Design-related bias in hospital fall risk screening tool predictive accuracy evaluations: systematic review and meta-analysis.

Introduction: Fall risk screening tools are frequently used as a part of falls prevention programs in hospitals. Design-related bias in evaluations of tool predictive accuracy could lead to overoptimistic results, which would then contribute to program failure in practice.

Methods: A systematic review was undertaken. Two blind reviewers assessed the methodology of relevant publications into a four-point classification system adapted from multiple sources. The association between study design classification and reported results was examined using linear regression with clustering based on screening tool and robust variance estimates with point estimates of Youden Index (= sensitivity + specificity - 1) as the dependent variable. Meta-analysis was then performed pooling data from prospective studies.

Results: Thirty-five publications met inclusion criteria, containing 51 evaluations of fall risk screening tools. Twenty evaluations were classified as retrospective validation evaluations, 11 as prospective (temporal) validation evaluations, and 20 as prospective (external) validation evaluations. Retrospective evaluations had significantly higher Youden Indices (point estimate [95% confidence interval]: 0.22 [0.11, 0.33]). Pooled Youden Indices from prospective evaluations demonstrated the STRATIFY, Morse Falls Scale, and nursing staff clinical judgment to have comparable accuracy.

Discussion: Practitioners should exercise caution in comparing validity of fall risk assessment tools where the evaluation has been limited to retrospective classifications of methodology. Heterogeneity between studies indicates that the Morse Falls Scale and STRATIFY may still be useful in particular settings, but that widespread adoption of either is unlikely to generate benefits significantly greater than that of nursing staff clinical judgment.

Fractal analysis of bone texture : a screening tool for stress fracture risk?

Background The aim of this study was to identify specific bone characteristics of stress fracture (SF) cases in sportswomen. To date, no tool is able to distinguish individuals who are at risk, limiting preventive measures.

Material and methods We investigated the skeletal system of sportswomen who did sustain SF in the past (n = 19) and compared it with that of female controls (C) with a similar sporting history but without any fracture history (n = 20).

Bone mass and body composition were measured using dual-energy X-ray absorptiometry. Bone micro-architecture was investigated by calcaneal ultrasound and fractal analysis of calcaneus radiographic images. Oestradiol levels were measured by E.I.A, and IGF-1 by R.I.A. Menstrual characteristics, nutrient intake, and training were assessed using questionnaires.

Results The result of the fractal analysis, expressed by the Hmean parameter, was significantly lower in the SF group, reflecting a more complex structure of the trabecular micro-architectural organization (P < 0·005). Body mass index (BMI) at birth was also found to be lower in the SF cases as compared with their C (P < 0·03).

Multivariate analysis revealed that the fractal parameter Hmean, bone mineral content (BMC) at Ward's triangle and the BMI at birth correctly assigned 84·85% of the female athletes into their respective SF or C groups (P = 0·001).

Conclusion These results suggest that the fractal parameter and the BMI at birth may be able to identify female athletes most at risk for this overuse bone injury, as their low indexes might reflect a greater skeletal sensitivity.

Contracting-agency analysis of the association between firm risk, investment opportunity set, corporate governance and firm performance

Tests the efficiency of corporate controls (board monitoring and incentive contracts) for growth or risk firms. By exploring the implications of controls and studying their interactive effects on firm performance, this study demonstrates how and why different firms use corporate governance controls to align managers' and shareholders' interests.

Performance analysis of cyber security awareness delivery methods

In order to decrease information security threats caused by human-related vulnerabilities, an increased concentration on information security awareness and training is necessary. There are numerous information security awareness training delivery methods. The purpose of this study was to determine what delivery method is most successful in providing security awareness training. We conducted security awareness training using various delivery methods such as text based, game based and a short video presentation with the aim of determining user preference delivery methods. Our study suggests that a combined delvery methods are better than individual secrity awareness delivery method.

