Assessment of the health impacts of the 2011 summer floods in Brisbane

Background: During December 2010 and January 2011, torrential rainfall in Queensland resulted in the worst flooding in over 50 years. We carried out a community-based survey to assess the health impacts of this flooding in the city of Brisbane. Methods: A community-based survey was conducted in 12 flood-affected electorates using postal questionnaires. A random sample of residents in these areas was drawn from electoral rolls. Questions examined sociodemographic information, the direct impact of flooding on the household, and perceived flood-related health impacts. Outcome variables included perceived flood-related effects on overall and respiratory health, along with mental health outcomes measured by psychosocial distress, reduced sleep quality and probable post-traumatic stress disorder (PTSD). Multivariable logistic regression was used to examine the association between flooding and health outcome variables, adjusted for current health status and socioeconomic factors. Results: 3000 residents were invited to participate in this survey, with 960 responses (32%). People whose households were directly impacted by flooding had a decrease in perceived overall health (OR 5.3, 95% CI: 2.8–10.2), along with increases in psychological distress (OR 1.9, 1.1–3.5), decreased sleep quality (OR 2.3, 1.2–4.4), and probable PTSD (OR 2.3, 1.2–4.5). Residents were also more likely to increase usage of both tobacco (OR 6.3, 2.4–16.8) and alcohol (OR 7.0, 2.2–22.3) after flooding. Conclusions: There were significant impacts of flood events on residents’ health, in particular psychosocial health. Improved support strategies may need to be integrated into existing disaster management programs to reduce flood-related health impacts.

Court Based Psychiatric Assessment: A Case for an Integrated and Diversionary Public Health Role

This article describes a follow-up study of 232 individuals who underwent psychiatric assessment by a Criminal Justice Mental Health Team (CJMHT) in 2001/2002, and also draws upon in-depth interviews conducted with 26 of the cohort. At assessment many people are identified with substance misuse problems, as homeless and with a history of psychiatric contact but in the main their problems are of insufficient severity to merit diversion to psychiatric hospital. The study mapped service contact, housing and offending in the 12 months following assessment and compared this to the 12 months prior to assessment, and found increased levels of service contact but also increased levels of offending and no decrease in homelessness. Thus assessment by the CJMHT brought few discernible advantages for the majority of clients. This was also the perception of the 26 clients who were interviewed. Their own perceptions of their lifestyle and the support that they deemed most valuable are described to identify means of enhancing the efficacy of court assessment.

The assessment of mental health in children with intellectual disability

Aim: Individuals with intellectual disability (ID) have higher rates of mental health problems than the general population. Assessment tends to rely heavily on self-report, but persons with ID often have difficulties in identifying and describing their own thoughts and feelings. Measures that are psychometrically sound with typically developing populations may not be as robust in samples with ID. The aim of the current study was to examine a range of self-report measures for assessing the mental health of children with ID, and to consider the appropriateness of minor modifications to those instruments. Method: The participants were 58 children with ID (mean 11.7 years) attending Year 6 in mainstream primary schools. At the first time point they completed four established measures of depression, anxiety and mood. Minor modifications were made to wording and format at re-administration six months later. Results: Internal consistency varied considerably across measures. Modifications resulted in small or no improvements, but the results were relatively consistent over time and across similar measures. Some gender differences were evident. Conclusions: The findings confirm the difficulties that children with ID may have when responding to self-report measures of mental health, and suggest that care should be taken in choice of instruments. While modifications can produce small improvements, it is clear that more robust measures of mental health are needed for persons with ID.

