Computerized identification of motor complications in Parkinson's disease

Objective: To investigate whether spirography-based objective measures are able to effectively characterize the severity of unwanted symptom states (Off and dyskinesia) and discriminate them from motor state of healthy elderly subjects. Background: Sixty-five patients with advanced Parkinson’s disease (PD) and 10 healthy elderly (HE) subjects performed repeated assessments of spirography, using a touch screen telemetry device in their home environments. On inclusion, the patients were either treated with levodopa-carbidopa intestinal gel or were candidates for switching to this treatment. On each test occasion, the subjects were asked trace a pre-drawn Archimedes spiral shown on the screen, using an ergonomic pen stylus. The test was repeated three times and was performed using dominant hand. A clinician used a web interface which animated the spiral drawings, allowing him to observe different kinematic features, like accelerations and spatial changes, during the drawing process and to rate different motor impairments. Initially, the motor impairments of drawing speed, irregularity and hesitation were rated on a 0 (normal) to 4 (extremely severe) scales followed by marking the momentary motor state of the patient into 2 categories that is Off and Dyskinesia. A sample of spirals drawn by HE subjects was randomly selected and used in subsequent analysis. Methods: The raw spiral data, consisting of stylus position and timestamp, were processed using time series analysis techniques like discrete wavelet transform, approximate entropy and dynamic time warping in order to extract 13 quantitative measures for representing meaningful motor impairment information. A principal component analysis (PCA) was used to reduce the dimensions of the quantitative measures into 4 principal components (PC). In order to classify the motor states into 3 categories that is Off, HE and dyskinesia, a logistic regression model was used as a classifier to map the 4 PCs to the corresponding clinically assigned motor state categories. A stratified 10-fold cross-validation (also known as rotation estimation) was applied to assess the generalization ability of the logistic regression classifier to future independent data sets. To investigate mean differences of the 4 PCs across the three categories, a one-way ANOVA test followed by Tukey multiple comparisons was used. Results: The agreements between computed and clinician ratings were very good with a weighted area under the receiver operating characteristic curve (AUC) coefficient of 0.91. The mean PC scores were different across the three motor state categories, only at different levels. The first 2 PCs were good at discriminating between the motor states whereas the PC3 was good at discriminating between HE subjects and PD patients. The mean scores of PC4 showed a trend across the three states but without significant differences. The Spearman’s rank correlations between the first 2 PCs and clinically assessed motor impairments were as follows: drawing speed (PC1, 0.34; PC2, 0.83), irregularity (PC1, 0.17; PC2, 0.17), and hesitation (PC1, 0.27; PC2, 0.77). Conclusions: These findings suggest that spirography-based objective measures are valid measures of spatial- and time-dependent deficits and can be used to distinguish drug-related motor dysfunctions between Off and dyskinesia in PD. These measures can be potentially useful during clinical evaluation of individualized drug-related complications such as over- and under-medications thus maximizing the amount of time the patients spend in the On state.

Faster, richer, better: rapid appraisal techniques for the study of IS implementation in virtual communities

A major issue in Information Systems (IS) research is how to combine relevance and rigor (Benbasat and Zmud, 1999) and reduce the widening gap between research results and adoption (Dunn, 1994). Qualitative researchers make use of interpretivist methods to add richness and depth to their understanding of user problems. Interpretivist methods applied to IS implementations can thus result in research which communicates those findings more effectively. However standard interpretivist data-collection and analysis methods can be time-consuming and expensive. Findings based on these methods may be irrelevant to practitioners by the time they reach publication stage. A potential solution to this problem lies in Rapid Appraisal or RA, a qualitative appraisal methodology derived from rural development-related research. It offers IS researchers an additional technique for learning and acquiring relevant information in a limited period of time that  supplements current data collection and analysis techniques. RA adds value to the traditional approach for studying diffusion of innovation, supporting and extending the IS researcher’s qualitative ‘tool-kit’. In this paper we review an electronic gateway designed to facilitate the diffusion of an Australian government to business [G2B] export documentation system, EXDOC, which was first implemented with meat producers. RA techniques were used to collect and analyse data regarding the implementation of the first regional Electronic Trade Facilitation Center [ETFC] successfully established for Australian exporters in the horticulture sector. The findings from the original EXDOC implementation in the meat sector were confirmed and extended through this study. These include the importance of developing a governance structure that ensures all community members share the benefits of an implementation and the fact that virtual trading communities are attractive to users only if they add value to their business and extend standard ways of operating. Interactive interviews, part of the RA approach; also enabled us to expand our understanding of the way in which procedures developed in the course of implementing an electronic market represent value-adding opportunities for virtual trading communities. The paper has special relevance for researchers investigating adoption and diffusion issues experienced by small-scale producers with low exposure to technology in remote and rural settings.

