Classification of pathology reports for cancer registry notifications

Objective: To develop a system for the automatic classification of pathology reports for Cancer Registry notifications. Method: A two pass approach is proposed to classify whether pathology reports are cancer notifiable or not. The first pass queries pathology HL7 messages for known report types that are received by the Queensland Cancer Registry (QCR), while the second pass aims to analyse the free text reports and identify those that are cancer notifiable. Cancer Registry business rules, natural language processing and symbolic reasoning using the SNOMED CT ontology were adopted in the system. Results: The system was developed on a corpus of 500 histology and cytology reports (with 47% notifiable reports) and evaluated on an independent set of 479 reports (with 52% notifiable reports). Results show that the system can reliably classify cancer notifiable reports with a sensitivity, specificity, and positive predicted value (PPV) of 0.99, 0.95, and 0.95, respectively for the development set, and 0.98, 0.96, and 0.96 for the evaluation set. High sensitivity can be achieved at a slight expense in specificity and PPV. Conclusion: The system demonstrates how medical free-text processing enables the classification of cancer notifiable pathology reports with high reliability for potential use by Cancer Registries and pathology laboratories.

Herbivores and nutrients control grassland plant diversity via light limitation

Human alterations to nutrient cycles1, 2 and herbivore communities3, 4, 5, 6, 7 are affecting global biodiversity dramatically2. Ecological theory predicts these changes should be strongly counteractive: nutrient addition drives plant species loss through intensified competition for light, whereas herbivores prevent competitive exclusion by increasing ground-level light, particularly in productive systems8, 9. Here we use experimental data spanning a globally relevant range of conditions to test the hypothesis that herbaceous plant species losses caused by eutrophication may be offset by increased light availability due to herbivory. This experiment, replicated in 40 grasslands on 6 continents, demonstrates that nutrients and herbivores can serve as counteracting forces to control local plant diversity through light limitation, independent of site productivity, soil nitrogen, herbivore type and climate. Nutrient addition consistently reduced local diversity through light limitation, and herbivory rescued diversity at sites where it alleviated light limitation. Thus, species loss from anthropogenic eutrophication can be ameliorated in grasslands where herbivory increases ground-level light.

Postmodern Theory and the Choreography of Michael Clark

This study addresses two interrelated questions: Can postmodern ‘theory’ illuminate an understanding of Michael Clark’s work? and, a sub-question, In which ways, if at all, does Clark’s work demonstrate a postmodern sensibility? Chapter one, the introduction to this study, provides a ‘portrait’ of postmodernism, that is, it addresses the question What is postmodernism? Chapter two is a biography of Michael Clark. The seminal sections to this study, however, are chapters three and four. Here the author blends a discussion of a) subject matter, treatment and meanings in Clark’s choreography, b) journalistic criticisms of those features of his work, and c) postmodern theory. The outcome of these chapters is to demonstrate that Clark’s works do indeed require re-interpretation and re-evaluation, and to illustrate how these factors might be achieved.

Effects of artificial shade on attack by the mahogany shoot borer, Hypsipyla robusta (Moore)

Swietenia macrophylla King (Meliaceae: Swietenioideae) provides one of the premier timbers of the world. The mahogany shoot borer Hypsipyla robusta Moore (Lepidoptera: Pyralidae) is an economically important pest of S. macrophylla throughout Asia, Africa and the Pacific. No viable method of controlling this pest is known. Previous observations have suggested that the presence of overhead shade may reduce attack by H. robusta, but this has not been investigated experimentally. This research was therefore designed to assess the influence of light availability on shoot-borer attack on S. macrophylla, by establishing seedlings under three different artificial shade regimes, then using these seedlings to test oviposition preference of adult moths, neonate larval survival and growth and development of shoot borer larvae. Oviposition preference of shoot borer moths was tested on leaves from seedlings grown under artificial shade for 63 weeks. A significant difference in choice was recorded between treatments, with 27.4 ± 1.5 eggs laid under high shade and 87.1 ± 1.8 under low shade. Neonate larval survival on early flushing leaflets of S. macrophylla did not differ significantly between shade treatments. Larval growth rate, estimated by measuring daily frass width, was significantly higher for those larvae fed on seedlings from the high and medium shade treatments (0.1 mm/day), than the low shade treatment (0.06 mm/day). In laboratory-reared larvae, the total mass of frass produced was significantly higher in the high shade treatment (0.4 g) than under the low shade treatment (0.2 g). Longer tunnel lengths were bored by larvae in plants grown under high shade (12.0 ± 2.4 cm) than under low shade (7.07 ± 1.9 cm). However, pupal mass under low shade was 48% higher than that under the high shade treatment, suggesting that plants grown under high shade were of lower nutritional quality for shoot borer larvae. These results indicate that shading of mahogany seedlings may reduce the incidence of shoot borer attack, by influencing both oviposition and larval development. The establishment of mahogany under suitable shade regimes may therefore provide a basis for controlling shoot borer attack using silvicultural approaches.