Innovative damage assessment of steel truss bridges using modal strain energy correlation

As a part of vital infrastructure and transportation network, bridge structures must function safely at all times. Bridges are designed to have a long life span. At any point in time, however, some bridges are aged. The ageing of bridge structures, given the rapidly growing demand of heavy and fast inter-city passages and continuous increase of freight transportation, would require diligence on bridge owners to ensure that the infrastructure is healthy at reasonable cost. In recent decades, a new technique, structural health monitoring (SHM), has emerged to meet this challenge. In this new engineering discipline, structural modal identification and damage detection have formed a vital component. Witnessed by an increasing number of publications is that the change in vibration characteristics is widely and deeply investigated to assess structural damage. Although a number of publications have addressed the feasibility of various methods through experimental verifications, few of them have focused on steel truss bridges. Finding a feasible vibration-based damage indicator for steel truss bridges and solving the difficulties in practical modal identification to support damage detection motivated this research project. This research was to derive an innovative method to assess structural damage in steel truss bridges. First, it proposed a new damage indicator that relies on optimising the correlation between theoretical and measured modal strain energy. The optimisation is powered by a newly proposed multilayer genetic algorithm. In addition, a selection criterion for damage-sensitive modes has been studied to achieve more efficient and accurate damage detection results. Second, in order to support the proposed damage indicator, the research studied the applications of two state-of-the-art modal identification techniques by considering some practical difficulties: the limited instrumentation, the influence of environmental noise, the difficulties in finite element model updating, and the data selection problem in the output-only modal identification methods. The numerical (by a planer truss model) and experimental (by a laboratory through truss bridge) verifications have proved the effectiveness and feasibility of the proposed damage detection scheme. The modal strain energy-based indicator was found to be sensitive to the damage in steel truss bridges with incomplete measurement. It has shown the damage indicator's potential in practical applications of steel truss bridges. Lastly, the achievement and limitation of this study, and lessons learnt from the modal analysis have been summarised.

Assessment of the health impacts of the 2011 summer floods in Brisbane

Objective To assess the effects of the 2011 floods in Brisbane, Australia, on residents’ physical and mental health. Methods Residents who had been affected by the floods completed a community-based survey that examined the direct impact of flooding on households and their perceived physical and mental health. Outcome variables included overall and respiratory health and mental health outcomes related to psychological distress, sleep quality, and posttraumatic stress disorder (PTSD). Multivariable logistic regression was used to examine the association between flooding and perceived health outcome variables, adjusted for current health status and sociodemographic factors. Results Residents whose households were directly affected by flooding were more likely to report poor overall (Odds Ratio [OR] 5.3; 95% CI, 2.8-10.1) and respiratory (OR 2.3; 95% CI, 1.1-4.6) health, psychological distress (OR 1.9; 95% CI, 1.1-3.5), poor sleep quality (OR 2.3; 95% CI, 1.2-4.4), and probable PTSD (OR 2.3; 95% CI, 1.2-4.5). Conclusions The 2011 Brisbane floods had significant impact on the physical and psychosocial health of residents. Improved support strategies may need to be integrated into existing disaster management programs to reduce flood-related health impacts, particularly those related to mental health.

Pervasive technology and public transport : opportunities beyond telematics

The advancements of technology in the field of public transport have been considerable. Information Technology (IT) has made the dissemination of information effortless, contributing to reduced perceived waiting time, increased sense of security, and value for money. Nevertheless, and in light of the ever more obvious widespread presence of powerful mobile devices, it seems that the use of technology may be geared towards supplementary services other than telematics. Looking at it from a passenger’s perspective, this article provides an overview of what IT-based services are currently offered in public transport and what is their assessed impact. We finalise by putting forward possible directions that future services might follow, and stress out the necessity to come up with frameworks that enable for the impact assessment on service quality and customer satisfaction.