Application of very-high-frequency (VHF) method to ceramic insulators

A VHF method (30-300 MHz) is applied to identify faults and defects in ceramic insulators. Insulators which exhibit internal cracks and fractures are used as test samples. Different artificial conditions are introduced to the test samples according to the IEC 507 standard under wet and dry conditions. Using a cascading signal processing technique and analysis methods such as FFT and fractal analysis, VHF signals acquired by digital scope are processed and analyzed. This study indicates that the fractal dimension can be used as an effective tool to isolate the common faulty conditions found on the ceramic insulators. The results from this study strongly support the prospect of using a VHF method to monitor the physical condition of ceramic insulators.

Methodological shifts in ratio-based modelling of corporate collapse

The year 1968 saw a major shift from univariate to multivariate methodological approaches to ratio-based modelling of corporate collapse. This was facilitated by the introduction of a new statistical tool called Multiple Discriminant Analysis (MDA). However, it did not take long before other statistical tools were developed. The primary objective for developing these tools was to enable deriving models that would at least do as good a job asMDA, but rely on fewer assumptions. With the introduction of new statistical tools, researchers became pre-occupied with testing them in signalling collapse. lLTUong the ratio-based approaches were Logit analysis, Neural Network analysis, Probit analysis, ID3, Recursive Partitioning Algorithm, Rough Sets analysis, Decomposition analysis, Going Concern Advisor, Koundinya and Purl judgmental approach, Tabu Search and Mixed Logit analysis. Regardless of which methodological approach was chosen, most were compared to MDA. This paper reviews these various approaches. Emphasis is placed on how they fared against MDA in signalling corporate collapse.

Object-oriented security modelling for healthcare

With the convergence of paper to electronic, the health industry is relying more on technology to maintain and update the well-being of patients. This reliance on technology requires an acute level of protection from unwanted technological disasters and/or human threats. Research shows insufficiencies with the implementation and use of security controls; as well as current analysis methods lacking the techniques to analyse technical and social aspects of security. The aim of this paper is to introduce an information security evaluation methodology for health information systems based on UML.

Utilizing hyperlink transitivity to improve web page clustering

The rapid increase of web complexity and size makes web searched results far from satisfaction in many cases due to a huge amount of information returned by search engines. How to find intrinsic relationships among the web pages at a higher level to implement efficient web searched information management and retrieval is becoming a challenge problem. In this paper, we propose an approach to measure web page similarity. This approach takes hyperlink transitivity and page importance into consideration. From this new similarity measurement, an effective hierarchical web page clustering algorithm is proposed. The primary evaluations show the effectiveness of the new similarity measurement and the improvement of web page clustering. The proposed page similarity, as well as the matrix-based hyperlink analysis methods, could be applied to other web-based research areas..

Validation of the use of Australian input-output data for building embodied energy simulation

Traditional!y, the simulation of buildings has focused 011 operational energy consumption in an attempt to determine the potential for energy savings. Whilst operational energy of Australian buildings accounts for around 20% of total energy consumption nationally, embodied energy represents 20 to 50 times the annual operational energy of 1110st Australian buildings. Lower values have been shown through a number of studies that have analysed the embodied energy of buildings and their products, however these have now shown to be incomplete in system boundary. Many of these studies have used traditional embodied energy analysis methods, such as process analysis and input-output analysis, Hybrid embodied energy analysis methods have been developed, but these need to be compared and validated. This paper reports on preliminary work on this topic. The findings so far suggest that current best-practice methods are sufficiently accurate for most typical applications, but this is heavily dependant upon data quality and availability.

Health information security evaluation: continued development of an object-oriented method

With the convergence of paper to electronic, the health industry is relying more on technology to maintain and update the well-being of patients. This reliance on technology requires an acute level of protection from
unwanted technological disasters and/or human threats. Research shows insufficiencies with the implementation and use of security controls; as well as current analysis methods lacking the techniques to analyse technical and social aspects of security. The aim of this paper is to introduce an information security evaluation methodology for health information systems based on UML.

An assessment of the energy and water embodied in commercial building construction

Growing global concern regarding the rapid rate at which humans are consuming the earth’s precious natural resources is leading to greater emphasis on more effective means of providing for our current and future needs. Energy and fresh water are the most crucial of these basic human needs. The energy and water required in the operation of buildings is fairly well known. Much less is known about the energy and water embodied in construction materials and products. It has been suggested that embodied energy typically represents 20 times the annual operational energy of current Australian buildings. Studies have suggested that the water embodied in buildings may be just as significant as that of energy. As for embodied energy, these studies have been based on traditional analysis methods, such as process and input-output analysis. These methods have been shown to suffer from errors relating to the availability of data and its reliability. Hybrid methods have been developed in an attempt to provide a more reliable assessment of the embodied energy and water associated with the construction of buildings. This paper evaluates the energy and water resources embodied in a commercial office building using a hybrid analysis method based on input-output data. It was found that the use of this hybrid analysis method increases the reliability and completeness of an embodied energy and water analysis of a typical commercial building by 45% and 64% respectively, over traditional analysis methods. The embodied energy and water associated with building construction is significant and thus represents an area where considerable energy and water savings are possible over the building life-cycle. These findings suggest that current best-practice methods of embodied energy and water analysis are sufficiently accurate for most typical applications, but this is heavily dependent upon data quality and availability.

