Measuring falls events in acute hospitals-A comparison of three reporting methods to identify missing data in the hospital reporting system

OBJECTIVES: To compare three different methods of falls reporting and examine the characteristics of the data missing from the hospital incident reporting system. DESIGN: Fourteen-month prospective observational study nested within a randomized controlled trial. SETTING: Rehabilitation, stroke, medical, surgical, and orthopedic wards in Perth and Brisbane, Australia. PARTICIPANTS: Fallers (n5153) who were part of a larger trial (1,206 participants, mean age 75.1 � 11.0). MEASUREMENTS: Three falls events reporting measures: participants’ self-report of fall events, fall events reported in participants’ case notes, and falls events reported through the hospital reporting systems. RESULTS: The three reporting systems identified 245 falls events in total. Participants’ case notes captured 226 (92.2%) falls events, hospital incident reporting systems captured 185 (75.5%) falls events, and participant selfreport captured 147 (60.2%) falls events. Falls events were significantly less likely to be recorded in hospital reporting systems when a participant sustained a subsequent fall, (P5.01) or when the fall occurred in the morning shift (P5.01) or afternoon shift (P5.01). CONCLUSION: Falls data missing from hospital incident report systems are not missing completely at random and therefore will introduce bias in some analyses if the factor investigated is related to whether the data ismissing.Multimodal approaches to collecting falls data are preferable to relying on a single source alone.

Using routinely collected hospital data for child maltreatment surveillance : issues, methods and patterns

Background: International data on child maltreatment are largely derived from child protection agencies, and predominantly report only substantiated cases of child maltreatment. This approach underestimates the incidence of maltreatment and makes inter-jurisdictional comparisons difficult. There has been a growing recognition of the importance of health professionals in identifying, documenting and reporting suspected child maltreatment. This study aimed to describe the issues around case identification using coded morbidity data, outline methods for selecting and grouping relevant codes, and illustrate patterns of maltreatment identified. Methods: A comprehensive review of the ICD-10-AM classification system was undertaken, including review of index terms, a free text search of tabular volumes, and a review of coding standards pertaining to child maltreatment coding. Identified codes were further categorised into maltreatment types including physical abuse, sexual abuse, emotional or psychological abuse, and neglect. Using these code groupings, one year of Australian hospitalisation data for children under 18 years of age was examined to quantify the proportion of patients identified and to explore the characteristics of cases assigned maltreatment-related codes. Results: Less than 0.5% of children hospitalised in Australia between 2005 and 2006 had a maltreatment code assigned, almost 4% of children with a principal diagnosis of a mental and behavioural disorder and over 1% of children with an injury or poisoning as the principal diagnosis had a maltreatment code assigned. The patterns of children assigned with definitive T74 codes varied by sex and age group. For males selected as having a maltreatment-related presentation, physical abuse was most commonly coded (62.6% of maltreatment cases) while for females selected as having a maltreatment-related presentation, sexual abuse was the most commonly assigned form of maltreatment (52.9% of maltreatment cases). Conclusion: This study has demonstrated that hospital data could provide valuable information for routine monitoring and surveillance of child maltreatment, even in the absence of population-based linked data sources. With national and international calls for a public health response to child maltreatment, better understanding of, investment in and utilisation of our core national routinely collected data sources will enhance the evidence-base needed to support an appropriate response to children at risk.

Defending the patch : a labour geography analysis of unions’ construction of and responses to the problem of declining union membership amongst youth