Health Assessment and Physical Examination

"This first Australia and New Zealand edition of the comprehensive Estes’ Health Assessment and Physical Examination is designed to teach students to assess a patient’s physical, psychological, cultural and emotional dimensions of health as a foundation of nursing care. The skills of interviewing, inspection, percussion, palpation, auscultation, and documentation are defined to help students to make clinical assessments and promote healthy patient outcomes. A strong emphasis on science encompasses all the technical aspects of anatomy, physiology and assessment, while highlighting clinically relevant information. Emphasis on caring is displayed through themes of assessment of the whole person, which also encourages nurses to think about care for themselves as well as patients."--publisher website

Exploiting SNOMED CT concepts and relationships for clinical information retrieval : Australian e-Health Research Centre and Queensland University of Technology at the TREC 2012 Medical Track

The Australian e-Health Research Centre and Queensland University of Technology recently participated in the TREC 2012 Medical Records Track. This paper reports on our methods, results and experience using an approach that exploits the concept and inter-concept relationships defined in the SNOMED CT medical ontology. Our concept-based approach is intended to overcome specific challenges in searching medical records, namely vocabulary mismatch and granularity mismatch. Queries and documents are transformed from their term-based originals into medical concepts as defined by the SNOMED CT ontology, this is done to tackle vocabulary mismatch. In addition, we make use of the SNOMED CT parent-child `is-a' relationships between concepts to weight documents that contained concept subsumed by the query concepts; this is done to tackle the problem of granularity mismatch. Finally, we experiment with other SNOMED CT relationships besides the is-a relationship to weight concepts related to query concepts. Results show our concept-based approach performed significantly above the median in all four performance metrics. Further improvements are achieved by the incorporation of weighting subsumed concepts, overall leading to improvement above the median of 28% infAP, 10% infNDCG, 12% R-prec and 7% Prec@10. The incorporation of other relations besides is-a demonstrated mixed results, more research is required to determined which SNOMED CT relationships are best employed when weighting related concepts.

Near Infrared Spectroscopy Evaluation of Articular Cartilage : Decision-Making in Arthroplasty : Real-Time Assessment of Articular Cartilage

Current diagnostic methods for assessing the severity of articular cartilage degenerative conditions, such as osteoarthritis, are inadequate. There is also a lack of techniques that can be used for real-time evaluation of the tissue during surgery to inform treatment decision and eliminate subjectivity. This book, derived from Dr Afara’s doctoral research, presents a scientific framework that is based on near infrared (NIR) spectroscopy for facilitating the non-destructive evaluation of articular cartilage health relative to its structural, functional, and mechanical properties. This development is a component of the ongoing research on advanced endoscopic diagnostic techniques in the Articular Cartilage Biomechanics Research Laboratory of Professor Adekunle Oloyede at Queensland University of Technology (QUT), Brisbane Australia.

Spatial variation of particle number concentration in school microscale environments and its impact on exposure assessment

It has not yet been established whether the spatial variation of particle number concentration (PNC) within a microscale environment can have an effect on exposure estimation results. In general, the degree of spatial variation within microscale environments remains unclear, since previous studies have only focused on spatial variation within macroscale environments. The aims of this study were to determine the spatial variation of PNC within microscale school environments, in order to assess the importance of the number of monitoring sites on exposure estimation. Furthermore, this paper aims to identify which parameters have the largest influence on spatial variation, as well as the relationship between those parameters and spatial variation. Air quality measurements were conducted for two consecutive weeks at each of the 25 schools across Brisbane, Australia. PNC was measured at three sites within the grounds of each school, along with the measurement of meteorological and several other air quality parameters. Traffic density was recorded for the busiest road adjacent to the school. Spatial variation at each school was quantified using coefficient of variation (CV). The portion of CV associated with instrument uncertainty was found to be 0.3 and therefore, CV was corrected so that only non-instrument uncertainty was analysed in the data. The median corrected CV (CVc) ranged from 0 to 0.35 across the schools, with 12 schools found to exhibit spatial variation. The study determined the number of required monitoring sites at schools with spatial variability and tested the deviation in exposure estimation arising from using only a single site. Nine schools required two measurement sites and three schools required three sites. Overall, the deviation in exposure estimation from using only one monitoring site was as much as one order of magnitude. The study also tested the association of spatial variation with wind speed/direction and traffic density, using partial correlation coefficients to identify sources of variation and non-parametric function estimation to quantify the level of variability. Traffic density and road to school wind direction were found to have a positive effect on CVc, and therefore, also on spatial variation. Wind speed was found to have a decreasing effect on spatial variation when it exceeded a threshold of 1.5 (m/s), while it had no effect below this threshold. Traffic density had a positive effect on spatial variation and its effect increased until it reached a density of 70 vehicles per five minutes, at which point its effect plateaued and did not increase further as a result of increasing traffic density.

