Sequential monitoring of hospital adverse events when control charts fail : the example of fall injuries in hospitals

Objective To evaluate methods for monitoring monthly aggregated hospital adverse event data that display clustering, non-linear trends and possible autocorrelation. Design Retrospective audit. Setting The Northern Hospital, Melbourne, Australia. Participants 171,059 patients admitted between January 2001 and December 2006. Measurements The analysis is illustrated with 72 months of patient fall injury data using a modified Shewhart U control chart, and charts derived from a quasi-Poisson generalised linear model (GLM) and a generalised additive mixed model (GAMM) that included an approximate upper control limit. Results The data were overdispersed and displayed a downward trend and possible autocorrelation. The downward trend was followed by a predictable period after December 2003. The GLM-estimated incidence rate ratio was 0.98 (95% CI 0.98 to 0.99) per month. The GAMM-fitted count fell from 12.67 (95% CI 10.05 to 15.97) in January 2001 to 5.23 (95% CI 3.82 to 7.15) in December 2006 (p<0.001). The corresponding values for the GLM were 11.9 and 3.94. Residual plots suggested that the GLM underestimated the rate at the beginning and end of the series and overestimated it in the middle. The data suggested a more rapid rate fall before 2004 and a steady state thereafter, a pattern reflected in the GAMM chart. The approximate upper two-sigma equivalent control limit in the GLM and GAMM charts identified 2 months that showed possible special-cause variation. Conclusion Charts based on GAMM analysis are a suitable alternative to Shewhart U control charts with these data.

Refining a teaching pattern: Reflection around artefacts

This book is about understanding the nature and application of reflection in higher education. It provides a theoretical model to guide the implementation of reflective learning and reflective practice across multiple disciplines and international contexts in higher education. The book presents research into the ways in which reflection is both considered and implemented in different ways across different professional disciplines, while maintaining a common purpose to transform and improve learning and/or practice. Chapter 13 'Refining a Teaching Pattern: Reflection Around Artefacts' explores reflective practices of an artefact, in this case fashion design garment samples.

An e-support firm's response to local e-readiness and the global e-business environment

The purpose of this study is to understand a small e-support firm’s response to the local e-readiness and the global e-business environment in a developing context. E-Support firms provide Web development and consultancy services to user organizations, assisting them in their uptake and maintenance of their Internet applications. Within the e-readiness research area, little is known about e-support firms, particularly in connection with their interaction with their local and the global e-business environment. As yet the emphasis on e-readiness studies has been at the national level. Nevertheless, the e-support sector is very significant in the successful adoption and diffusion of the Internet and related applications in any economy. It is thus important to understand how such firms relate to their e-business environments.That said, this study draws on the interpretive case study of a small e-support firm in Ghana, a developing context, to investigate the firm’s response to the e-readiness level of the local and the global e-business environment. Findings show that the firm could employ resources from the global environment to address most of the infrastructural challenges posed by a relatively poor local e-readiness context. However, its attempt to transfer advanced e-business technologies from the global e-business environment to the local e-business context did not succeed. This chapter offers implications for practice and research concerning the notion of reconciling local and global e-business environments in the small e-support sector.

What is the apparent angle of a Kelvin ship wave pattern?