Tornado Damage Assessment in the aftermath of the May 20th 2013 Moore Oklahoma Tornado

This report presents observations, findings, and recommendations from an engineering reconnaissance trip following the May 20th, 2013 tornado that struck Moore, Oklahoma. A team of faculty, research scientists, professional engineers, and civil engineering students were tasked with investigating and documenting the performance of critical facility buildings and residences, (IBC Occupancy Category II, III, and IV), in Moore, OK. The Enhanced Fujita (EF) 5 tornado created a 17-mile long damage swath destroying over 12,000 buildings and killing 24 people. The total economic loss from this single event was estimated at $3 billion. The May 20th tornado was the third major tornado to hit Moore in the previous 15 years.

Avoiding giving advice in telephone counselling for children and young people

Kids Helpline is an Australian 24-hour telephone counselling helpline for children and young people up to the age of 25 years old. The service operates with the core values of empowerment for clients, and the use of child-centred practices, one aspect of which is a non-directive approach highlighted by the avoidance of overt advice giving. Through analysis of a single call to the helpline, this chapter demonstrates how counsellors actively manage and minimise the normative and asymmetric properties of advice in the course if helping clients develop options for change. In doing so we illustrate the practical relevance and enactment of abstract institutional policies and discuss the interactional affordances of institutional constraints on practice.

Michael Kirby's challenge: Intellectual property, HIV/AIDS, and human rights

In July 2014, Melbourne hosted the 20th International AIDS Conference. The event opened, paying tribute to the late Dutch HIV/AIDS researcher Professor Joep Lange, with his image projected onto a screen, with the accompanying quotation: ‘If we can bring a bottle of Coke to every corner of Africa, we should be able to also deliver antiretroviral drugs.’

Plant species’ origin predicts dominance and response to nutrient enrichment and herbivores in global grasslands

Exotic species dominate many communities; however the functional significance of species’ biogeographic origin remains highly contentious. This debate is fuelled in part by the lack of globally replicated, systematic data assessing the relationship between species provenance, function and response to perturbations. We examined the abundance of native and exotic plant species at 64 grasslands in 13 countries, and at a subset of the sites we experimentally tested native and exotic species responses to two fundamental drivers of invasion, mineral nutrient supplies and vertebrate herbivory. Exotic species are six times more likely to dominate communities than native species. Furthermore, while experimental nutrient addition increases the cover and richness of exotic species, nutrients decrease native diversity and cover. Native and exotic species also differ in their response to vertebrate consumer exclusion. These results suggest that species origin has functional significance, and that eutrophication will lead to increased exotic dominance in grasslands.

Burden attributable to child maltreatment in Australia

Child maltreatment is a complex phenomenon, with four main types (childhood sexual abuse, physical abuse, emotional abuse, and neglect) highly interrelated. All types of maltreatment have been linked to adverse health consequences and exposure to multiple forms of maltreatment increases risk. In Australia to date, only burden attributable to childhood sexual abuse has been estimated. This study synthesized the national evidence and quantified the burden attributable to the four main types of child maltreatment. Meta-analyses, based on quality-effects models, generated pooled prevalence estimates for each maltreatment type. Exposure to child maltreatment was examined as a risk factor for depressive disorders, anxiety disorders and intentional self-harm using counterfactual estimation and comparative risk assessment methods. Adjustments were made for co-occurrence of multiple forms of child maltreatment. Overall, an estimated 23.5% of self-harm, 20.9% of anxiety disorders and 15.7% of depressive disorders burden in males; and 33.0% of self-harm, 30.6% of anxiety disorders and 22.8% of depressive disorders burden in females was attributable to child maltreatment. Child maltreatment was estimated to cause 1.4% (95% uncertainty interval 0.4–2.3%) of all disability-adjusted life years (DALYs) in males, and 2.4% (0.7–4.1%) of all DALYs in females in Australia in 2010. Child maltreatment contributes to a substantial proportion of burden from depressive and anxiety disorders and intentional self-harm in Australia. This study demonstrates the importance of including all forms of child maltreatment as risk factors in future burden of disease studies.

Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: Quantifying the epidemiological transition

Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age–sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6–6·6), from 65·3 years (65·0–65·6) in 1990 to 71·5 years (71·0–71·9) in 2013, HALE at birth rose by 5·4 years (4·9–5·8), from 56·9 years (54·5–59·1) to 62·3 years (59·7–64·8), total DALYs fell by 3·6% (0·3–7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6–29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non–communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

Soliciting additional concerns in the primary care consultation and the utility of a brief communication intervention to aid solicitation: A qualitative study

Objective To investigate the perspectives of general practitioners (GPs) on the practice of soliciting additional concerns (ACs) and the acceptability and utility of two brief interventions (prompts) designed to aid the solicitation. Methods Eighteen GPs participating in a feasibility randomised controlled trial were interviewed. Interviews were semi-structured and audio-recorded. Data were analysed using a Framework Approach. Results Participants perceived eliciting ACs as important for: reducing the need for multiple visits, identifying serious illness early, and increasing patient and GP satisfaction. GPs found the prompts easy to use and some continued their use after the study had ended to aid time management. Others noted similarities between the intervention and their usual practice. Nevertheless, soliciting ACs in every consultation was not unanimously supported. Conclusion The prompts were acceptable to GPs within a trial context, but there was disagreement as to whether ACs should be solicited routinely. Some GPs considered the intervention to aid their prioritisation efficiency within consultations. Practice implications Some GPs will find prompts which encourage ACs to be solicited early in the consultation enable them to better organise priorities and manage time-limited consultations more effectively.

Reformin implementaatio - Michael Fullanin teoriaan perustuva muutosteoreettisten tekijöiden sisällönanalyyttinen tarkastelu Kelpo-kehittämistoiminnan kunnallisten koordinaattoreiden puheessa

The educational reform, launched in Finland in 2008, concerns the implementation of the Special Education Strategy (Opetusministeriö 2007) under an improvement initiative called Kelpo. One of the main proposed alterations of the Strategy relates to the support system of comprehensive school pupils. The existed two-level model (general and special support) is to be altered by the new three-level model (general, intensified and special support). There are 233 municipalities involved nationwide in the Kelpo initiative, each of which has a municipal coordinator as a national delegate. The Centre for Educational Assessment [the Centre] at the University of Helsinki, led by Professor Jarkko Hautamäki, carries out the developmental assessment of the initiative’s developmental process. As a part of that assessment the Centre interviewed 151 municipal coordinators in November 2008. This thesis considers the Kelpo initiative from Michael Fullan’s change theory’s aspect. The aim is to identify the change theoretical factors in the speech of the municipal coordinators interviewed by the Centre, and to constitute a view of what the crucial factors in the reform implementation process are. The appearance of the change theoretical factors, in the coordinators’ speech, and the meaning of these appearances are being considered from the change process point of view. The Centre collected the data by interviewing the municipal coordinators (n=151) in small groups of 4-11 people. The interview method was based on Vesala and Rantanen’s (2007) qualitative attitude survey method which was adapted and evolved for the Centre’s developmental assessment by Hilasvuori. The method of the analysis was a qualitative theory-based content analysis, processed using the Atlas.ti software. The theoretical frame of reference was grounded on Fullan’s change theory and the analysis was based on three change theoretical categories: implementation, cooperation and perspectives in the change process. The analysis of the interview data revealed spoken expressions in the coordinators’ speech which were either positively or negatively related to the theoretical categories. On the grounds of these change theoretical relations the existence of the change process was observed. The crucial factors of reform implementation were found, and the conclusion is that the encounter of the new reform-based and already existing strategies in school produces interface challenges. These challenges are particularly confronted in the context of the implementation of the new three-level support model. The interface challenges are classified as follows: conceptual, method-based, action-based and belief-based challenges. Keywords: reform, implementation, change process, Michael Fullan, Kelpo, intensified support, special support