Multivariate methods to identify cancer-related symptom clusters

Multivariate methods are required to assess the interrelationships among multiple, concurrent symptoms. We examined the conceptual and contextual appropriateness of commonly used multivariate methods for cancer symptom cluster identification. From 178 publications identified in an online database search of Medline, CINAHL, and PsycINFO, limited to articles published in English, 10 years prior to March 2007, 13 cross-sectional studies met the inclusion criteria. Conceptually, common factor analysis (FA) and hierarchical cluster analysis (HCA) are appropriate for symptom cluster identification, not principal component analysis. As a basis for new directions in symptom management, FA methods are more appropriate than HCA. Principal axis factoring or maximum likelihood factoring, the scree plot, oblique rotation, and clinical interpretation are recommended approaches to symptom cluster identification.

Vitamin D and sun protection : the impact of mixed public health messages in Australia

Exposure of the skin to sunlight can cause skin cancer and is also necessary for cutaneous vitamin D production. Media reports have highlighted the purported health benefits of vitamin D. Our aim was to examine attitudes and behaviours related to sun protection and vitamin D. A cross-sectional study of 2,001 residents in Queensland, Australia aged 20-70 years was undertaken. Information collected included: skin cancer risk factors; perceptions about levels of sun exposure required to maintain vitamin D; belief that sun protection increases risk of vitamin D deficiency; intention, and actual change in sun protection practices for adults and children. Multivariate models examined predictors of attitudinal and behavioural change. One-third (32%) believed a fair-skinned adult, and 31% thought a child required at least 30 minutes per day in summer sun to maintain vitamin D levels. Reductions in sun protection were reported by 21% of adults and 14% of children. Factors associated with belief that sun protection may result in not obtaining enough vitamin D included aged ≥ 60 years (OR=1.35, 95% CI 1.09-1.66) and having skin that tanned easily (OR=1.96, 95% CI 1.38-2.78). Participants from low income households, and those who frequently used sun protective clothing were more likely to have reduced sun protection practices (OR=1.33, 95% CI 1.10-1.73 and OR=1.73, 95% CI 1.36-2.20, respectively). This study provides evidence of reductions in sun protection practices in a population living in a high UV environment. There is an urgent need to re-focus messages regarding sun exposure and for continued sun protection practices.

Sportway toward sport event consumption

Research has lead to a proliferation of multi-attribute scales to understand the motives for sport event attendance. The large number of potential motives, coupled with the long questionnaires needed to measure them, creates challenges for sport marketing research in natural populations. This research brings parsimony to the study of sport consumer behaviour by developing and testing a core set of five SportWay facets of motivation. Results provide guidance to sport marketing professionals and academics in survey development decisions related to selecting the most appropriate motives and items.

Destination branding : tracking brand equity for a competitive set of near-home destinations

In the emerging literature related to destination branding, little has been reported about performance metrics. The focus of most research reported to date has been concerned with the development of destination brand identities and the implementation of campaigns (see for example, Crockett & Wood 1999, Hall 1999, May 2001, Morgan et al 2002). One area requiring increased attention is that of tracking the performance of destination brands over time. This is an important gap in the tourism literature, given: i) the increasing level of investment by destination marketing organisations (DMO) in branding since the 1990s, ii) the complex political nature of DMO brand decision-making and increasing accountability to stakeholders (see Pike, 2005), and iii) the long-term nature of repositioning a destination’s image in the market place (see Gartner & Hunt, 1987). Indeed, a number of researchers in various parts of the world have pointed to a lack of market research monitoring destination marketing objectives, such as in Australia (see Prosser et. al 2000, Carson, Beattie and Gove 2003), North America (Sheehan & Ritchie 1997, Masberg 1999), and Europe (Dolnicar & Schoesser 2003)...

Choosing to become a 'lost cause': the perverse effects of benefit preconditions

This paper argues that preconditions for welfare benefit entitlements based on labour market prospects can be counterproductive when they create an incentive for individuals to abstain from any investment earlier in life that could improve future prospects. Benefit entitlements based partly on investments made prior to labour market entry are then Pareto-improving.

