Response shift, recall bias and their effect on measuring change in health-related quality of life amongst older hospital patients

Background: Assessments of change in subjective patient reported outcomes such as health-related quality of life (HRQoL) are a key component of many clinical and research evaluations. However, conventional longitudinal evaluation of change may not agree with patient perceived change if patients' understanding of the subjective construct under evaluation changes over time (response shift) or if patients' have inaccurate recollection (recall bias). This study examined whether older adults' perception of change is in agreement with conventional longitudinal evaluation of change in their HRQoL over the duration of their hospital stay. It also investigated this level of agreement after adjusting patient perceived change for recall bias that patients may have experienced. Methods: A prospective longitudinal cohort design nested within a larger randomised controlled trial was implemented. 103 hospitalised older adults participated in this investigation at a tertiary hospital facility. The EQ-5D utility and Visual Analogue Scale (VAS) scores were used to evaluate HRQoL. Participants completed EQ-5D reports as soon as they were medically stable (within three days of admission) then again immediately prior to discharge. Three methods of change score calculation were used (conventional change, patient perceived change and patient perceived change adjusted for recall bias). Agreement was primarily investigated using intraclass correlation coefficients (ICC) and limits of agreement. Results: Overall 101 (98%) participants completed both admission and discharge assessments. The mean (SD) age was 73.3 (11.2). The median (IQR) length of stay was 38 (20-60) days. For agreement between conventional longitudinal change and patient perceived change: ICCs were 0.34 and 0.40 for EQ-5D utility and VAS respectively. For agreement between conventional longitudinal change and patient perceived change adjusted for recall bias: ICCs were 0.98 and 0.90 respectively. Discrepancy between conventional longitudinal change and patient perceived change was considered clinically meaningful for 84 (83.2%) of participants, after adjusting for recall bias this reduced to 8 (7.9%). Conclusions: Agreement between conventional change and patient perceived change was not strong. A large proportion of this disagreement could be attributed to recall bias. To overcome the invalidating effect of response shift (on conventional change) and recall bias (on patient perceived change) a method of adjusting patient perceived change for recall bias has been described.

Evidence of disagreement between patient-perceived change and conventional longitudinal evaluation of change in health-related quality of life among older adults

Objective: To identify agreement levels between conventional longitudinal evaluation of change (post–pre) and patient-perceived change (post–then test) in health-related quality of life. Design: A prospective cohort investigation with two assessment points (baseline and six-month follow-up) was implemented. Setting: Community rehabilitation setting. Subjects: Frail older adults accessing community-based rehabilitation services. Intervention: Nil as part of this investigation. Main measures: Conventional longitudinal change in health-related quality of life was considered the difference between standard EQ-5D assessments completed at baseline and follow-up. To evaluate patient-perceived change a ‘then test’ was also completed at the follow-up assessment. This required participants to report (from their current perspective) how they believe their health-related quality of life was at baseline (using the EQ-5D). Patient-perceived change was considered the difference between ‘then test’ and standard follow-up EQ-5D assessments. Results: The mean (SD) age of participants was 78.8 (7.3). Of the 70 participants 62 (89%) of data sets were complete and included in analysis. Agreement between conventional (post–pre) and patient-perceived (post–then test) change was low to moderate (EQ-5D utility intraclass correlation coefficient (ICC)¼0.41, EQ-5D visual analogue scale (VAS) ICC¼0.21). Neither approach inferred greater change than the other (utility P¼0.925, VAS P¼0.506). Mean (95% confidence interval (CI)) conventional change in EQ-5D utility and VAS were 0.140 (0.045,0.236) and 8.8 (3.3,14.3) respectively, while patient-perceived change was 0.147 (0.055,0.238) and 6.4 (1.7,11.1) respectively. Conclusions: Substantial disagreement exists between conventional longitudinal evaluation of change in health-related quality of life and patient-perceived change in health-related quality of life (as measured using a then test) within individuals.

Change is life process

A paper presented at the Rockhampton Women's Business Network Breakfast on 6 October 2000. Breakfast presentations were to be sharing, reflective and a light start to the day.

Effect of thermal treatment on adsorption-desorption of ammonia and sulfur dioxide on palygorskite : change of surface acid-alkali properties

Thermally activated Palygorskite (Pg) has been found to be a good adsorbent material for ammonia (NH3) and sulfur dioxide (SO2). This research investigated the effect of thermal treatment on pore structure and surface acid-alkali properties of Pg through the adsorption-desorption of NH3 and SO2. The results showed that, up to 200 °C, the adsorption of NH3 on Pg was significantly higher than SO2. This was due to NH3 being adsorbed in the internal surface of Pg and forming hydrogen bonds (H-bonds) with coordinated water. The increase in thermal treatment temp. from 150 to 550 °C, showed a gradual decrease in the no. of surface acid sites, while the no. of surface alk. sites increased from 200 to 400 °C. The change of surface acidity-alk. sites is due to the collapse of internal channels of Pg and desorption of different types of hydroxyls assocd. with the Pg structure.

