Can SNOMED CT as implemented in New South Wales, Australia be used for road trauma injury surveillance in emergency departments?

The introduction of Systematized Nomenclature of Medicine - Clinical Terms (Snomed CT) for diagnosis coding in emergency departments (EDs) in New South Wales (NSW) has implications for injury surveillance abilities. This study aimed to assess the consequences of its introduction, as implemented as part of the ED information system in NSW, for identifying road trauma-related injuries in EDs. It involved a retrospective analysis of road trauma-related injuries identified in linked police, ED and mortality records during March 2007 to December 2009. Between 53.7% to 78.4% of all Snomed CT classifications in the principal provisional diagnosis field referred to the type of injury or symptom experienced by the individual. Of the road users identified by police, 3.2% of vehicle occupants, 6% of motorcyclists, 10.0% of pedal cyclists and 5.2% of pedestrians were identified using Snomed CT classifications in the principal provisional diagnosis field. The introduction of Snomed CT may provide flexible terminologies for clinicians. However, unless carefully implemented in information systems, its flexibility can lead to mismatches between the intention and actual use of defined data fields. Choices available in Snomed CT to indicate either symptoms, diagnoses, or injury mechanisms need to be controlled and these three concepts need to be retained in separate data fields to ensure a clear distinction between their classification in the ED.

Innovation through action research in environmental education : from project to praxis

This thesis is a work-in-progress that articulates my research journey based on the development of a curriculum innovation in environmental education. This journey had two distinct, but intertwined phases: action research based fieldwork, conducted collaboratively, to create a whole school approach to environmental education curriculum planning; and a phase of analysis and reflection based on the emerging findings, as I sought to create personal "living educational theory" about change and innovation. A key stimulus for the study was the perceived theory-practice gap in environmental education, which is often presented in the literature as a criticism of teachers for failing to achieve the values and action objectives of critical environmental education. Hence, many programs and projects are considered to be superficial and inconsequential in terms of their ability to seriously address environmental issues. The intention of this study was to work with teachers in a project that would be an exemplar of critical environmental education. This would be in the form of a whole school "learnscaping" curriculum in a primary school whereby the schoolgrounds would be utilised for interdisciplinary critical environment education. Parallel with the three cycles of action research in this project, my research objectives were to identify and comment upon the factors that influence the generation of successful educational innovation. It was anticipated that the project would be a collaboration involving me, as researcher-facilitator, and many of the teachers in the school as active participants. As the project proceeded through its action cycles, however, it became obvious that the goal of developing a critical environmental education curriculum, and the use of highly participatory processes, were unrealistic. Institutional and organisational rigidities in education generally, teachers' day-to-day work demands, and the constant juggle of work, family and other responsibilities for all participants acted as significant constraints. Consequently, it became apparent that the learnscaping curriculum would not be the hoped-for exemplar. Progress was slow and, at times, the project was in danger of stalling permanently. While the curriculum had some elements of critical environmental education, these were minor and not well spread throughout the school. Overall, the outcome seemed best described as a "small win"; perhaps just another example of the theory-practice gap that I had hoped this project would bridge. Towards the project's end, however, my continuing reflection led to an exploration of chaos/complexity theory which gave new meaning to the concept of a "small win". According to this theory, change is not the product of linear processes applied methodically in purposeful and diligent ways, but emerges from serendipitous events that cannot be planned for, or forecast in advance. When this perspective of change is applied to human organisations - in this study, a busy school - the context for change is recognised not as a stable, predictable environment, but as a highly complex system where change happens all the time, cannot be controlled, and no one can be really sure where the impacts might lead. This so-called "butterfly effect" is a central idea of this theory where small changes or modifications are created - the effects of which are difficult to know, let alone determine - and which can have large-scale impacts. Allied with this effect is the belief that long term developments in an organisation that takes complexity into account, emerge by spontaneous self-organising evolution, requiring political interaction and learning in groups, rather than systematic progress towards predetermined goals or "visions". Hence, because change itself and the contexts of change are recognised as complex, chaos/complexity theory suggests that change is more likely to be slow and evolutionary - cultural change - rather than fast and revolutionary where the old is quickly ushered out by radical reforms and replaced by new structures and processes. Slow, small-scale changes are "normal", from a complexity viewpoint, while rapid, wholesale change is both unlikely and unrealistic. Therefore, the frustratingly slow, small-scale, imperfect educational changes that teachers create - including environmental education initiatives - should be seen for what they really are. They should be recognised as successful changes, the impacts of which cannot be known, but which have the potential to magnify into large-scale changes into the future. Rather than being regarded as failures for not meeting critical education criteria, "small wins" should be cause for celebration and support. The intertwined phases of collaborative action research and individual researcher reflection are mirrored in the thesis structure. The first three chapters, respectively, provide the thesis overview, the literature underpinning the study's central concern, and the research methodology. Chapters 4, 5, and 6 report on each of the three action research cycles of the study, namely Laying the Groundwork, Down to Work!, and The Never-ending Story. Each of these chapters presents a narrative of events, a literature review specific to developments in the cycle, and analysis and critique of the events, processes and outcomes of each cycle. Chapter 7 provides a synthesis of the whole of the study, outlining my interim propositions about facilitating curriculum change in schools through action research, and the implications of these for environmental education.

