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.

A reflective model for colour studies learning

In a university context how should colour be taught in order to engage students? Entwistle states, ‘What we learn depends on how we learn, and why we have to learn it.’ Therefore, there is a need to address the accumulating evidence that highlights the effects of learning environments on the quality of student learning when considering colour education. It is necessary to embrace the contextual demands while ensuring that the student knowledge of colour and the joy of discovering its characteristics in practice are enhanced. Institutional policy is forcing educators to re-evaluate traditional studio’s effectiveness and the intensive 'hands-on' interactive approach that is embedded in such an approach. As curriculum development involves not only theory and project work, the classroom culture and physical environment also need to be addressed. The increase in student numbers impacting the number of academic staff/student ratio, availability of teaching support as well as increasing variety of student age, work commitments, learning styles and attitudes have called for positive changes to how we teach. The Queensland University of Technology’s restructure in 2005 was a great opportunity to re-evaluate and redesign the approach to teaching within the design units of Interior Design undergraduate program –including colour. The resultant approach “encapsulates a mode of delivery, studio structure, as well as the learning context in which students and staff interact to facilitate learning”1 with a potential “to be integrated into a range of Interior Design units as it provides an adaptive educational framework rather than a prescriptive set of rules”.

What is that place? Observations of the impact of environment colour through photographic analysis

Isolating the impact of a colour, or a combination of colours, is extremely difficult to achieve because it is difficult to remove other environmental elements such as sound, odours, light, and occasion from the experience of being in a place. In order to ascertain the impact of colour on how we interpret the world in day to day situations, the current study records participant responses to achromatic scenes of the built environment prior to viewing the same scene in colour. A number of environments were photographed in colour or copied from design books; and copies of the images saved as both colour and black/grey/white. An overview of the study will be introduced by firstly providing examples of studies which have linked colour to meaning and emotions. For example, yellow is said to be connected to happiness1 ; or red evokes feelings of anger2 or passion. A link between colour and the way we understand and/or feel is established however, there is a further need for knowledge of colour in context. In response to this need, the current achromatic/chromatic environmental study will be described and discussed in light of the findings. Finally, suggestions for future research are posed. Based on previous research the authors hypothesised that a shift in environmental perception by participants would occur. It was found that the impact of colour includes a shift in perception of aspects such as its atmosphere and youthfulness. Through studio-class discussions it was also noted that the predicted age of the place, the function, and in association, the potential users when colour was added (or deleted) were often challenged. It is posited that the ability of a designer (for example, interior designer, architect, or landscape architect) to design for a particular target group—user and/or clients will be enhanced through more targeted studies relating colour in situ. The importance of noting the perceptual shift for the participants in our study, who were young designers, is the realisation that colour potentially holds the power to impact on the identity of an architectural form, an interior space, and/or particular elements such as doorways, furniture settings, and the like.

Multilineage differentiation potential of bone and cartilage cells derived from explant culture

To date, mesenchymal stem cells (MSCs) from various tissues have been reported, but the yield and differentiation potential of different tissue-derived MSCs is still not clear. This study was undertaken in an attempt to investigate the multilineage stem cell potential of bone and cartilage explant cultures in comparison with bone marrow derived mesenchymal stem cells (BMSCs). The results showed that the surface antigen expression of tissue-derived cells was consistent with that of mesenchymal stem cells, such as lacking the haematopoietic and common leukocyte markers (CD34, CD45) while expressing markers related to adhesion (CD29, CD166) and stem cells (CD90, CD105). The tissue-derived cells were able to differentiate into osteoblast, chondrocyte and adipocyte lineage pathways when stimulated in the appropriate differentiating conditions. However, compared with BMSCs, tissue-derived cells showed less capacity for multilineage differentiation when the level of differentiation was assessed in monolayer culture by analysing the expression of tissue-specific genes by reverse transcription polymerase chain reaction (RT-PCR) and histology. In high density pellet cultures, tissue-derived cells were able to differentiate into chondrocytes, expressing chondrocyte markers such as proteoglycans, type II collagen and aggrecan. Taken together, these results indicate that cells derived from tissue explant cultures reserved certain degree of differentiation properties of MSCs in vitro.