While the half-angle which encloses a Kelvin ship wave pattern is commonly accepted to be 19.47 degrees, recent observations and calculations for sufficiently fast-moving ships suggest that the apparent wake angle decreases with ship speed. One explanation for this decrease in angle relies on the assumption that a ship cannot generate wavelengths much greater than its hull length. An alternative interpretation is that the wave pattern that is observed in practice is defined by the location of the highest peaks; for wakes created by sufficiently fast-moving objects, these highest peaks no longer lie on the outermost divergent waves, resulting in a smaller apparent angle. In this paper, we focus on the problems of free surface flow past a single submerged point source and past a submerged source doublet. In the linear version of these problems, we measure the apparent wake angle formed by the highest peaks, and observe the following three regimes: a small Froude number pattern, in which the divergent waves are not visible; standard wave patterns for which the maximum peaks occur on the outermost divergent waves; and a third regime in which the highest peaks form a V-shape with an angle much less than the Kelvin angle. For nonlinear flows, we demonstrate that nonlinearity has the effect of increasing the apparent wake angle so that some highly nonlinear solutions have apparent wake angles that are greater than Kelvin's angle. For large Froude numbers, the effect on apparent wake angle can be more dramatic, with the possibility of strong nonlinearity shifting the wave pattern from the third regime to the second. We expect our nonlinear results will translate to other more complicated flow configurations, such as flow due to a steadily moving closed body such as a submarine.

Cultivation

The interest in potentially economically valuable plants (for food, timber, dyes, fabric, and drugs) was part of the concerted effort given by colonial governments towards providing botanic gardens in new colonies. While convicts and guards laboured in Brisbane Town from 1825 until 1849, botanists such as Alan Cunningham were discovering the delights of native plants in their numerous excursions. Their observations and collections of seeds were sent south (to the local botanic gardens at Melbourne and Sydney) and onward to the Royal Botanic Gardens in Britain (at Kew and Edinburgh). This set the local pattern for future exchanges among the global British Imperial botanic garden network...

A computational model for BMP movement in sea urchin embryos

Bone morphogen proteins (BMPs) are distributed along a dorsal-ventral (DV) gradient in many developing embryos. The spatial distribution of this signaling ligand is critical for correct DV axis specification. In various species, BMP expression is spatially localized, and BMP gradient formation relies on BMP transport, which in turn requires interactions with the extracellular proteins Short gastrulation/Chordin (Chd) and Twisted gastrulation (Tsg). These binding interactions promote BMP movement and concomitantly inhibit BMP signaling. The protease Tolloid (Tld) cleaves Chd, which releases BMP from the complex and permits it to bind the BMP receptor and signal. In sea urchin embryos, BMP is produced in the ventral ectoderm, but signals in the dorsal ectoderm. The transport of BMP from the ventral ectoderm to the dorsal ectoderm in sea urchin embryos is not understood. Therefore, using information from a series of experiments, we adapt the mathematical model of Mizutani et al. (2005) and embed it as the reaction part of a one-dimensional reaction–diffusion model. We use it to study aspects of this transport process in sea urchin embryos. We demonstrate that the receptor-bound BMP concentration exhibits dorsally centered peaks of the same type as those observed experimentally when the ternary transport complex (Chd-Tsg-BMP) forms relatively quickly and BMP receptor binding is relatively slow. Similarly, dorsally centered peaks are created when the diffusivities of BMP, Chd, and Chd-Tsg are relatively low and that of Chd-Tsg-BMP is relatively high, and the model dynamics also suggest that Tld is a principal regulator of the system. At the end of this paper, we briefly compare the observed dynamics in the sea urchin model to a version that applies to the fly embryo, and we find that the same conditions can account for BMP transport in the two types of embryos only if Tld levels are reduced in sea urchin compared to fly.

A different breed altogether? Distinctions between local and metropolitan journalism cultures

While a number of scholars have explored the special exigencies of local as opposed to metropolitan journalism, rarely have studies examined such differences in relation to journalism culture as constituted by journalists’ professional views. To address the gap in our knowledge, this study reports results from a representative survey of local and metropolitan newspaper journalists in Australia. Findings suggest that territorial context accounts for some significant differences in journalists’ demographics, as well as their role perceptions. In line with past research, local newspaper journalists exhibit much stronger support for the community forum and advocacy role. At the same time, and contrary to expectations, there is very little difference in their support of the watchdog role compared with metropolitan journalists. By combining questions about journalistic ideals and enactment in their work, and finding differences in the two, this study also has important implications for the methodological development of survey studies.