Meta-analysis of individual patient data from randomized trials of chemotherapy plus cetuximab as first-line treatment for advanced non-small cell lung cancer

OBJECTIVES: Four randomized phase II/III trials investigated the addition of cetuximab to platinum-based, first-line chemotherapy in patients with advanced non-small cell lung cancer (NSCLC). A meta-analysis was performed to examine the benefit/risk ratio for the addition of cetuximab to chemotherapy. MATERIALS AND METHODS: The meta-analysis included individual patient efficacy data from 2018 patients and individual patient safety data from 1970 patients comprising respectively the combined intention-to-treat and safety populations of the four trials. The effect of adding cetuximab to chemotherapy was measured by hazard ratios (HRs) obtained using a Cox proportional hazards model and odds ratios calculated by logistic regression. Survival rates at 1 year were calculated. All applied models were stratified by trial. Tests on heterogeneity of treatment effects across the trials and sensitivity analyses were performed for all endpoints. RESULTS: The meta-analysis demonstrated that the addition of cetuximab to chemotherapy significantly improved overall survival (HR 0.88, p=0.009, median 10.3 vs 9.4 months), progression-free survival (HR 0.90, p=0.045, median 4.7 vs 4.5 months) and response (odds ratio 1.46, p<0.001, overall response rate 32.2% vs 24.4%) compared with chemotherapy alone. The safety profile of chemotherapy plus cetuximab in the meta-analysis population was confirmed as manageable. Neither trials nor patient subgroups defined by key baseline characteristics showed significant heterogeneity for any endpoint. CONCLUSION: The addition of cetuximab to platinum-based, first-line chemotherapy for advanced NSCLC significantly improved outcome for all efficacy endpoints with an acceptable safety profile, indicating a favorable benefit/risk ratio.

Defining food literacy and its components

Food literacy has emerged as a term to describe the everyday practicalities associated with healthy eating. The term is increasingly used in policy, practice, research and by the public; however, there is no shared understanding of its meaning. The purpose of this research was to develop a definition of food literacy which was informed by the identification of its components. This was considered from two perspectives: that of food experts which aimed to reflect the intention of existing policy and investment, and that of individuals, who could be considered experts in the everyday practicalities of food provisioning and consumption. Given that food literacy is likely to be highly contextual, this second study focused on disadvantaged young people living in an urban area who were responsible for feeding themselves. The Expert Study used a Delphi methodology (round one n = 43). The Young People’s Study used semi-structured, life-course interviews (n = 37). Constructivist Grounded Theory was used to analyse results. This included constant comparison of data within and between studies. From this, eleven components of food literacy were identified which fell into the domains of: planning and management; selection; preparation; and eating. These were used to develop a definition for the term “food literacy”.