Signs, symptoms and comorbidities in contact lens-related microbial keratitis

Purpose: The aim of this study was to characterize the clinical signs, symptoms, and ocular and systemic comorbidities in a large case series of contact lens-related microbial keratitis. Methods: Two hundred ninety-seven cases of contact lens-related microbial keratitis, aged between 15 and 64 years were detected through surveillance of hospital and community based ophthalmic practitioners in Australia and New Zealand. Full clinical data were available for 190 cases and 90 were interviewed by telephone. Clinical data included the size, location, and degree of anterior chamber response. Symptom data were available from the practitioner and from participant self-report. Associations between symptoms and disease severity were evaluated. Data on ocular and systemic disease were collected from participants and practitioners. The frequency of comorbidities was compared between the different severities of disease and to population norms. Results: More severe disease was associated with greater symptom severity and pain was the most prevalent symptom reported. Ninety-one percent of cases showed progression of ocular symptoms after lens removal, and symptom progression was associated with all severities of disease. Twenty-five percent of cases reported prior episodes requiring emergency attention. Thyroid disease (p 0.05) and self-reported poor health (p 0.001) were more common in cases compared with age-matched population norms. Discussion: Information on the signs, symptoms, and comorbidities associated with contact lens-related microbial keratitis may be useful in patient education and for practitioners involved in the fitting of lenses and management of complications. Although pain was the most common symptom experienced, progression of symptoms despite lens removal was close to universal. Poor general health, particularly respiratory disease and thyroid disease was more common in cases than in the general population, which may prompt practitioners to recommend flexibility in wear schedules when in poor health or the selection of a lower risk wear schedule in at risk patients

Marketing buzz : towards a framework for entrepreneurs

Despite the increasing recognition of the importance of word of mouth as an integral component of a firms’ marketing efforts, there has been little emphasis on developing suitable guidelines for entrepreneurs who wish to leverage scarce resources by pursuing more innovative marketing techniques. In addition, although there has been a great deal of research into the nature of social networks and interpersonal communication via word of mouth, there have been few attempts to link this research with the firms marketing strategy. In this paper, we consider the diffusion of innovation literature and recent research into social network structure and propose a framework that may be useful for enhancing the marketing efforts of entrepreneurial firms.

Realism and control : problem-based learning programs as a data source for work-related research

Problem-based learning (PBL) is a pedagogical methodology that presents the learner with a problem to be solved to stimulate and situate learning. This paper presents key characteristics of a problem-based learning environment that determines its suitability as a data source for workrelated research studies. To date, little has been written about the availability and validity of PBL environments as a data source and its suitability for work-related research. We describe problembased learning and use a research project case study to illustrate the challenges associated with industry work samples. We then describe the PBL course used in our research case study and use this example to illustrate the key attributes of problem-based learning environments and show how the chosen PBL environment met the work-related research requirements of the research case study. We propose that the more realistic the PBL work context and work group composition, the better the PBL environment as a data source for a work-related research. The work context is more realistic when relevant and complex project-based problems are tackled in industry-like work conditions over longer time frames. Work group composition is more realistic when participants with industry-level education and experience enact specialized roles in different disciplines within a professional community.

Influence of presbyopic corrections on driving-related eye and head movements

Purpose: To investigate whether wearing different presbyopic refractive corrections alters the pattern of eye and head movements when searching for dynamic targets in driving-related traffic scenes. Methods: Eye and head movements of 20 presbyopes (mean age = 56.2 ± 5.7 years), who had no experience of wearing presbyopic corrections or were unadapted wearers were recorded using the faceLABTM eye and head tracker, while wearing five different corrections: single vision lenses (SV), progressive addition lenses (PALs), bifocal spectacles (BIF), monovision and multifocal contact lenses (MTF CLs) in random order (within-subjects comparison). Recorded traffic scenes of suburban roads and expressways with edited targets were viewed as dynamic stimuli. Results: The magnitude of eye and head movements was significantly greater for SV, BIF and PALs than monovision and MTF CLs (p < 0.001). In addition, BIF wear led to more eye movements than PAL wear (p = 0.017), while PAL wear resulted in greater head movements than SV wear (p = 0.018). The ratio of eye to head movement was smaller for PALs than all other groups (p < 0.001). The number of saccades made to fixate a target was significantly higher for BIF and PALs than monovision or MTF CLs (p < 0.05). Conclusions: Different presbyopic corrections can alter eye and head movement patterns. Wearing spectacles such as BIF and PALs produced relatively greater eye and head movements and saccades when viewing dynamic targets. The impact of these changes in eye and head movement patterns may have implications for driving performance under real world driving conditions.