Fixed-wing attitude estimation using temporal tracking of the horizon and optical flow

In this paper, a method has been developed for estimating pitch angle, roll angle and aircraft body rates based on horizon detection and temporal tracking using a forward-looking camera, without assistance from other sensors. Using an image processing front-end, we select several lines in an image that may or may not correspond to the true horizon. The optical flow at each candidate line is calculated, which may be used to measure the body rates of the aircraft. Using an Extended Kalman Filter (EKF), the aircraft state is propagated using a motion model and a candidate horizon line is associated using a statistical test based on the optical flow measurements and the location of the horizon. Once associated, the selected horizon line, along with the associated optical flow, is used as a measurement to the EKF. To test the accuracy of the algorithm, two flights were conducted, one using a highly dynamic Uninhabited Airborne Vehicle (UAV) in clear flight conditions and the other in a human-piloted Cessna 172 in conditions where the horizon was partially obscured by terrain, haze and smoke. The UAV flight resulted in pitch and roll error standard deviations of 0.42◦ and 0.71◦ respectively when compared with a truth attitude source. The Cessna flight resulted in pitch and roll error standard deviations of 1.79◦ and 1.75◦ respectively. The benefits of selecting and tracking the horizon using a motion model and optical flow rather than naively relying on the image processing front-end is also demonstrated.

A controlled rapid approach to curriculum change : addressing the pressures of increased test-based accountability on schools

Increasingly, large amounts of public and private money are being invested in education and as a result, schools are becoming more accountable to stakeholders for this financial input. In terms of the curriculum, governments worldwide are frequently tying school funding to students‟ and schools‟ academic performances, which are monitored through high-stakes testing programs. To accommodate the resultant pressures from these testing initiatives, many principals are re-focussing their school‟s curriculum on the testing requirements. Such a re-focussing, which was examined critically in this thesis, constituted an externally facilitated rapid approach to curriculum change. In line with previously enacted change theories and recommendations from these, curriculum change in schools has tended to be a fairly slow, considered, collaborative process that is facilitated internally by a deputy-principal (curriculum). However, theoretically based research has shown that such a process has often proved to be difficult and very rarely successful. The present study reports and theorises the experiences of an externally facilitated process that emerged from a practitioner model of change. This case study of the development of the controlled rapid approach to curriculum change began by establishing the reasons three principals initiated curriculum change and why they then engaged an outsider to facilitate the process. It also examined this particular change process from the perspectives of the research participants. The investigation led to the revision of the practitioner model as used in the three schools and challenged the current thinking about the process of school curriculum change. The thesis aims to offer principals and the wider education community an alternative model for consideration when undertaking curriculum change. Finally, the thesis warns that, in the longer term, the application of study‟s revised model (the Controlled Rapid Approach to Curriculum Change [CRACC] Model) may have less then desirable educational consequences.

Shifting the technology context : career-change entrants’ transition into teaching

Becoming a teacher in technology-rich classrooms is a complex and challenging transition for career-change entrants. Those with generic or specialist Information and Communication Technology (ICT) expertise bring a mindset about purposeful uses of ICT that enrich student learning and school communities. The transition process from a non-education environment is both enhanced and constrained by shifting the technology context of generic or specialist ICT expertise, developed through a former career as well as general life experience. In developing an understanding of the complexity of classrooms and creating a learner centred way of working, perceptions about learners and learning evolve and shift. Shifts in thinking about how ICT expertise supports learners and enhances learning preceded shifts in perceptions about being a teacher, working with colleagues, and functioning in schools that have varying degrees of intensity and impact on evolving professional identities. Current teacher education and school induction programs are seen to be falling short of meeting the needs of career-change entrants and, as a flow on, the students they nurture. Research (see, for example, Tigchelaar, Brouwer, & Korthagen, 2008; Williams & Forgasz, 2009) highlights the value of generic and specialist expertise career-change teachers bring to the profession and draws attention to the challenges such expertise begets (Anthony & Ord, 2008; Priyadharshini & Robinson-Pant, 2003). As such, the study described in this thesis investigated perceptions of career-change entrants, who have generic (Mishra & Koehler, 2006) or specialist expertise, that is, ICT qualifications and work experience in the use of ICT. The career-change entrants‘ perceptions were sought as they shifted the technology context and transitioned into teaching in technology-rich classrooms. The research involved an interpretive analysis of qualitative data and quantitative data. The study used the explanatory case study (Yin, 1994) methodology enriched through grounded theory processes (Strauss & Corbin, 1998), to develop a theory about professional identity transition from the perceptions of the participants in the study. The study provided insights into the expertise and experiences of career change entrants, particularly in relation to how professional identities that include generic and specialist ICT knowledge and expertise were reconfigured while transitioning into the teaching profession. This thesis presents the Professional Identity Transition Theory that encapsulates perceptions about teaching in technology-rich classrooms amongst a selection of the increasing number of career-change entrants. The theory, grounded in the data, (Strauss & Corbin, 1998) proposes that career-change entrants experience transition phases of varying intensity that impact on professional identity, retention and development as a teacher. These phases are linked to a shift in perceptions rather than time as a teacher. Generic and specialist expertise in the use of ICT is a weight of the past and an asset that makes the transition process more challenging for career-change entrants. The study showed that career-change entrants used their experiences and perceptions to develop a way of working in a school community. Their way of working initially had an adaptive orientation focussed on immediate needs as their teaching practice developed. Following a shift of thinking, more generative ways of working focussed on the future emerged to enable continual enhancement and development of practice. Sustaining such learning is a personal, school and systemic challenge for the teaching profession.