If the trade union movement is to remain an influential force in the industrial, economic and socio/political arenas of industrialised nations it is vital that its recruitment of young members improve dramatically. Australian union membership levels have declined markedly over the last three decades and youth union membership levels have decreased more than any age group. Currently around 10% of young workers aged between 16-24 years are members of unions in Australia compared to 26% of workers aged 45-58 (Oliver, 2008). This decline has occurred throughout the union movement, in all states and in almost all industries and occupations. This research, which consists of interviews with union organisers and union officials, draws on perspectives from the labour geography literature to explore how union personnel located in various places, spaces and scales construct the issue of declining youth union membership. It explores the scale of connections within the labour movement and the extent to which these connections are leveraged to address the problem of youth union membership decline. To offer the reader a sense of context and perspective, the thesis firstly outlines the historical development of the union movement. It also reviews the literature on youth membership decline. Labour geography offers a rich and apposite analytical tool for investigation of this area. The notion of ‘scale’ as a dynamic, interactive, constructed and reconstructed entity (Ellem, 2006) is an appropriate lens for viewing youth-union membership issues. In this non-linear view, scale is a relational element which interplays with space, place and the environment (Howett, in Marston, 2000) rather than being ‘sequential’ and hierarchical. Importantly, the thesis investigates the notion of unions as ‘spaces of dependence’ (Cox, 1998a, p.2), organisations whose space is centred upon realising essential interests. It also considers the quality of unions’ interactions with others – their ‘spaces of engagement‘(Cox, 1998a, p.2), and the impact that this has upon their ability to recruit youth. The findings reveal that most respondents across the spectrum of the union movement attribute the decline in youth membership levels to factors external to the movement itself, such as changes to industrial relations legislation and the impact of globalisation on employment markets. However, participants also attribute responsibility for declining membership levels to the union movement itself, citing factors such as a lack of resourcing and a need to change unions’ perceived identity and methods of operation. The research further determined that networks of connections across the union movement are tenuous and, to date, are not being fully utilised to assist unions to overcome the youth recruitment dilemma. The study concludes that potential connections between unions are hampered by poor resourcing, workload issues and some deeply entrenched attitudes related to unions ‘defending (and maintaining) their patch’.

Comparing cost uplift in infrastructure delivery methods : a case based approach

The alliance project delivery method is used for approximately one third of all Australian government infrastructure projects representing $8-$10 billion per annum. Despite its widespread use, little is known about the differences between estimated project cost and actual cost over the project lifecycle. This paper presents the findings of research into 14 Australian government alliance case studies investigating the observed cost uplift over each project’s lifecycle. I find that significant cost uplift is likely and that this uplift is greater than that afflicting traditional delivery methods. Furthermore, most of the cost uplift occurs at a different place in the project lifecycle, namely between Business Case and Contractual Commitment.

Persistent ocean monitoring with underwater gliders : towards accurate reconstruction of dynamic ocean processes

Ocean processes are dynamic and complex events that occur on multiple different spatial and temporal scales. To obtain a synoptic view of such events, ocean scientists focus on the collection of long-term time series data sets. Generally, these time series measurements are continually provided in real or near-real time by fixed sensors, e.g., buoys and moorings. In recent years, an increase in the utilization of mobile sensor platforms, e.g., Autonomous Underwater Vehicles, has been seen to enable dynamic acquisition of time series data sets. However, these mobile assets are not utilized to their full capabilities, generally only performing repeated transects or user-defined patrolling loops. Here, we provide an extension to repeated patrolling of a designated area. Our algorithms provide the ability to adapt a standard mission to increase information gain in areas of greater scientific interest. By implementing a velocity control optimization along the predefined path, we are able to increase or decrease spatiotemporal sampling resolution to satisfy the sampling requirements necessary to properly resolve an oceanic phenomenon. We present a path planning algorithm that defines a sampling path, which is optimized for repeatability. This is followed by the derivation of a velocity controller that defines how the vehicle traverses the given path. The application of these tools is motivated by an ongoing research effort to understand the oceanic region off the coast of Los Angeles, California. The computed paths are implemented with the computed velocities onto autonomous vehicles for data collection during sea trials. Results from this data collection are presented and compared for analysis of the proposed technique.