Damage assessment in reinforced concrete flexural members using modal strain energy based method

Damage assessment (damage detection, localization and quantification) in structures and appropriate retrofitting will enable the safe and efficient function of the structures. In this context, many Vibration Based Damage Identification Techniques (VBDIT) have emerged with potential for accurate damage assessment. VBDITs have achieved significant research interest in recent years, mainly due to their non-destructive nature and ability to assess inaccessible and invisible damage locations. Damage Index (DI) methods are also vibration based, but they are not based on the structural model. DI methods are fast and inexpensive compared to the model-based methods and have the ability to automate the damage detection process. DI method analyses the change in vibration response of the structure between two states so that the damage can be identified. Extensive research has been carried out to apply the DI method to assess damage in steel structures. Comparatively, there has been very little research interest in the use of DI methods to assess damage in Reinforced Concrete (RC) structures due to the complexity of simulating the predominant damage type, the flexural crack. Flexural cracks in RC beams distribute non- linearly and propagate along all directions. Secondary cracks extend more rapidly along the longitudinal and transverse directions of a RC structure than propagation of existing cracks in the depth direction due to stress distribution caused by the tensile reinforcement. Simplified damage simulation techniques (such as reductions in the modulus or section depth or use of rotational spring elements) that have been extensively used with research on steel structures, cannot be applied to simulate flexural cracks in RC elements. This highlights a big gap in knowledge and as a consequence VBDITs have not been successfully applied to damage assessment in RC structures. This research will address the above gap in knowledge and will develop and apply a modal strain energy based DI method to assess damage in RC flexural members. Firstly, this research evaluated different damage simulation techniques and recommended an appropriate technique to simulate the post cracking behaviour of RC structures. The ABAQUS finite element package was used throughout the study with properly validated material models. The damaged plasticity model was recommended as the method which can correctly simulate the post cracking behaviour of RC structures and was used in the rest of this study. Four different forms of Modal Strain Energy based Damage Indices (MSEDIs) were proposed to improve the damage assessment capability by minimising the numbers and intensities of false alarms. The developed MSEDIs were then used to automate the damage detection process by incorporating programmable algorithms. The developed algorithms have the ability to identify common issues associated with the vibration properties such as mode shifting and phase change. To minimise the effect of noise on the DI calculation process, this research proposed a sequential order of curve fitting technique. Finally, a statistical based damage assessment scheme was proposed to enhance the reliability of the damage assessment results. The proposed techniques were applied to locate damage in RC beams and slabs on girder bridge model to demonstrate their accuracy and efficiency. The outcomes of this research will make a significant contribution to the technical knowledge of VBDIT and will enhance the accuracy of damage assessment in RC structures. The application of the research findings to RC flexural members will enable their safe and efficient performance.

Barriers to the adoption of health information technology

Information Technology (IT) is successfully applied in a diverse range of fields. Though, the field of Medical Informatics is more than three decades old, it shows a very slow progress compared to many other fields in which the application of IT is growing rapidly. The spending on IT in health care is shooting up but the road to successful use of IT in health care has not been easy. This paper discusses about the barriers to the successful adoption of information technology in clinical environments and outlines the different approaches used by various countries and organisations to tackle the issues successfully. Investing financial and other resources to overcome the barriers for successful adoption of HIT is highly important to realise the dream of a future healthcare system with each customer having secure, private Electronic Health Record (EHR) that is available whenever and wherever needed, enabling the highest degree of coordinated medical care based on the latest medical knowledge and evidence. Arguably, the paper reviews barriers to HIT from organisations’ alignment in respect to the leadership; with their stated values when accepting or willingness to consider the HIT as a determinant factor on their decision-making processes. However, the review concludes that there are many aspects of the organisational accountability and readiness to agree to the technology implementation.