Palaeoecology of the Mount Etna bat fauna, coastal Eastern Queensland

Global warming is already threatening many animal and plant communities worldwide, however, the effect of climate change on bat populations is poorly known. Understanding the factors influencing the survival of bats is crucial to their conservation, and this cannot be achieved solely by modern ecological studies. Palaeoecological investigations provide a perspective over a much longer temporal scale, allowing the understanding of the dynamic patterns that shaped the distribution of modern taxa. In this study twelve microchiropteran fossil assemblages from Mount Etna, central-eastern Queensland, ranging in age from more than 500,000 years to the present day, were investigated. The aim was to assess the responses of insectivorous bats to Quaternary environmental changes, including climatic fluctuations and recent anthropogenic impacts. In particular, this investigation focussed on the effects of increasing late Pleistocene aridity, the subsequent retraction of rainforest habitat, and the impact of cave mining following European settlement at Mount Etna. A thorough examination of the dental morphology of all available extant Australian bat taxa was conducted in order to identify the fossil taxa prior to their analysis in term of species richness and composition. This detailed odontological work provided new diagnostic dental characters for eighteen species and one genus. It also provided additional useful dental characters for three species and seven genera. This odontological analysis allowed the identification of fifteen fossil bat taxa from the Mount Etna deposits, all being representatives of extant bats, and included ten taxa identified to the species level (i.e., Macroderma gigas, Hipposideros semoni, Rhinolophus megaphyllus, Miniopterus schreibersii, Miniopterus australis, Scoteanax rueppellii, Chalinolobus gouldii, Chalinolobus dwyeri, Chalinolobus nigrogriseus and Vespadelus troughtoni) and five taxa identified to the generic level (i.e., Mormopterus, Taphozous, Nyctophilus, Scotorepens and Vespadelus). Palaeoecological analysis of the fossil taxa revealed that, unlike the non-volant mammal taxa, bats have remained essentially stable in terms of species diversity and community membership between the mid-Pleistocene rainforest habitat and the mesic habitat that occurs today in the region. The single major exception is Hipposideros semoni, which went locally extinct at Mount Etna. Additionally, while intensive mining operations resulted in the abandonment of at least one cave that served as a maternity roost in the recent past, the diversity of the Mount Etna bat fauna has not declined since European colonisation. The overall resilience through time of the bat species discussed herein is perhaps due to their unique ecological, behavioural, and physiological characteristics as well as their ability to fly, which have allowed them to successfully adapt to their changing environment. This study highlights the importance of palaeoecological analyses as a tool to gain an understanding of how bats have responded to environmental change in the past and provides valuable information for the conservation of threatened modern species, such as H. semoni.

High-challenge teaching for senior English as an Additional Language (EAL) learners in times of change

This paper will present a brief overview of the recent shifts within English and EAL/D (English as an additional language/dialect) curriculum documents and their focus on critical literacy, using the Queensland context as a case in point. The English syllabus landscape in Queensland has continued to morph in recent years. From 2002 to 2009, teachers of senior English and English as an Additional Language (EAL/D) have witnessed no less than four separate syllabus documents that impact on their daily work. The Australian Curriculum, when finally implemented, will also require teachers to navigate and grapple with its particular obligations and affordances. The combined effect of the shifts and tensions between recent policy documents has led to confusion about exactly how to cater for EAL/D learners in mainstream English. We discuss the possible effects of this on teachers as the agents of policy implementation and argue that in spite of such contradictions, EAL/D teachers can productively use syllabus frameworks to craft pedagogy to cater for their EAL/D learners’ language and literacy needs. Following this, we present aspects of the teaching practice of four teachers of senior EAL/D, who provide intellectually-engaging, critical literacy pedagogy that takes into account the language proficiency level of their learners, within the required curriculum. Such practice provides teachers with valuable pedagogic possibilities to meet EAL/D learners’ needs within continually varying policy terrain.