Geometric Control Theory and its Application to Underwater Vehicles

This dissertation is based on theoretical study and experiments which extend geometric control theory to practical applications within the field of ocean engineering. We present a method for path planning and control design for underwater vehicles by use of the architecture of differential geometry. In addition to the theoretical design of the trajectory and control strategy, we demonstrate the effectiveness of the method via the implementation onto a test-bed autonomous underwater vehicle. Bridging the gap between theory and application is the ultimate goal of control theory. Major developments have occurred recently in the field of geometric control which narrow this gap and which promote research linking theory and application. In particular, Riemannian and affine differential geometry have proven to be a very effective approach to the modeling of mechanical systems such as underwater vehicles. In this framework, the application of a kinematic reduction allows us to calculate control strategies for fully and under-actuated vehicles via kinematic decoupled motion planning. However, this method has not yet been extended to account for external forces such as dissipative viscous drag and buoyancy induced potentials acting on a submerged vehicle. To fully bridge the gap between theory and application, this dissertation addresses the extension of this geometric control design method to include such forces. We incorporate the hydrodynamic drag experienced by the vehicle by modifying the Levi-Civita affine connection and demonstrate a method for the compensation of potential forces experienced during a prescribed motion. We present the design method for multiple different missions and include experimental results which validate both the extension of the theory and the ability to implement control strategies designed through the use of geometric techniques. By use of the extension presented in this dissertation, the underwater vehicle application successfully demonstrates the applicability of geometric methods to design implementable motion planning solutions for complex mechanical systems having equal or fewer input forces than available degrees of freedom. Thus, we provide another tool with which to further increase the autonomy of underwater vehicles.

A Taxonomy of image matching techniques for stereo vision

Stereo vision is a method of depth perception, in which depth information is inferred from two (or more) images of a scene, taken from different perspectives. Applications of stereo vision include aerial photogrammetry, autonomous vehicle guidance, robotics, industrial automation and stereomicroscopy. A key issue in stereo vision is that of image matching, or identifying corresponding points in a stereo pair. The difference in the positions of corresponding points in image coordinates is termed the parallax or disparity. When the orientation of the two cameras is known, corresponding points may be projected back to find the location of the original object point in world coordinates. Matching techniques are typically categorised according to the nature of the matching primitives they use and the matching strategy they employ. This report provides a detailed taxonomy of image matching techniques, including area based, transform based, feature based, phase based, hybrid, relaxation based, dynamic programming and object space methods. A number of area based matching metrics as well as the rank and census transforms were implemented, in order to investigate their suitability for a real-time stereo sensor for mining automation applications. The requirements of this sensor were speed, robustness, and the ability to produce a dense depth map. The Sum of Absolute Differences matching metric was the least computationally expensive; however, this metric was the most sensitive to radiometric distortion. Metrics such as the Zero Mean Sum of Absolute Differences and Normalised Cross Correlation were the most robust to this type of distortion but introduced additional computational complexity. The rank and census transforms were found to be robust to radiometric distortion, in addition to having low computational complexity. They are therefore prime candidates for a matching algorithm for a stereo sensor for real-time mining applications. A number of issues came to light during this investigation which may merit further work. These include devising a means to evaluate and compare disparity results of different matching algorithms, and finding a method of assigning a level of confidence to a match. Another issue of interest is the possibility of statistically combining the results of different matching algorithms, in order to improve robustness.

Multi-objective four-dimensional vehicle motion planning in large dynamic environments

This paper presents Multi-Step A* (MSA*), a search algorithm based on A* for multi-objective 4D vehicle motion planning (three spatial and one time dimension). The research is principally motivated by the need for offline and online motion planning for autonomous Unmanned Aerial Vehicles (UAVs). For UAVs operating in large, dynamic and uncertain 4D environments, the motion plan consists of a sequence of connected linear tracks (or trajectory segments). The track angle and velocity are important parameters that are often restricted by assumptions and grid geometry in conventional motion planners. Many existing planners also fail to incorporate multiple decision criteria and constraints such as wind, fuel, dynamic obstacles and the rules of the air. It is shown that MSA* finds a cost optimal solution using variable length, angle and velocity trajectory segments. These segments are approximated with a grid based cell sequence that provides an inherent tolerance to uncertainty. Computational efficiency is achieved by using variable successor operators to create a multi-resolution, memory efficient lattice sampling structure. Simulation studies on the UAV flight planning problem show that MSA* meets the time constraints of online replanning and finds paths of equivalent cost but in a quarter of the time (on average) of vector neighbourhood based A*.

Methods to achieve net environmental gain in the course of development in Queensland

To achieve best environmental management practice in Queensland, effort needs to be extended into the private sector. A Regional Landscape Strategy compiled for any substantial new proposal must identify the most promising technique(s) (from an available tool kit of 13) by which a developer (of any type) is more likely to sustain on-site resources while assisting government deliver its future plans in any region of the State. Offsetting may prove to be one of the most effective of these tools. However, policy must address‘offset land mitigation’, whereby the necessary financial incentives are introduced. Practicable methods by which offset sites can be selected, and measurement of their consequent environmental benefit, have now been devised and tested to assist this process.

