Educational interventions for preventing vascular catheter bloodstream infections in critical care: Evidence map, systematic review and economic evaluation

Background Bloodstream infections resulting from intravascular catheters (catheter-BSI) in critical care increase patients' length of stay, morbidity and mortality, and the management of these infections and their complications has been estimated to cost the NHS annually £19.1–36.2M. Catheter-BSI are thought to be largely preventable using educational interventions, but guidance as to which types of intervention might be most clinically effective is lacking. Objective To assess the effectiveness and cost-effectiveness of educational interventions for preventing catheter-BSI in critical care units in England. Data sources Sixteen electronic bibliographic databases – including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health Literature (CINAHL), NHS Economic Evaluation Database (NHS EED), EMBASE and The Cochrane Library databases – were searched from database inception to February 2011, with searches updated in March 2012. Bibliographies of systematic reviews and related papers were screened and experts contacted to identify any additional references. Review methods References were screened independently by two reviewers using a priori selection criteria. A descriptive map was created to summarise the characteristics of relevant studies. Further selection criteria developed in consultation with the project Advisory Group were used to prioritise a subset of studies relevant to NHS practice and policy for systematic review. A decision-analytic economic model was developed to investigate the cost-effectiveness of educational interventions for preventing catheter-BSI. Results Seventy-four studies were included in the descriptive map, of which 24 were prioritised for systematic review. Studies have predominantly been conducted in the USA, using single-cohort before-and-after study designs. Diverse types of educational intervention appear effective at reducing the incidence density of catheter-BSI (risk ratios statistically significantly < 1.0), but single lectures were not effective. The economic model showed that implementing an educational intervention in critical care units in England would be cost-effective and potentially cost-saving, with incremental cost-effectiveness ratios under worst-case sensitivity analyses of < £5000/quality-adjusted life-year. Limitations Low-quality primary studies cannot definitively prove that the planned interventions were responsible for observed changes in catheter-BSI incidence. Poor reporting gave unclear estimates of risk of bias. Some model parameters were sourced from other locations owing to a lack of UK data. Conclusions Our results suggest that it would be cost-effective and may be cost-saving for the NHS to implement educational interventions in critical care units. However, more robust primary studies are needed to exclude the possible influence of secular trends on observed reductions in catheter-BSI.

Efficacy and feasibility of a tele-health intervention for acute coronary syndrome patients with depression: Results of the 'MoodCare' randomized controlled trial

Background Depression is common after a cardiac event, yet there remain few approaches to management that are both effective and scalable. Purpose We aimed to evaluate the 6-month efficacy and feasibility of a tele-health program (MoodCare) that integrates depression management into a cardiovascular disease risk reduction program for acute coronary syndrome patients with low mood. Methods A two-arm, parallel, randomized design was used comprising 121 patients admitted to one of six hospitals for acute coronary syndrome. Results Significant treatment effects were observed for Patient Health Questionnaire 9 (PHQ9) depression (mean difference [change] = −1.8; p = 0.025; effect size: d = 0.36) for the overall sample, when compared with usual medical care. Results were more pronounced effects for those with a history of depression (mean difference [change] = −2.7; p = 0.043; effect size: d = 0.65). Conclusions MoodCare was effective for improving depression in acute coronary syndrome patients, producing effect sizes exceeding those of some face-to-face psychotherapeutic interventions and pharmacotherapy. (Trial Registration Number: ACTRN1260900038623.)

Occupational injury risk among Australian paramedics: An analysis of national data

Objective To identify the occupational risks for Australian paramedics, by describing the rate of injuries and fatalities and comparing those rates with other reports. Design and participants Retrospective descriptive study using data provided by Safe Work Australia for the period 2000–2010. The subjects were paramedics who had been injured in the course of their duties and for whom a claim had been made for workers compensation payments. Main outcome measures Rates of injury calculated from the data provided. Results The risk of serious injury among Australian paramedics was found to be more than seven times higher than the Australian national average. The fatality rate for paramedics was about six times higher than the national average. On average, every 2 years during the study period, one paramedic died and 30 were seriously injured in vehicle crashes. Ten Australian paramedics were seriously injured each year as a result of an assault. The injury rate for paramedics was more than two times higher than the rate for police officers. Conclusions The high rate of occupational injuries and fatalities among paramedics is a serious public health issue. The risk of injury in Australia is similar to that in the United States. While it may be anticipated that injury rates would be higher as a result of the nature of the work and environment of paramedics, further research is necessary to identify and validate the strategies required to minimise the rates of occupational injury for paramedics.