Project managers and technical change : curriculum development in strategic technology management

Traditional business approaches do not take account of the rapid technological developments underpinning today's world. Further understanding the role of technology and its efficient management to build and maintain a competitive edge in business can allow project managers to more successfully manage organisations, and to adapt to and capitalise on, today’s rapidly changing environment. Strategic Technology Management links engineering, science and management principles to identify, choose, and implement the most effective means of attaining compatibility between internal skills and resources of an organisation and its competitive, economic and social environment. This paper reviews the rationale and the development of a new Strategic Technology Management subject in QUT’s Master of Project Management program. It discusses recent developments in the area of technology management from an international perspective, provides details of the curriculum developed and discusses the experience of completing two years of teaching the new program.

Temporal tissue patterns in bone healing of sheep

Secondary fracture healing in long bones leads to the successive formation of intricate patterns of tissues in the newly formed callus. The main aim of this work was to quantitatively describe the topology of these tissue patterns at different stages of the healing process and to generate averaged images of tissue distribution. This averaging procedure was based on stained histological sections (2, 3, 6, and 9 weeks post-operatively) of 64 sheep with a 3 mm tibial mid-shaft osteotomy, stabilized either with a rigid or a semi-rigid external fixator. Before averaging, histological images were sorted for topology according to six identified tissue patterns. The averaged images were obtained for both fixation types and the lateral and medial side separately. For each case, the result of the averaging procedure was a collection of six images characterizing quantitatively the progression of the healing process. In addition, quantified descriptions of the newly formed cartilage and the bone area fractions (BA/TA) of the bony callus are presented. For all cases, a linear increase in the BA/TA of the bony callus was observed. The slope was greatest in the case of the most rigid stabilization and lowest in the case of the least stiff. This topological description of the progression of bone healing will allow quantitative validation (or falsification) of current mechano-biological theories.

Spatial and temporal variations of mechanical properties and mineral content of the external callus during bone healing

After bone fracture, various cellular activities lead to the formation of different tissue types, which form the basis for the process of secondary bone healing. Although these tissues have been quantified by histology, their material properties are not well understood. Thus, the aim of this study is to correlate the spatial and temporal variations in the mineral content and the nanoindentation modulus of the callus formed via intramembranous ossification over the course of bone healing. Midshaft tibial samples from a sheep osteotomy model at time points of 2, 3, 6 and 9 weeks were employed. PMMA embedded blocks were used for quantitative back scattered electron imaging and nanoindentation of the newly formed periosteal callus near the cortex. The resulting indentation modulus maps show the heterogeneity in the modulus in the selected regions of the callus. The indentation modulus of the embedded callus is about 6 GPa at the early stage. At later stages of mineralization, the average indentation modulus reaches 14 GPa. There is a slight decrease in average indentation modulus in regions distant to the cortex, probably due to remodelling of the peripheral callus. The spatial and temporal distribution of mineral content in the callus tissue also illustrates the ongoing remodelling process observed from histological analysis. Most interestingly the average indentation modulus, even at 9 weeks, remains as low as 13 GPa, which is roughly 60% of that for cortical sheep bone. The decreased indentation modulus in the callus compared to cortex is due to the lower average mineral content and may be perhaps also due to the properties of the organic matrix which might be different from normal bone.

Assessment reform and educational change in Australia

This chapter addresses the changing climate of assessment policy and practice in Australia in response to global trends in education and the mounting accountability demands of standards-driven reform. Queensland, a State of Australia, has a tradition of respecting and trusting teacher judgment through the practice of, and policy commitment to, externally moderated school-based assessment. This chapter outlines the global trends in curriculum and assessment reform, and then analyzes the impact of international comparisons on national policy. The creation of the Australian Curriculum, Assessment and Reporting Authority (ACARA) together with the intent of establishing a standards-referenced framework raises tensions and challenges for teachers’ practice. The argument for sustaining confidence in teacher-based assessment is developed with reference to research evidence pertaining to the use of more authentic assessments and moderation practices for the purposes of improving learning, equity and accountability. Evidence is drawn from local studies of teacher judgment practice and used to demonstrate these developments and in so doing illuminate the complex issues of engaging the demands of policy while sustaining confidence in teacher assessment.