Altering heavy vehicle air suspension dynamic forces by modifying air lines

An experimental programme in 2007 used three air suspended heavy vehicles travelling over typical urban roads to determine whether dynamic axle-to-chassis forces could be reduced by using larger-than-standard diameter longitudinal air lines. This paper presents methodology, interim analysis and partial results from that programme. Alterations to dynamic measures derived from axle-to-chassis forces for the case of standard-sized longitudinal air lines vs. the test case where larger longitudinal air lines were fitted are presented and discussed. This leads to conclusions regarding the possibility that dynamic loadings between heavy vehicle suspensions and chassis may be reduced by fitting larger longitudinal air lines to air-suspended heavy vehicles. Reductions in the shock and vibration loads to heavy vehicle suspension components could lead to lighter and more economical chassis and suspensions. This could therefore lead to reduced tare and increased payloads without an increase in gross vehicle mass.

Vibration characteristics of plate elements subjected in-plane loads (axial loads)

Axial deformations resulting from in-plane loads (axial forces) of plate elements impact significantly on their vibration characteristics. Although, numerous methods have been developed to quantify axial forces and hence deformations of individual plate elements with different boundary conditions based on their natural frequencies, these methods are unable to apply to the plate elements in a structural system. This is because the natural frequency is a global parameter for the entire structure. Thus, this paper proposes a comprehensive vibration based procedure to quantify axial deformations of plate elements in a structural framing system. Unique capabilities of the proposed method present through illustrative examples. Keywords- Plate Elements, Dynamic Stiffness Matrix, Finite Element Method, Vibration Characteristics, Axial Deformation

Plantar enthesopathy : thickening of the enthesis is correlated with energy dissipation of the plantar fat pad during walking

Background: The enthesis of the plantar fascia is thought to play an important role in stress dissipation. However, the potential link between entheseal thickening characteristic of enthesopathy and the stress-dissipating properties of the intervening plantar fat pad have not been investigated. Purpose: This study was conducted to identify whether plantar fat pad mechanics explain variance in the thickness of the fascial enthesis in individuals with and without plantar enthesopathy. Study Design: Case-control study; Level of evidence, 3. Methods: The study population consisted of 9 patients with unilateral plantar enthesopathy and 9 asymptomatic, individually matched controls. The thickness of the enthesis of the symptomatic, asymptomatic, and a matched control limb was acquired using high-resolution ultrasound. The compressive strain of the plantar fat pad during walking was estimated from dynamic lateral radiographs acquired with a multifunction fluoroscopy unit. Peak compressive stress was simultaneously acquired via a pressure platform. Principal viscoelastic parameters were estimated from subsequent stress-strain curves. Results: The symptomatic fascial enthesis (6.7 ± 2.0 mm) was significantly thicker than the asymptomatic enthesis (4.2 ± 0.4 mm), which in turn was thicker than the enthesis (3.3 ± 0.4 mm) of control limbs (P < .05). There was no significant difference in the mean thickness, peak stress, peak strain, or secant modulus of the plantar fat pad between limbs. However, the energy dissipated by the fat pad during loading and unloading was significantly lower in the symptomatic limb (0.55 ± 0.17) when compared with asymptomatic (0.69 ± 0.13) and control (0.70 ± 0.09) limbs (P < .05). The sonographic thickness of the enthesis was correlated with the energy dissipation ratio of the plantar fat pad (r = .72, P < .05), but only in the symptomatic limb. Conclusion: The energy-dissipating properties of the plantar fat pad are associated with the sonograpic appearance of the enthesis in symptomatic limbs, providing a previously unidentified link between the mechanical behavior of the plantar fat pad and enthesopathy.