Driving-related eye and head movements are changed by the type of presbyopic correction

Purpose: To investigate whether wearing different presbyopic vision corrections alters the pattern of eye and head movements when viewing dynamic driving-related traffic scenes. Methods: Participants included 20 presbyopes (mean age: 56±5.7 years) who had no experience of wearing presbyopic vision corrections (i.e. all were single vision wearers). Eye and head movements were recorded while wearing five different vision corrections: single vision lenses (SV), progressive addition spectacle lenses (PALs), bifocal spectacle lenses (BIF), monovision (MV) and multifocal contact lenses (MTF CL) in random order. Videotape recordings of traffic scenes of suburban roads and expressways (with edited targets) were presented as dynamic driving-related stimuli and digital numeric display panels included as near visual stimuli (simulating speedometer and radio). Eye and head movements were recorded using the faceLAB™ system and the accuracy of target identification was also recorded. Results: The magnitude of eye movements while viewing the driving-related traffic scenes was greater when wearing BIF and PALs than MV and MTF CL (p≤0.013). The magnitude of head movements was greater when wearing SV, BIF and PALs than MV and MTF CL (p<0.0001) and the number of saccades was significantly higher for BIF and PALs than MV (p≤0.043). Target recognition accuracy was poorer for all vision corrections when the near stimulus was located at eccentricities inferiorly and to the left, rather than directly below the primary position of gaze (p=0.008), and PALs gave better performance than MTF CL (p=0.043). Conclusions: Different presbyopic vision corrections alter eye and head movement patterns. In particular, the larger magnitude of eye and head movements and greater number of saccades associated with the spectacle presbyopic corrections, may impact on driving performance.

Teaching cause-of-death certification : lessons from international experience

The accuracy of cause-of-death statistics substantially depends on the quality of cause-of-death information in death certificates, primarily completed by medical doctors. Deficiencies in cause-of-death certification have been observed across the world, and over time. Despite educational interventions targeting to improve the quality of death certification, their intended impacts are rarely evaluated. This review aims to provide empirical evidence that could guide the modification of existing educational programs, or the development of new interventions, which are necessary to improve the capacity of certifiers as well as the quality of cause-of-death certification, and thereby, the quality of mortality statistics.

Daggy shirts, daggy slogans? marketing unions to young people

In light of declining trade union density, specifically among young workers, this article explores how trade unions recruit, service and organize young people. Our focus is the way in which trade unions market their services to the young. We use, as a lens of analysis, the services and social marketing literature and the concept of an ‘unsought, experience good’ to explore trade union strategy. Based on interviews with a number of union officials in the state of Queensland, it is clear that unions see the issue of recruitment of young people as significant, and that innovative strategies are being used in at least some unions. However, the research also indicates that despite union awareness, strategies are uneven and resource allocation is patchy. While the research was carried out in one state, the results and conclusion are broadly applicable to the Australian labour movement as a whole, and have implications for union movements in other Anglophone countries.

Sources of coding discrepancies in injury morbidity data: Implications for injury surveillance

Objective: To examine the sources of coding discrepancy for injury morbidity data and explore the implications of these sources for injury surveillance.-------- Method: An on-site medical record review and recoding study was conducted for 4373 injury-related hospital admissions across Australia. Codes from the original dataset were compared to the recoded data to explore the reliability of coded data aand sources of discrepancy.---------- Results: The most common reason for differences in coding overall was assigning the case to a different external cause category with 8.5% assigned to a different category. Differences in the specificity of codes assigned within a category accounted for 7.8% of coder difference. Differences in intent assignment accounted for 3.7% of the differences in code assignment.---------- Conclusions: In the situation where 8 percent of cases are misclassified by major category, the setting of injury targets on the basis of extent of burden is a somewhat blunt instrument Monitoring the effect of prevention programs aimed at reducing risk factors is not possible in datasets with this level of misclassification error in injury cause subcategories. Future research is needed to build the evidence base around the quality and utility of the ICD classification system and application of use of this for injury surveillance in the hospital environment.

Identifying work related injuries : comparison of methods for interrogating text fields

Background: Work-related injuries in Australia are estimated to cost around $57.5 billion annually, however there are currently insufficient surveillance data available to support an evidence-based public health response. Emergency departments (ED) in Australia are a potential source of information on work-related injuries though most ED’s do not have an ‘Activity Code’ to identify work-related cases with information about the presenting problem recorded in a short free text field. This study compared methods for interrogating text fields for identifying work-related injuries presenting at emergency departments to inform approaches to surveillance of work-related injury.---------- Methods: Three approaches were used to interrogate an injury description text field to classify cases as work-related: keyword search, index search, and content analytic text mining. Sensitivity and specificity were examined by comparing cases flagged by each approach to cases coded with an Activity code during triage. Methods to improve the sensitivity and/or specificity of each approach were explored by adjusting the classification techniques within each broad approach.---------- Results: The basic keyword search detected 58% of cases (Specificity 0.99), an index search detected 62% of cases (Specificity 0.87), and the content analytic text mining (using adjusted probabilities) approach detected 77% of cases (Specificity 0.95).---------- Conclusions The findings of this study provide strong support for continued development of text searching methods to obtain information from routine emergency department data, to improve the capacity for comprehensive injury surveillance.