Modeling approaches for pesticide exposure assessment in rice paddies

Pesticide use in paddy rice production may contribute to adverse ecological effects in surface waters. Risk assessments conducted for regulatory purposes depend on the use of simulation models to determine predicted environment concentrations (PEC) of pesticides. Often tiered approaches are used, in which assessments at lower tiers are based on relatively simple models with conservative scenarios, while those at higher tiers have more realistic representations of physical and biochemical processes. This chapter reviews models commonly used for predicting the environmental fate of pesticides in rice paddies. Theoretical considerations, unique features, and applications are discussed. This review is expected to provide information to guide model selection for pesticide registration, regulation, and mitigation in rice production areas.

Designing informal learning experiences for early career academics using a knowledge ecosystem model

This article presents a ‘knowledge ecosystem’ model of how early career academics experience using information to learn while building their social networks for developmental purposes. Developed using grounded theory methodology, the model offers a way of conceptualising how to empower early career academics through 1) agency (individual and relational) and 2) facilitation of personalised informal learning (design of physical and virtual systems and environments) in spaces where developmental relationships are formed including programs, courses, events, community, home and social media. It is suggested that the knowledge ecosystem model is suitable for use in designing informal learning experiences for early career academics.

Risk analysis of prostate cancer in PRACTICAL, a multinational consortium, using 25 known prostate cancer susceptibility loci

Background Genome-wide association studies have identified multiple genetic variants associated with prostate cancer risk which explain a substantial proportion of familial relative risk. These variants can be used to stratify individuals by their risk of prostate cancer. Methods We genotyped 25 prostate cancer susceptibility loci in 40,414 individuals and derived a polygenic risk score (PRS).We estimated empirical odds ratios (OR) for prostate cancer associated with different risk strata defined by PRS and derived agespecific absolute risks of developing prostate cancer by PRS stratum and family history. Results The prostate cancer risk for men in the top 1% of the PRS distribution was 30.6 (95% CI, 16.4-57.3) fold compared with men in the bottom 1%, and 4.2 (95% CI, 3.2-5.5) fold compared with the median risk. The absolute risk of prostate cancer by age of 85 years was 65.8% for a man with family history in the top 1% of the PRS distribution, compared with 3.7% for a man in the bottom 1%. The PRS was only weakly correlated with serum PSA level (correlation = 0.09). Conclusions Risk profiling can identify men at substantially increased or reduced risk of prostate cancer. The effect size, measured by OR per unit PRS, was higher in men at younger ages and in men with family history of prostate cancer. Incorporating additional newly identified loci into a PRS should improve the predictive value of risk profiles. Impact:We demonstrate that the risk profiling based on SNPs can identify men at substantially increased or reduced risk that could have useful implications for targeted prevention and screening programs.

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same region.

Generalizability of established prostate cancer risk variants in men of African ancestry

Genome-wide association studies have identified more than 80 risk variants for prostate cancer, mainly in European or Asian populations. The generalizability of these variants in other racial/ethnic populations needs to be understood before the loci can be used widely in risk modeling. In our study, we examined 82 previously reported risk variants in 4,853 prostate cancer cases and 4,678 controls of African ancestry. We performed association testing for each variant using logistic regression adjusted for age, study and global ancestry. Of the 82 known risk variants, 68 (83%) had effects that were directionally consistent in their association with prostate cancer risk and 30 (37%) were significantly associated with risk at p < 0.05, with the most statistically significant variants being rs116041037 (p = 3.7 × 10(-26) ) and rs6983561 (p = 1.1 × 10(-16) ) at 8q24, as well as rs7210100 (p = 5.4 × 10(-8) ) at 17q21. By exploring each locus in search of better markers, the number of variants that captured risk in men of African ancestry (p < 0.05) increased from 30 (37%) to 44 (54%). An aggregate score comprised of these 44 markers was strongly associated with prostate cancer risk [per-allele odds ratio (OR) = 1.12, p = 7.3 × 10(-98) ]. In summary, the consistent directions of effects for the vast majority of variants in men of African ancestry indicate common functional alleles that are shared across populations. Further exploration of these susceptibility loci is needed to identify the underlying biologically relevant variants to improve prostate cancer risk modeling in populations of African ancestry.