Long-term azithromycin for Indigenous children with non-cystic-fibrosis bronchiectasis or chronic suppurative lung disease (Bronchiectasis Intervention Study) : a multicentre, double-blind, randomised controlled trial

Background Indigenous children in high-income countries have a heavy burden of bronchiectasis unrelated to cystic fibrosis. We aimed to establish whether long-term azithromycin reduced pulmonary exacerbations in Indigenous children with non-cystic-fibrosis bronchiectasis or chronic suppurative lung disease. Methods Between Nov 12, 2008, and Dec 23, 2010, we enrolled Indigenous Australian, Maori, and Pacific Island children aged 1—8 years with either bronchiectasis or chronic suppurative lung disease into a multicentre, double-blind, randomised, parallel-group, placebo-controlled trial. Eligible children had had at least one pulmonary exacerbation in the previous 12 months. Children were randomised (1:1 ratio, by computer-generated sequence with permuted block design, stratified by study site and exacerbation frequency [1—2 vs ≥3 episodes in the preceding 12 months]) to receive either azithromycin (30 mg/kg) or placebo once a week for up to 24 months. Allocation concealment was achieved by double-sealed, opaque envelopes; participants, caregivers, and study personnel were masked to assignment until after data analysis. The primary outcome was exacerbation (respiratory episodes treated with antibiotics) rate. Analysis of the primary endpoint was by intention to treat. At enrolment and at their final clinic visits, children had deep nasal swabs collected, which we analysed for antibiotic-resistant bacteria. This study is registered with the Australian New Zealand Clinical Trials Registry; ACTRN12610000383066. Findings 45 children were assigned to azithromycin and 44 to placebo. The study was stopped early for feasibility reasons on Dec 31, 2011, thus children received the intervention for 12—24 months. The mean treatment duration was 20·7 months (SD 5·7), with a total of 902 child-months in the azithromycin group and 875 child-months in the placebo group. Compared with the placebo group, children receiving azithromycin had significantly lower exacerbation rates (incidence rate ratio 0·50; 95% CI 0·35—0·71; p<0·0001). However, children in the azithromycin group developed significantly higher carriage of azithromycin-resistant bacteria (19 of 41, 46%) than those receiving placebo (four of 37, 11%; p=0·002). The most common adverse events were non-pulmonary infections (71 of 112 events in the azithromycin group vs 132 of 209 events in the placebo group) and bronchiectasis-related events (episodes or investigations; 22 of 112 events in the azithromycin group vs 48 of 209 events in the placebo group); however, study drugs were well tolerated with no serious adverse events being attributed to the intervention. Interpretation Once-weekly azithromycin for up to 24 months decreased pulmonary exacerbations in Indigenous children with non-cystic-fibrosis bronchiectasis or chronic suppurative lung disease. However, this strategy was also accompanied by increased carriage of azithromycin-resistant bacteria, the clinical consequences of which are uncertain, and will need careful monitoring and further study.

Motivations and Intentions : A Case Study of Design-Led Activism

With a focus on intention and motivation, this paper describes a study involving three organisational communities and their collective effort to develop and provide more inclusive housing for people with disabilities and their families. While many studies, such as that by Rocha & Miles (2009), focus on commercial organisations, and sustainability from an economic perspective, this study involves a not-for-profit organisation (the accommodation and service provider) as well as a research organisation and a design action group volunteering their services free of charge. From this pro-bono context, the paper describes a case study that explores the nature of the collective as a basis for creative practice and political activism and the theoretical implications and wider application in terms of emerging research in the area of collaborative entrepreneurship and design activism.

The judgments of Justice Lionel Murphy

Member of High Court Bench; includes references to Aboriginal voting rights; protection of Aboriginal sites in Franklin Dam Case; authors statements from cases - Onus v Alcoa of Australia Ltd, Portland; Neal v Queen, Yarrabah, Koowarta v BjelkePeterson, and Racial Discrimination Act 1975, Archer River; Queen v Toohey (Kenbi, Cox Peninsula); Coe v Commonwealth; Veen v Queen.