A critical analysis of techniques for risk mitigation in the construction industry

Risks exist in every form of construction project. The risks associated with construction projects are often diverse and varied and the management of these risks is nowadays considered compulsory in order to achieve project success. This paper analyses the diverse strategies of risk mitigation that have been employed in construction projects. These strategies are classified into analysed categories of procurement strategies. contingency and co-operative approach along with the utilisation of a designated risk manager. The analysis showed that in order to improve risk mitigation within the construction industry, there is a requirement tor an industry based standard. This standard will improve the efficiency and effectiveness of the risk mitigation response technique to risk management.

Indirect government controls over Australia's social security expenditure : a Foucauldian analysis

Purpose – The aim of this study is to examine how the use of indirect government control mechanisms is used as a means of holding government agencies such as job network providers and recipients of social security benefits accountable. The mechanisms of indirect government will be examined using Michel Foucault's discourses on disciplinary power, surveillance and normalisation.

Design/methodology/approach – The mechanisms of indirect government are investigated through a survey questionnaire and focus group interviews. The questionnaire is assessed and analysed using descriptive statistics and principal component analysis with varimax rotation.

Findings – It is found that the rationing and disciplinary mechanisms of the breaching regime, through a process of disciplinary power, surveillance and normalisation, combine to help hold government agencies and recipients of social security benefits accountable, which in turn helps control the level of social security expenditure.

Originality/value – The current study extends our understanding of the functions of indirect government by providing an applied example of how the process of government works indirectly through government agencies and the abundant rules and regulations that underpin such bureaucracies.

Terrorism and social exclusion : misplaced risk - common security

Recent thinking on globalization places risk at the centre of contemporary life. Yet what if our perception of risk is misplaced? What if the greatest risk is not terrorism itself but the conditions that allow terrorism to flourish? This fascinating book illustrates that elevated perceptions of terrorism-related risks are having a deleterious impact on many societies, exacerbating feelings of exclusion among individuals and groups. Via their exploration of various societies, the expert contributors show that as a causal factor of terrorism, social exclusion can be remedied by inclusive, participatory and deliberative measures. They prescribe a recalibration of counter-terrorism policies to unite rather than divide multicultural societies.

Factor analysis of partners' commitment to risk management in public-private partnership projects

Purpose – The purpose of this paper is to investigate and uncover key determinants that could explain partners' commitment to risk management in public-private partnership projects so that partners' risk management commitment is taken into the consideration of optimal risk allocation strategies.

Design/methodology/approach – Based on an extensive literature review and an examination of the purchasing power parity (PPP) market, an industry-wide questionnaire survey was conducted to collect the data for a confirmatory factor analysis. Necessary statistical tests are conducted to ensure the validity of the analysis results.

Findings – The factor analysis results show that the procedure of confirmatory factor analysis is statistically appropriate and satisfactory. As a result, partners' organizational commitment to risk management in public-private partnerships can now be determined by a set of components, namely general attitude to a risk, perceived one's own ability to manage a risk, and the perceived reward for bearing a risk.

Practical implications – It is recommended, based on the empirical results shown in this paper, that, in addition to partners' risk management capability, decision-makers, both from public and private sectors, should also seriously consider partners' risk management commitment. Both factors influence the formation of optimal risk allocation strategies, either by their individual or interacting effects. Future research may therefore explore how to form optimal risk allocation strategies by integrating organizational capability and commitment, the determinants and measurement of which have been established in this study.

Originality/value – This paper makes an original contribution to the general body of knowledge on risk allocation in large-scale infrastructure projects in Australia adopting the procurement method of public-private partnership. In particular, this paper has innovatively established a measurement model of organisational commitment to risk management, which is crucial to determining optimal risk allocation strategies and in turn achieving project success. The score coefficients of all obtained components can be used to construct components by linear combination so that commitment to risk management can be measured. Previous research has barely focused on this topic.

Self-reported medication side effects in an older cohort living independently in the community - the Melbourne Longitudinal Study on Health Ageing (MELSHA) : cross-sectional analysis of prevalence and risk factors

Background Medication side effects are an important cause of morbidity, mortality and costs in older people. The aim of our study was to examine prevalence and risk factors for self-reported medication side effects in an older cohort living independently in the community.