Travel behaviours of immigrants in Queensland, Australia

The aim of this research is to determine if there is a significant difference in public transport usage between Australian-born and overseas-born travellers in South East Queensland and identify if further investigation into this demographic factor is necessary. Using the household travel survey data of Southeast Queensland, Australia, this paper analyses the travel behaviours of immigrants and non-immigrants in the region. The immigrant population is divided into six sub-groups based on their continent of origin. The analysis results suggest that immigrants are more likely to use public transit in Brisbane over other regions in the study. Overall, this research strongly suggests that in Australia, a higher proportion of the immigrant population is more likely to use public transit compared to the proportion of the local population.

De Profundis (Theatre Soundtrack)

This creative work is an original soundtrack for the multimedia performance adaptation of Oscar Wilde’s De Profundis, led by David Fenton and Brian Lucas and produced by Metro Arts. Intermediality offers unique challenges to the composer creating towards live performance. Given the text-based nature of the piece, and the prevalence of screen content, music had a distinct role to play in supporting the intermedial performance environment. Drawing from Oscar Wilde’s own writings in the initial stages [“...richer cadences…more curious effects” “…the cry of Marysas” and the “deferred resolution of Chopin”] , the deliberately risky compositional process experimented with improvised location recordings and found sounds, random and fragmented assemblages of vintage recordings, rough methods and obsolete recording technology, and the sonic kinship of the hissing sibilances of the sea, theatrical applause and the crackle of antique recording devices (which had just been invented in Wilde’s time) worked into wefts of sound. As the soundtrack emerged, is was clearly resistant to ‘concepts’ imposed from the outside, and as the field of possibilities expanded and engaged in dialogue with the other elements of the performance (live and projected) certain pieces were selected by the director and curated into the emerging work. Thus leitmotifs emerged, rather than being imposed from the outset, with a particular through line holding: if it was too obviously like ‘music’, (which is usually used in theatre as emotional lubrication and narrative signpost) it didn’t work, and if it sounded like avant-garde sound-art, it was too grating and detracted from the primacy of the text. As a composer I worked this sweet spot inbetween these two poles as well as serving David Fenton’s curation: he determined which compositions to incorporate, reiterate and omit as part of the process of writing text, action and image and the compositional process responded with organic elaborations and variations on these selections. Musical resolution was mostly deferred until the closing stages of the performance. The soundtrack was present for the duration of the show, and Artshub reviewed the musical component thus: “...the score by David Megarrity is a refined, understated ambient scaffolding.” It premiered at the Visy Theatre, Brisbane Powerhouse, on 22 April 2015.

A thermometer for interdependence: Exploring patterns of interdependence using networks of affordances

Interdependence is a central concept in systems and organizations, yet our methods for measuring it are not well developed. Here, we report on a novel method for transforming digital trace data into networks of events that can be used to visualize and measure interdependence. The edges in the network represent sequential flow and the vertices represent actors, actions and artifacts. We refer to this representation as an affordance network. As with conventional approaches such as process mining, our method uses input from a stream of time-stamped occurrences, but the representation is simpler and more appropriate for exploration and theory building. As digital trace data becomes more widely available, this method may become more useful in information systems research and practice. Like a thermometer, it helps us measure a basic property of a system that would otherwise be difficult to see.

History, Transfer, Politics : Five studies on the legacy of Uppsala philosophy

The Uppsala school of Axel Hägerström can be said to have been the last genuinely Swedish philosophical movement. On the other hand, the Swedish analytic tradition is often said to have its roots in Hägerström s thought. This work examines the transformation from Uppsala philosophy to analytic philosophy from an actor-based historical perspective. The aim is to describe how a group of younger scholars (Ingemar Hedenius, Konrad Marc-Wogau, Anders Wedberg, Alf Ross, Herbert Tingsten, Gunnar Myrdal) colonised the legacy of Hägerström and Uppsala philosophy, and faced the challenges they met in trying to reconcile this legacy with the changing philosophical and political currents of the 1930s and 40s. Following Quentin Skinner, the texts are analysed as moves or speech acts in a particular historical context. The thesis consists of five previously published case studies and an introduction. The first study describes how the image of Hägerström as the father of the Swedish analytic tradition was created by a particular faction of younger Uppsala philosophers who (re-) presented the Hägerströmian philosophy as a parallel movement to logical empiricism. The second study examines the confrontations between Uppsala philosophy and logical empiricism in both the editorial board and in the pages of Sweden s leading philosophical journal Theoria. The third study focuses on how the younger generation redescribed Hägerströmian legal philosophical ideas (Scandinavian Legal Realism), while the fourth study discusses how they responded to the accusations of a connection between Hägerström s value nihilistic theory and totalitarianism. Finally, the fifth study examines how the Swedish social scientist and Social Democratic intellectual Gunnar Myrdal tried to reconcile value nihilism with a strong political programme for social reform. The contribution of this thesis to the field consists mainly in a re-evaluation of the role of Uppsala philosophy in the history of Swedish philosophy. From this perspective the Uppsala School was less a collection of certain definite philosophical ideas than an intellectual legacy that was the subject of fierce struggles. Its theories and ideas were redescribed in various ways by individual actors with different philosophical and political intentions.