Publishing

Publishing is no doubt one of the oldest and most diverse sectors in the creative economy. While publishing originally was associated with print and paper, the term is nowadays also commonly used to represent organizations that control, administer and license intellectual properties in other sectors of the creative economy such as videogames and music. While the title of this chapter is ‘Publishing’, we have no intention of covering all publishing related activities, but will focus on the economic consequences of digitization on two traditional and important print media sectors, namely books and magazines. Within these sectors we will specifically focus on consumer magazines and trade books, in other words books and magazines that are sold via commercial retailers to consumers. It is relevant to study these two publishing industries, since they share a number of very fundamental characteristics and have experienced similar economic consequences caused by the digitization of the creative economy. Both industries have undergone a gradual shift from print to digital and increasingly rely on revenues based on digital content carriers such as e- books, tablet magazine applications, special interest websites, blogs and so on.

The Politics and Legality of Prisoner Disenfranchisement in Australian Federal Elections

To remove the right of prisoners to vote does many things. … It signals that whatever the prisoner says is not of interest to those at the top, that you are not interested in talking to them or even listening to them, that you want to exclude them and that you have no interest in knowing about them. INTRODUCTION In June 2006, Australia passed legislation disenfranchising all prisoners serving full-time custodial sentences from voting in federal elections. This followed a succession of changes dating from 1983 that alternately extended and restricted the prisoner franchise. In 1989 and 1995, the Australian Labor Party (ALP) federal government prepared draft legislation removing any restrictions on prisoner voting rights in federal elections; the measures were defeated and withdrawn. With the 2006 legislation, the Howard Coalition government (composed of the Liberal and National parties) successfully achieved the total disenfranchisement it first sought in 1998. This chapter examines the politics and legality of the 2006 disenfranchisement. This will be approached, first, by briefly outlining the key provisions of the Commonwealth Electoral Act 1918, offering a short legislative history of prisoner franchise, and examining some of the key constitutional issues. Second, the 2006 disenfranchisement introduced in the Electoral and Referendum (Electoral Integrity and Other Measures) Act 2006 will be examined in greater detail, particularly in terms of the manner in which it was achieved and the arguments that were mobilized both in support of and against the change.

Creative practices in the design studio culture : collaboration and communication

For the purpose of developing collaborative support in design studio environments, we have carried out ethnographic fieldwork in professional and academic product design studios. Our intention was to understand design practices beyond the productivity point of view and take into account the experiential, inspirational and aesthetical aspects of design practices. Using examples from our fieldwork, we develop our results around three broad themes by which design professionals support communication and collaboration: (1) use of artefacts, (2) use of space and (3) designerly practices. We use the results of our fieldwork for drawing implications for designing technologies for the design studio culture.

Experiential role of artefacts in cooperative design

The role of material artefacts in supporting distributed and co-located work practices has been well acknowledged within HCI and CSCW research. In this paper, we show that in addition to their ecological, coordinative and organizational support, artefacts also play an 'experiential' role. In this case, artefacts not only improve efficiency or have a purely functional role (e.g. allowing people to complete tasks quickly), but the materiality, use and manifestations of these artefacts bring quality and richness to people's performance and help them make better sense of their everyday lives. In a domain such as industrial design, such artefacts play an important role for supporting creativity and innovation. Based on our ethnographic fieldwork on understanding cooperative design practices of industrial design students and researchers, we describe several experiential practices that are supported by design-related artefacts such as sketches, drawings, physical models and explorative prototypes -- used and developed in designers' everyday work. Our main intention in carrying out this kind of research is to develop technologies to support designers' everyday practices. We believe that with the emergence of ubiquitous computing, there is a growing need to focus on the personal, social and creative side of people's everyday experiences. By focusing on the experiential practices of designers, we can provide a much broader view in the design of new interactive technologies.

Exploring mediated interactions : a design exercise

With the emergence of personal and ubiquitous computing systems in the last decade, interaction designers have started designing products by employing quality oriented aspects such as user experience, playfulness, enchantment and others. In order to explore novel forms of mediated interactions, designers need to focus beyond the basic user requirements and usability issues. We present a procedure and results of a design exercise that we carried out with students of a master's course on Visual Design. Our intention was to explore new forms of mediated interaction by using a specific design exercise. We provide the details of the resulted design concepts and discuss the usefulness of our design exercise.