Methods The Melbourne Longitudinal Study on Healthy Ageing (MELSHA), collected information on those aged 65 years or older living independently in the community and commenced in 1994. Data on medication side effects was collected from the baseline cohort (n = 1000) in face-to-face baseline interviews in 1994 and analysed as cross-sectional data. Risk factors examined were: socio-demographics, health status and medical conditions; medication use and health service factors. Analysis included univariate logistic regression to estimate unadjusted risk and multivariate logistic regression analysis to assess confounding and estimate adjusted risk.

Results Self-reported medication side effects were reported by approximately 6.7% (67/1000) of the entire baseline MELSHA cohort, and by 8.5% (65/761) of those on medication. Identified risk factors were increased education level, co-morbidities and health service factors including recency of visiting the pharmacist, attending younger doctors, and their doctor's awareness of their medications. The greatest increase in risk for medication side effects was associated with liver problems and their doctor's awareness of their medications. Aging and gender were not risk factors.

Conclusion Prevalence of self-reported medication side effects was comparable with that reported in adults attending General Practices in a primary care setting in Australia. The prevalence and identified risk factors provide further insight and opportunity to develop strategies to address the problem of medication side effects in older people living independently in the community setting.

Critical infrastructure systems : security analysis and modelling approach

A system security analysis and system modelling framework tool is proposed adopting an associated conceptual methodology as the basis for assessing security and conceptually modelling a critical infrastructure system incident. The intent is to identify potential system security issues and gain operational insights that will contribute to improving system resilience, contingency planning, disaster recovery and ameliorating incident management responses for critical infrastructure system incidents. The aforementioned system security analysis and modelling framework is applied to an adverse critical infrastructure system incident case study. This paper reports on the practical application of the framework to a case study of an actual critical infrastructure system failure and the resultant incident implications for the system and the wider regional communities.

Multilevel analysis of the Be Active Eat Well intervention : environmental and behavioural influences on reductions in child obesity risk

Background: The Be Active Eat Well (BAEW) community-based child obesity prevention intervention was successful in modestly reducing unhealthy weight gain in primary school children using a multi-strategy and multi-setting approach.

Objective: To (1) examine the relationship between changes in obesity-related individual, household and school factors and changes in standardised child body mass index (zBMI), and (2) determine if the BAEW intervention moderated these effects.

Methods: The longitudinal relationships between changes in individual, household and school variables and changes in zBMI were explored using multilevel modelling, with measurement time (baseline and follow-up) at level 1, individual (behaviours, n=1812) at level 2 and households (n=1318) and schools (n=18) as higher levels (environments). The effect of the intervention was tested while controlling for child age, gender and maternal education level.

Results: This study confirmed that the BAEW intervention lowered child zBMI compared with the comparison group (−0.085 units, P=0.03). The variation between household environments was found to be a large contributor to the percentage of unexplained change in child zBMI (59%), compared with contributions from the individual (23%) and school levels (1%). Across both groups, screen time (P=0.03), sweet drink consumption (P=0.03) and lack of household rules for television (TV) viewing (P=0.05) were associated with increased zBMI, whereas there was a non-significant association with the frequency the TV was on during evening meals (P=0.07). The moderating effect of the intervention was only evident for the relationship between the frequency of TV on during meals and zBMI, however, this effect was modest (P=0.04).

Conclusions: The development of childhood obesity involves multi-factorial and multi-level influences, some of which are amenable to change. Obesity prevention strategies should not only target individual behaviours but also the household environment and family practices. Although zBMI changes were modest, these findings are encouraging as small reductions can have population level impacts on childhood obesity levels.

Emerging wireless personal area networks(WPANs) : - An analysis of techniques, tools and threats

Wireless Personal Area Networks provide a pivotal role in local area network technology complementing traditional Wireless Local Area Network technologies. Bluetooth, ZigBee and NFC (Near Field Communications) have emerged as key WPAN technologies with UWB (Ultra Wide Band) standards currently evolving. They are however subject to the usual range of security vulnerabilities found in wireless LANs such as spoofing, snooping, man-in-the-middle, denial of service and other attacks. However security in WPANs is not as mature as it is in Wireless LANs and further work is needed in order to provide comparable protection. This paper examines a range of WPAN technologies and security issues and proposes protection mechanisms that can mitigate risk in each case. © 2012 IEEE.