Effect of an interactive therapeutic robotic animal on engagement, mood states, agitation and psychotropic drug use in people with dementia: A cluster-randomised controlled trial protocol

Introduction: Apathy, agitated behaviours, loneliness and depression are common consequences of dementia. This trial aims to evaluate the effect of a robotic animal on behavioural and psychological symptoms of dementia in people with dementia living in long-term aged care. Methods and analysis: A cluster-randomised controlled trial with three treatment groups: PARO (robotic animal), Plush-Toy (non-robotic PARO) or Usual Care (Control). The nursing home sites are Australian Government approved and accredited facilities of 60 or more beds. The sites are located in South-East Queensland, Australia. A sample of 380 adults with a diagnosis of dementia, aged 60 years or older living in one of the participating facilities will be recruited. The intervention consists of three individual 15 min non-facilitated sessions with PARO or Plush- Toy per week, for a period of 10 weeks. The primary outcomes of interest are improvement in agitation, mood states and engagement. Secondary outcomes include sleep duration, step count, change in psychotropic medication use, change in treatment costs, and staff and family perceptions of PARO or Plush-Toy. Video data will be analysed using Noldus XT Pocket Observer; descriptive statistics will be used for participants’ demographics and outcome measures; cluster and individual level analyses to test all hypotheses and Generalised Linear Models for cluster level and Generalised Estimation Equations and/or Multi-level Modeling for individual level data. Ethics and dissemination: The study participants or their proxy will provide written informed consent. The Griffith University Human Research Ethics Committee has approved the study (NRS/03/14/HREC). The results of the study will provide evidence of the efficacy of a robotic animal as a psychosocial treatment for the behavioural and psychological symptoms of dementia. Findings will be presented at local and international conference meetings and published in peer-reviewed journals.

Unsupervised Domain Adaptation by Domain Invariant Projection

Domain-invariant representations are key to addressing the domain shift problem where the training and test exam- ples follow different distributions. Existing techniques that have attempted to match the distributions of the source and target domains typically compare these distributions in the original feature space. This space, however, may not be di- rectly suitable for such a comparison, since some of the fea- tures may have been distorted by the domain shift, or may be domain specific. In this paper, we introduce a Domain Invariant Projection approach: An unsupervised domain adaptation method that overcomes this issue by extracting the information that is invariant across the source and tar- get domains. More specifically, we learn a projection of the data to a low-dimensional latent space where the distance between the empirical distributions of the source and target examples is minimized. We demonstrate the effectiveness of our approach on the task of visual object recognition and show that it outperforms state-of-the-art methods on a stan- dard domain adaptation benchmark dataset

Domain Adaptation on the Statistical Manifold

In this paper, we tackle the problem of unsupervised domain adaptation for classification. In the unsupervised scenario where no labeled samples from the target domain are provided, a popular approach consists in transforming the data such that the source and target distributions be- come similar. To compare the two distributions, existing approaches make use of the Maximum Mean Discrepancy (MMD). However, this does not exploit the fact that prob- ability distributions lie on a Riemannian manifold. Here, we propose to make better use of the structure of this man- ifold and rely on the distance on the manifold to compare the source and target distributions. In this framework, we introduce a sample selection method and a subspace-based method for unsupervised domain adaptation, and show that both these manifold-based techniques outperform the cor- responding approaches based on the MMD. Furthermore, we show that our subspace-based approach yields state-of- the-art results on a standard object recognition benchmark.