Hierarchical Bayesian models for estimating the extent of plant pest invasions

Plant biosecurity requires statistical tools to interpret field surveillance data in order to manage pest incursions that threaten crop production and trade. Ultimately, management decisions need to be based on the probability that an area is infested or free of a pest. Current informal approaches to delimiting pest extent rely upon expert ecological interpretation of presence / absence data over space and time. Hierarchical Bayesian models provide a cohesive statistical framework that can formally integrate the available information on both pest ecology and data. The overarching method involves constructing an observation model for the surveillance data, conditional on the hidden extent of the pest and uncertain detection sensitivity. The extent of the pest is then modelled as a dynamic invasion process that includes uncertainty in ecological parameters. Modelling approaches to assimilate this information are explored through case studies on spiralling whitefly, Aleurodicus dispersus and red banded mango caterpillar, Deanolis sublimbalis. Markov chain Monte Carlo simulation is used to estimate the probable extent of pests, given the observation and process model conditioned by surveillance data. Statistical methods, based on time-to-event models, are developed to apply hierarchical Bayesian models to early detection programs and to demonstrate area freedom from pests. The value of early detection surveillance programs is demonstrated through an application to interpret surveillance data for exotic plant pests with uncertain spread rates. The model suggests that typical early detection programs provide a moderate reduction in the probability of an area being infested but a dramatic reduction in the expected area of incursions at a given time. Estimates of spiralling whitefly extent are examined at local, district and state-wide scales. The local model estimates the rate of natural spread and the influence of host architecture, host suitability and inspector efficiency. These parameter estimates can support the development of robust surveillance programs. Hierarchical Bayesian models for the human-mediated spread of spiralling whitefly are developed for the colonisation of discrete cells connected by a modified gravity model. By estimating dispersal parameters, the model can be used to predict the extent of the pest over time. An extended model predicts the climate restricted distribution of the pest in Queensland. These novel human-mediated movement models are well suited to demonstrating area freedom at coarse spatio-temporal scales. At finer scales, and in the presence of ecological complexity, exploratory models are developed to investigate the capacity for surveillance information to estimate the extent of red banded mango caterpillar. It is apparent that excessive uncertainty about observation and ecological parameters can impose limits on inference at the scales required for effective management of response programs. The thesis contributes novel statistical approaches to estimating the extent of pests and develops applications to assist decision-making across a range of plant biosecurity surveillance activities. Hierarchical Bayesian modelling is demonstrated as both a useful analytical tool for estimating pest extent and a natural investigative paradigm for developing and focussing biosecurity programs.

Reinforced hydrogels for silicone copolymer delivery for scar remediation

Hypertrophic scars are formed by collagen overproduction in wounded areas and often occur in victims of severe burns. There are several methods for hypertrophic scar remediation and silicone gel therapy is one of the more successful methods. Research by others has shown that the activity of these gels may be due to migration of amphiphilic silicone oligomers from the gel and into the dermis, down-regulating production of collagen by fibroblasts. Normal silicone oil (PDMS) does not produce the same effect on fibroblasts. The main purpose of this project is the introduction of a particular amphiphilic silicone rake copolymer into an appropriate network which can absorb and release the silicone copolymer on the scarred area. Hydrogels are polymeric crosslinked networks which can swell in water or a drug solution, and gradually release the drug when applied to the skin. The application of gel enhances the effectiveness of the therapy, reduces the period of treatment and can be comfortable for patients to use. Polyethylene glycol (PEG) based networks have been applied in this research, because the amphiphilic silicone rake copolymer to be used as a therapy has polyethylene oxide (PEO) as a side chain. These PEO side chains have very similar chemical structure to a PEG gel chain so enhancing both the compatibility and the diffusion of the amphiphilic silicone rake copolymer into and out of the gel. Synthesis of PEG-based networks has been performed by two methods: in situ silsesquioxane formation as crosslink with a sol-gel reaction under different conditions and UV curing. PEG networks have low mechanical properties which is a fundamental limitation of the polymer backbone. For mechanical properties enhancement, composite networks were synthesized using nano-silica with different surface modification. The chemical structure of in situ silsesquioxane in the dry network has been examined by Solid State NMR, Differential Scanning Calorimetry (DSC) and swelling measurements in water. Mechanical properties of dry networks were tested by Dynamic Mechanical Thermal Analysis (DMTA) to determine modulus and interfacial interaction between silica and the network. In this way a family of self-reinforced networks has been produced that have been shown to absorb and deliver the active amphiphilic silicone- PEO rake copolymer.