Sense and sensibility by Jane Austen

It's the fact that it's Austen mentioned here that provokes a response. The broad cultural veneration of Jane Austen means that even those who have never read her work are likely to have a strong reaction to Emerson's famou quotation. It is worth considering Emerson's accustion befor teaching an Austen novel, as many of his assertions will be amde - albeit in different terms - byt twenty-first-century students.

Living walls - a way to green the built environment

Actions Towards Sustainable Outcomes Environmental Issues/Principal Impacts The increasing urbanisation of cities brings with it several detrimental consequences, such as: • Significant energy use for heating and cooling many more buildings has led to urban heat islands and increased greenhouse gas emissions. • Increased amount of hard surfaces, which not only contributes to higher temperatures in cities, but also to increased stormwater runoff. • Degraded air quality and noise. • Health and general well-being of people is frequently compromised, by inadequate indoor air quality. • Reduced urban biodiversity. Basic Strategies In many design situations, boundaries and constraints limit the application of cutting EDGe actions. In these circumstances, designers should at least consider the following: • Living walls are an emerging technology, and many Australian examples function more as internal feature walls. However,as understanding of the benefits and construction of living walls develops this technology could be part of an exterior facade that enhances a building’s thermal performance. • Living walls should be designed to function with an irrigation system using non-potable water. Cutting EDGe Strategies • Living walls can be part of a design strategy that effectively improves the thermal performance of a building, thereby contributing to lower energy use and greenhouse gas emissions. • Including living walls in the initial stages of design would provide greater flexibility to the design, especially of the facade, structural supports, mechanical ventilation and watering systems, thus lowering costs. • Designing a building with an early understanding of living walls can greatly reduce maintenance costs. • Including plant species and planting media that would be able to remove air impurities could contribute to improved indoor air quality, workplace productivity and well-being. Synergies and References • Living walls are a key research topic at the Centre for Subtropical Design, Queensland University of Technology: http://www.subtropicaldesign.bee.qut.edu.au • BEDP Environment Design Guide: DES 53: Roof and Facade Gardens • BEDP Environment Design Guide: GEN 4: Positive Development – Designing for Net Positive Impacts (see green scaffolding and green space frame walls). • Green Roofs Australia: www.greenroofs.wordpress.com • Green Roofs for Healthy Cities USA: www.greenroofs.org

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.

Mechanobiology of Bone Development and Computational Simulations

Bone is important because it provides the skeleton structural integrity and enables movement and locomotion. Its development and morphology follow its function. It adapts to changes of mechanical loading and has the ability to repair itself after damage or fracture. The processes of bone development, bone adaptation, and bone regeneration in fracture healing are regulated, in part, by mechanical stimuli that result when the bone is loaded.

Modelling the effects of bone fragment contact in fracture healing

The fracture healing process is modulated by the mechanical environment created by imposed loads and motion between the bone fragments. Contact between the fragments obviously results in a significantly different stress and strain environment to a uniform fracture gap containing only soft tissue (e.g. haematoma). The assumption of the latter in existing computational models of the healing process will hence exaggerate the inter-fragmentary strain in many clinically-relevant cases. To address this issue, we introduce the concept of a contact zone that represents a variable degree of contact between cortices by the relative proportions of bone and soft tissue present. This is introduced as an initial condition in a two-dimensional iterative finite element model of a healing tibial fracture, in which material properties are defined by the volume fractions of each tissue present. The algorithm governing the formation of cartilage and bone in the fracture callus uses fuzzy logic rules based on strain energy density resulting from axial compression. The model predicts that increasing the degree of initial bone contact reduces the amount of callus formed (periosteal callus thickness 3.1mm without contact, down to 0.5mm with 10% bone in contact zone). This is consistent with the greater effective stiffness in the contact zone and hence, a smaller inter-fragmentary strain. These results demonstrate that the contact zone strategy reasonably simulates the differences in the healing sequence resulting from the closeness of reduction.

