatisfaction at the abdominal, arm and thigh regions.

The effectiveness of using a simple ARIA based geographical classification to identify road crash patterns in rural and urban areas of Queensland

Research has noted a ‘pronounced pattern of increase with increasing remoteness' of death rates in road crashes. However, crash characteristics by remoteness are not commonly or consistently reported, with definitions of rural and urban often relying on proxy representations such as prevailing speed limit. The current paper seeks to evaluate the efficacy of the Accessibility / Remoteness Index of Australia (ARIA+) to identifying trends in road crashes. ARIA+ does not rely on road-specific measures and uses distances to populated centres to attribute a score to an area, which can in turn be grouped into 5 classifications of increasing remoteness. The current paper uses applications of these classifications at the broad level of Australian Bureau of Statistics' Statistical Local Areas, thus avoiding precise crash locating or dedicated mapping software. Analyses used Queensland road crash database details for all 31,346 crashes resulting in a fatality or hospitalisation occurring between 1st July, 2001 and 30th June 2006 inclusive. Results showed that this simplified application of ARIA+ aligned with previous definitions such as speed limit, while also providing further delineation. Differences in crash contributing factors were noted with increasing remoteness such as a greater representation of alcohol and ‘excessive speed for circumstances.' Other factors such as the predominance of younger drivers in crashes differed little by remoteness classification. The results are discussed in terms of the utility of remoteness as a graduated rather than binary (rural/urban) construct and the potential for combining ARIA crash data with census and hospital datasets.

A disordered approach

It seems a new behaviour disorder is identified every week. Forms of conduct once simply regarded as part of the human condition, are rapidly being reinterpreted as types of mental illness. Individuals are no longer simply quiet or shy, they are reclassified as suffering from Generalised Social Phobia, or Selective Mutism, or Avoidant Personality Disorder. Others are no longer simply unpopular or obnoxious, they are reclassified as Borderline Personality Disorder, or Antisocial Personality Disorder. Still more are no longer lively or boisterous, they have Attention Deficit Hyperactivity Disorder, or Conduct Disorder, or Oppositional Defiance Disorder.

High porosity chained aggregates from the topsoil of the lunar regolith dust

The unusual behaviour of fine lunar regolith like stickiness and low heat conductivity is dominated by the structural arrangement of its finest fraction. Here, we show the previously unknown phenomenon of a globular 3D superstructure within the dust fraction of regolith. A study using the recently developed Transmission X-ray Microscopy (TXM) with tomographic reconstruction reveals a highly porous network of cellular voids in the finest dust fraction aggregates in lunar soil. Such porous chained aggregates are composed of sub-micron particles that form a network of cellular voids a few micrometers in diameter. Discovery of such a superstructure within the finest fraction of lunar topsoil enables a model of heat transfer to be constructed.

Age-related development of a refractive index plateau in the human lens : evidence for a distinct nucleus

The human lens comprises two distinct regions in which the refractive index changes at different rates. The periphery contains a rapidly increasing refractive index gradient, which becomes steeper with age. The inner region contains a shallow gradient, which flattens with age, due to formation of a central plateau, of RI = 1.418, which reaches a maximum size of 7.0 × 3.05 mm around age 60 years. Formation of the plateau can be attributed to compression of fibre cells generated in prenatal life. Present in prenatal but not in postnatal fibre cells, γ-crystallin may play a role in limiting nuclear cell compression.

Development and validation of 3-Minute Nutrition Screening (3-MinNS) tool for acute hospital patients in Singapore