Promoting active lifestyles in young children: investigating mothers’ decisions about their child’s physical activity and screen time behaviours

Objectives Given increasing trends of obesity being noted from early in life and that active lifestyles track across time, it is important that children at a very young age be active to combat a foundation of unhealthy behaviours forming. This study investigated, within a theory of planned behaviour (TPB) framework, factors which influence mothers’ decisions about their child’s 1) adequate physical activity (PA) and 2) limited screen time behaviours. Methods Mothers (N = 162) completed a main questionnaire, via on-line or paper-based administration, which comprised standard TPB items in addition to measures of planning and background demographic variables. One week later, consenting mothers completed a follow-up telephone questionnaire which assessed the decisions they had made regarding their child’s PA and screen time behaviours during the previous week. Results Hierarchical multiple regression analyses revealed support for the predictive model, explaining an overall 73% and 78% of the variance in mothers’ intention and 38% and 53% of the variance in mothers’ decisions to ensure their child engages in adequate PA and limited screen time, respectively. Attitude and subjective norms predicted intention in both target behaviours, as did intentions with behaviour. Contrary to predictions, perceived behavioural control (PBC) in PA behaviour and planning in screen time behaviour were not significant predictors of intention, neither was PBC a predictor of either behaviour. Conclusions The findings illustrate the various roles that psycho-social factors play in mothers’ decisions to ensure their child engages in active lifestyle behaviours which can help to inform future intervention programs aimed at combating very young children’s inactivity.

Learning and teaching epidemiology with audience response technology

Background The learning and teaching of epidemiology is core to many public health programs. Many students find the content of epidemiology, and specifically risk of bias assessment, challenging to learn. Howbeit, learning is enhanced when knowledge is able to be acquired from an active-learning, hands-on experience. Methods The innovative use of wireless audience response technology “clickers” was incorporated into the lectures of the university’s post-graduate epidemiology units and the tailored epidemiological modules delivered for professional disciplines (e.g. optometry). Clickers were used to apply several pedagogical approaches of active learning including peer-instruction and real-world simulation. Students were also assessed for their gain in knowledge within the lecture (pre-post) and their perceptions of how the use of clickers helped them learn. The routine university-wide end of semester Insight Survey provided further information of the student’s satisfaction with the approach. Results The technology was useful in identifying deficits of knowledge of key concepts either before or after instruction. Where key concepts were re-tested post-lecture, as expected, knowledge increased significantly and provided immediate feed-back to students. Across the lecture series, typically 85% of students identified the technology helped them learn, increased their opportunity to interact with the lecturer, and recommend their use for future classes. The Insight Survey report identified 93% of respondents identified the unit in which clickers were consistently used provided good learning opportunities. Numerous student comments supported the teaching method. Conclusions Epidemiological subject matter lends itself to incorporation of audience response technology. The use of the technology to facilitate interactive voting provides an instant response and participation of everyone to enhance the classroom experience. The pedagogical approach increases students’ knowledge and increases their satisfaction with the unit.

Vote with your feet : local community polling on urban screens

Falling prices have led to an ongoing spread of public displays in urban areas. Still, they mostly show passive content such as commercials and digital signage. At the same time, technological advances have enabled the creation of interactive displays potentially increasing their attractiveness for the audience, e.g. through providing a platform for civic discourse. This poses considerable challenges, since displays need to communicate the opportunity to engage, motivate the audience to do so, and be easy to use. In this paper we present Vote With Your Feet, a hyperlocal public polling tool for urban screens allowing users to express their opinions. Similar to vox populi interviews on TV or polls on news websites, the tool is meant to reflect the mindset of the community on topics such as current affairs, cultural identity and local matters. It is novel in that it focuses on a situated civic discourse and provides a tangible user interface, tackling the mentioned challenges. It shows one Yes/No question at a time and enables users to vote by stepping on one of two tangible buttons on the ground. This user interface was introduced to attract people’s attention and to lower participation barriers. Our field study showed that Vote With Your Feet is perceived as inviting and that it can spark discussions among co-located people.