Bringing academics on board : encouraging institution-wide diffusion of e-learning environments

Rapid advances in educational and information communications technology (ICT)have encouraged some educators to move beyond traditional face to face and distance education correspondence modes toward a rich, technology mediated e-learning environment. Ready access to multimedia at the desktop has provided the opportunity for educators to develop flexible, engaging and interactive learning resources incorporating multimedia and hypermedia. However, despite this opportunity, the adoption and integration of educational technologies by academics across the tertiary sector has typically been slow. This paper presents the findings of a qualitative study that investigated factors influencing the manner in which academics adopt and integrate educational technology and ICT. The research was conducted at a regional Australian university, the University of Southern Queensland (USQ), and focused on the development of e-learning environments. These e-learning environments include a range of multimodal learning objects and multiple representations of content that seek to cater for different learning styles and modal preferences, increase interaction, improve learning outcomes, provide a more inclusive and equitable curriculum and more closely mirror the on campus learning experience. This focus of this paper is primarily on the barriers or inhibitors academics reported in the study, including institutional barriers, individual inhibitors and pedagogical concerns. Strategies for addressing these obstacles are presented and implications and recommendations for educational institutions are discussed.

Establishment of a preclinical ovine model for tibial segmental bone defect repair by applying bone tissue engineering strategies

Currently, well-established clinical therapeutic approaches for bone reconstruction are restricted to the transplantation of autografts and allografts, and the implantation of metal devices or ceramic-based implants to assist bone regeneration. Bone grafts possess osteoconductive and osteoinductive properties, however they are limited in access and availability and associated with donor site morbidity, haemorrhage, risk of infection, insufficient transplant integration, graft devitalisation, and subsequent resorption resulting in decreased mechanical stability. As a result, recent research focuses on the development of alternative therapeutic concepts. The field of tissue engineering has emerged as an important approach to bone regeneration. However, bench to bedside translations are still infrequent as the process towards approval by regulatory bodies is protracted and costly, requiring both comprehensive in vitro and in vivo studies. The subsequent gap between research and clinical translation, hence commercialization, is referred to as the ‘Valley of Death’ and describes a large number of projects and/or ventures that are ceased due to a lack of funding during the transition from product/technology development to regulatory approval and subsequently commercialization. One of the greatest difficulties in bridging the Valley of Death is to develop good manufacturing processes (GMP) and scalable designs and to apply these in pre-clinical studies. In this article, we describe part of the rationale and road map of how our multidisciplinary research team has approached the first steps to translate orthopaedic bone engineering from bench to bedside byestablishing a pre-clinical ovine critical-sized tibial segmental bone defect model and discuss our preliminary data relating to this decisive step.

Making sense of the resource-based view?

The Resource Based View (RBV) of strategic management has been criticized for relying on inconsistent assumptions of rationality, and mutually inconsistent underlying hypotheses. In this paper, I outline how these critiques can be addressed by re-building RBV on a sense-making foundation. The core notions from sense-making of bounded cognition, retrospective sense-making, incrementalism, loose coupling, causal maps and organizational paradigm are introduced. These are then used to propose a re-construction of key RBV constructs, extending some conceptual discussions, and providing for a conceptually consistent formulation. Implications for the use of RBV as a theory and future research are discussed.

Adopting building information modeling (BIM) as collaboration platform in the design industry

This paper discusses the preliminary findings of an ongoing research project aimed at developing a technological, operational and strategic analysis of adopting BIM in AEC/FM (Architecture-Engineering-Construction/Facility Management) industry as a collaboration tool. Outcomes of the project will provide specifications and guidelines as well as establish industry standards for implementing BIM in practice. This research primarily focuses on BIM model servers as a collaboration platform, and hence the guidelines are aimed at enhancing collaboration capabilities. This paper reports on the findings from: (1) a critical review of latest BIM literature and commercial applications, and (2) workshops with focus groups on changing work-practice, role of technology, current perception and expectations of BIM. Layout for case studies being undertaken is presented. These findings provide a base to develop comprehensive software specifications and national guidelines for BIM with particular emphasis on BIM model servers as collaboration platforms.