Health informatics domain knowledge analysis : an information technology perspective

Health Informatics is an intersection of information technology, several disciplines of medicine and health care. It sits at the common frontiers of health care services including patient centric, processes driven and procedural centric care. From the information technology perspective it can be viewed as computer application in medical and/or health processes for delivering better health care solutions. In spite of the exaggerated hype, this field is having a major impact in health care solutions, in particular health care deliveries, decision making, medical devices and allied health care industries. It also affords enormous research opportunities for new methodological development. Despite the obvious connections between Medical Informatics, Nursing Informatics and Health Informatics, most of the methodologies and approaches used in Health Informatics have so far originated from health system management, care aspects and medical diagnostic. This paper explores reasoning for domain knowledge analysis that would establish Health Informatics as a domain and recognised as an intellectual discipline in its own right.

Effects of air pollution exposure on adult bicycle commuters : an investigation of respiratory health, motorised traffic proximity and the utility of commute re-routing

Bicycle commuting has the potential to be an effective contributing solution to address some of modern society’s biggest issues, including cardiovascular disease, anthropogenic climate change and urban traffic congestion. However, individuals shifting from a passive to an active commute mode may be increasing their potential for air pollution exposure and the associated health risk. This project, consisting of three studies, was designed to investigate the health effects of bicycle commuters in relation to air pollution exposure, in a major city in Australia (Brisbane). The aims of the three studies were to: 1) examine the relationship of in-commute air pollution exposure perception, symptoms and risk management; 2) assess the efficacy of commute re-routing as a risk management strategy by determining the exposure potential profile of ultrafine particles along commute route alternatives of low and high proximity to motorised traffic; and, 3) evaluate the feasibility of implementing commute re-routing as a risk management strategy by monitoring ultrafine particle exposure and consequential physiological response from using commute route alternatives based on real-world circumstances; 3) investigate the potential of reducing exposure to ultrafine particles (UFP; < 0.1 µm) during bicycle commuting by lowering proximity to motorised traffic with real-time air pollution and acute inflammatory measurements in healthy individuals using their typical, and an alternative to their typical, bicycle commute route. The methods of the three studies included: 1) a questionnaire-based investigation with regular bicycle commuters in Brisbane, Australia. Participants (n = 153; age = 41 ± 11 yr; 28% female) reported the characteristics of their typical bicycle commute, along with exposure perception and acute respiratory symptoms, and amenability for using a respirator or re-routing their commute as risk management strategies; 2) inhaled particle counts measured along popular pre-identified bicycle commute route alterations of low (LOW) and high (HIGH) motorised traffic to the same inner-city destination at peak commute traffic times. During commute, real-time particle number concentration (PNC; mostly in the UFP range) and particle diameter (PD), heart and respiratory rate, geographical location, and meteorological variables were measured. To determine inhaled particle counts, ventilation rate was calculated from heart-rate-ventilation associations, produced from periodic exercise testing; 3) thirty-five healthy adults (mean ± SD: age = 39 ± 11 yr; 29% female) completed two return trips of their typical route (HIGH) and a pre-determined altered route of lower proximity to motorised traffic (LOW; determined by the proportion of on-road cycle paths). Particle number concentration (PNC) and diameter (PD) were monitored in real-time in-commute. Acute inflammatory indices of respiratory symptom incidence, lung function and spontaneous sputum (for inflammatory cell analyses) were collected immediately