It is important to detect and treat malnutrition in hospital patients so as to improve clinical outcome and reduce hospital stay. The aim of this study was to develop and validate a nutrition screening tool with a simple and quick scoring system for acute hospital patients in Singapore. In this study, 818 newly admitted patients aged above 18 years old were screened using five parameters that contribute to the risk of malnutrition. A dietitian blinded to the nutrition screening score assessed the same patients using the reference standard, Subjective Global Assessment (SGA) within 48 hours. The sensitivity and specificity were established using the Receiver Operator Characteristics (ROC) curve and the best cutoff scores determined. The nutrition parameter with the largest Area Under the ROC Curve (AUC) was chosen as the final screening tool, which was named 3-Minute Nutrition Screening (3-MinNS). The combination of the parameters weight loss, intake and muscle wastage (3-MinNS), gave the largest AUC when compared with SGA. Using 3-MinNS, the best cutoff point to identify malnourished patients is three (sensitivity 86%, specificity 83%). The cutoff score to identify subjects at risk of severe malnutrition is five (sensitivity 93%, specificity 86%). 3-Minute Nutrition Screening is a valid, simple and rapid tool to identify patients at risk of malnutrition in Singapore acute hospital patients. It is able to differentiate patients at risk of moderate malnutrition and severe malnutrition for prioritization and management purposes.

Collaborative recovery: An integrative model for working with individuals that experience chronic or recurring mental illness.

Objectives: Recovery is an emerging movement in mental health. Evidence for recovery-based approaches is not well developed and approaches to implement recovery-oriented services are not well articulated. The collaborative recovery model (CRM) is presented as a model that assists clinicians to use evidence-based skills with consumers, in a manner consistent with the recovery movement. A current 5 year multisite Australian study to evaluate the effectiveness of CRM is briefly described. Conclusion: The collaborative recovery model puts into practice several aspects of policy regarding recovery-oriented services, using evidence-based practices to assist individuals who have chronic or recurring mental disorders (CRMD). It is argued that this model provides an integrative framework combining (i) evidence-based practice; (ii) manageable and modularized competencies relevant to case management and psychosocial rehabilitation contexts; and (iii) recognition of the subjective experiences of consumers.

The use of the Index for Inclusion in a regional educational learning community

This project utilised the materials of the Index for Inclusion (Booth & Ainscow, 2002) to enhance the development of a learning community of educators in Education Queensland in 2009. The values, dimensions and indicators of the Index for Inclusion, were incorporated into the professional development package, On the Same Page (Education Queensland, 2008), to enhance its wider purpose to improve inclusive education practices explicit within the P-12 Curriculum Framework (Education Queensland, 2008). The incorporation of the values, dimensions and indicators of the Index enabled deeper reflection by participants about their expectations of students and their resulting teaching practices. The subsequent development of action plans assisted participants to develop “a curriculum for all” (Education Queensland, 2008, p. 9). Deeper reflection, action planning and ‘distance travelled’ in understanding of inclusive education were apparent in the comments by participants and their evaluation of the professional development package.

Data-driven impostor selection for T-norm score normalisation and the background dataset in SVM-based speaker verification

A data-driven background dataset refinement technique was recently proposed for SVM based speaker verification. This method selects a refined SVM background dataset from a set of candidate impostor examples after individually ranking examples by their relevance. This paper extends this technique to the refinement of the T-norm dataset for SVM-based speaker verification. The independent refinement of the background and T-norm datasets provides a means of investigating the sensitivity of SVM-based speaker verification performance to the selection of each of these datasets. Using refined datasets provided improvements of 13% in min. DCF and 9% in EER over the full set of impostor examples on the 2006 SRE corpus with the majority of these gains due to refinement of the T-norm dataset. Similar trends were observed for the unseen data of the NIST 2008 SRE.

Introduction of a short writing task to measure and develop academic literacy in first year health undergraduates

This paper describes an initiative in the Faculty of Health at the Queensland University of Technology, Australia, where a short writing task was introduced to first year undergraduates in four courses including Public Health, Nursing, Social Work and Human Services, and Human Movement Studies. Over 1,000 students were involved in the trial. The task was assessed using an adaptation of the MASUS Procedure (Measuring the Academic Skills of University Students) (Webb & Bonanno, 1994). Feedback to the students including MASUS scores then enabled students to be directed to developmental workshops targeting their academic literacy needs. Students who achieved below the benchmark score were required to attend academic writing workshops in order to obtain the same summative 10% that was obtained by those who had achieved above the benchmark score. The trial was very informative, in terms of determining task appropriateness and timing, student feedback, student use of support, and student perceptions of the task and follow-up workshops. What we learned from the trial will be presented with a view to further refinement of this initiative.