pre-commute, and one and three hours post-commute. The main results of the three studies are that: 1) healthy individuals reported a higher incidence of specific acute respiratory symptoms in- and post- (compared to pre-) commute (p < 0.05). The incidence of specific acute respiratory symptoms was significantly higher for participants with respiratory disorder history compared to healthy participants (p < 0.05). The incidence of in-commute offensive odour detection, and the perception of in-commute air pollution exposure, was significantly lower for participants with smoking history compared to healthy participants (p < 0.05). Females reported significantly higher incidence of in-commute air pollution exposure perception and other specific acute respiratory symptoms, and were more amenable to commute re-routing, compared to males (p < 0.05). Healthy individuals have indicated a higher incidence of acute respiratory symptoms in- and post- (compared to pre-) bicycle commuting, with female gender and respiratory disorder history indicating a comparably-higher susceptibility; 2) total mean PNC of LOW (compared to HIGH) was reduced (1.56 x e4 ± 0.38 x e4 versus 3.06 x e4 ± 0.53 x e4 ppcc; p = 0.012). Total estimated ventilation rate did not vary significantly between LOW and HIGH (43 ± 5 versus 46 ± 9 L•min; p = 0.136); however, due to total mean PNC, accumulated inhaled particle counts were 48% lower in LOW, compared to HIGH (7.6 x e8 ± 1.5 x e8 versus 14.6 x e8 ± 1.8 x e8; p = 0.003); 3) LOW resulted in a significant reduction in mean PNC (1.91 x e4 ± 0.93 x e4 ppcc vs. 2.95 x e4 ± 1.50 x e4 ppcc; p ≤ 0.001). Commute distance and duration were not significantly different between LOW and HIGH (12.8 ± 7.1 vs. 12.0 ± 6.9 km and 44 ± 17 vs. 42 ± 17 mins, respectively). Besides incidence of in-commute offensive odour detection (42 vs. 56 %; p = 0.019), incidence of dust and soot observation (33 vs. 47 %; p = 0.038) and nasopharyngeal irritation (31 vs. 41 %; p = 0.007), acute inflammatory indices were not significantly associated to in-commute PNC, nor were these indices reduced with LOW compared to HIGH. The main conclusions of the three studies are that: 1) the perception of air pollution exposure levels and the amenability to adopt exposure risk management strategies where applicable will aid the general population in shifting from passive, motorised transport modes to bicycle commuting; 2) for bicycle commuting at peak morning commute times, inhaled particle counts and therefore cardiopulmonary health risk may be substantially reduced by decreasing exposure to motorised traffic, which should be considered by both bicycle commuters and urban planners; 3) exposure to PNC, and the incidence of offensive odour and nasopharyngeal irritation, can be significantly reduced when utilising a strategy of lowering proximity to motorised traffic whilst bicycle commuting, without significantly increasing commute distance or duration, which may bring important benefits for both healthy and susceptible individuals. In summary, the findings from this project suggests that bicycle commuters can significantly lower their exposure to ultrafine particle emissions by varying their commute route to reduce proximity to motorised traffic and associated combustion emissions without necessarily affecting their time of commute. While the health endpoints assessed with healthy individuals were not indicative of acute health detriment, individuals with pre-disposing physiological-susceptibility may benefit considerably from this risk management strategy – a necessary research focus with the contemporary increased popularity of both promotion and participation in bicycle commuting.

Quantitative and qualitative assessment of the regenerative potential of osteoblasts versus bone marrow derived mesenchymal stem cells in the reconstruction of critical sized segmental tibial bone defects in a large animal model

This thesis is about the use of different cells for bone tissue engineering. The cells were used in combination with a novel biomaterial in a large tibial bone defects in a sheep model. Furthermore this study developed a novel cell delivery procedure for bone tissue engineering. This novel procedure of cell delivery could overcome the current problems of cell-based tissue engineering and serve as a baseline for the translation of novel concepts into clinical application.