Local health policy development processes in the Netherlands: an expanded toolbox for health promotion

Although much research has been done on the existence and formation of risk and issue based health policies, there is only little insight in health policy development processes in a broader context. This hampers intervention in these policy processes to adequately develop integrated and effective health policies.

Legislation in the Netherlands requires municipalities to develop and implement local health policies. These policies are supposed to aim at the promotion of health across sectors and with a strong community involvement. Health policy development processes have been studied in four Dutch municipalities. For each case, we identified a range of stakeholders and monitored the change or stability of their characteristics over 3 years. In addition, for each case, three overlaying maps of networks were made addressing communication and collaboration actions within the defined set of stakeholders. We point out a number of barriers which impede integrated policy development at the local level: the importance given to local health policy, the medical approach to health development, the organizational self-interest rather than public health concern, the absence of policy entrepreneurial activity.

Furthermore, this article advocates the use of complementary theoretical frameworks and the expansion of the methodological toolbox for health promotion. The value of stakeholder and network analysis in the health promotion domain, at this stage, is two-fold. First, mapping relevant actors, their positions and connections in networks provides us with insight into their capacity to participate and contribute to health policy development. Second, these new tools contribute to a further understanding of policy entrepreneurial roles to be taken up by health promotion professionals and health authorities in favour of the socio-environmental approach to health.

Notwithstanding the value of this first step, more research is required into both the practical application as well as in the theoretical connections with, for example, Multiple Streams theory.

Seasonality of blue and fin whale calls and the influence of sea ice in the Western Antarctic Peninsula

The calling seasonality of blue (Balaenoptera musculus) and fin (B. physalus) whales was assessed using acoustic data recorded on seven autonomous acoustic recording packages (ARPs) deployed from March 2001 to February 2003 in the Western Antarctic Peninsula. Automatic detection and acoustic power analysis methods were used for determining presence and absence of whale calls. Blue whale calls were detected year round, on average 177 days per year, with peak calling in March and April, and a secondary peak in October and November. Lowest calling rates occurred between June and September, and in December. Fin whale calling rates were seasonal with calls detected between February and June (on average 51 days/year), and peak calling in May. Sea ice formed a month later and retreated a month earlier in 2001 than in 2002 over all recording sites. During the entire deployment period, detected calls of both species of whales showed negative correlation with sea ice concentrations at all sites, suggesting an absence of blue and fin whales in areas covered with sea ice. A conservative density estimate of calling whales from the acoustic data yields 0.43 calling blue whales per 1000 n mi² and 1.30 calling fin whales per 1000 n mi², which is about one-third higher than the density of blue whales and approximately equal to the density of fin whales estimated from the visual surveys.

Information navigation and knowledge discovery in virtual communities

Over the past decade, advances in the Internet and media technology have literally brought people closer than ever before. It is interesting to note that traditional sociological definitions of a community have been outmoded, for community has extended far beyond the geographical boundaries that were held by traditional definitions (Wellman & Gulia, 1999). Virtual or online community was defined in such a context to describe various forms of computer-mediated communication (CMC). Although virtual communities do not necessarily arise from the Internet, the overwhelming popularity of the Internet is one of the main reasons that virtual communities receive so much attention (Rheingold, 1999). The beginning of virtual communities is attributed to scientists who exchanged information and cooperatively conduct research during the 1970s. There are four needs of participants in a virtual community: member interest, social interaction, imagination, and transaction (Hagel & Armstrong, 1997). The first two focus more on the information exchange and knowledge discovery; the imagination is for entertainment; and the transaction is for commerce strategy. In this article, we investigate the function of information exchange and knowledge discovery in virtual communities. There are two important inherent properties embedded in virtual communities (Wellman, 2001):

Practical application of the Delphi technique in a bicultural mental health nursing study in New Zealand

Background. Numerous studies have employed the Delphi technique to seek expert opinion about aspects of clinical practice. When researching literature on the Delphi technique, however, we discovered discrepancies in its application, and a lack of detail when reporting design, administration, and analysis methods. Such lack of specificity hinders the replicability and assessment of the clinical and cultural validity and reliability of Delphi studies.

Aim. The aim of this paper is to detail the practical application of the Delphi technique as a culturally and clinically valid means of accessing expert opinion on the importance of clinical criteria.

Methods. Reference is made to a bicultural New Zealand mental health nursing clinical indicator study that employed a three-round reactive Delphi survey. Equal proportions of Maori and non-Maori nurses (n = 20) and consumers (n = 10) rated the importance of 91 clinical indicator statements for the achievement of professional practice standards. Additional statements (n = 21) suggested by Delphi participants in round 1 were included in subsequent rounds. In round 2, participants explained the rating they applied to statements that had not reached consensus in round 1, and summarized responses were provided to participants in round 3. Consensus was considered to have been achieved if 85% of round 3 ratings lay within a 2-point bracket on the 5-point Likert-scale overall, or in one of the Maori nurse, non-Maori nurse, or consumer groups. A mean rating of 4·5 after round 3 was set as the importance threshold.

Findings. Consensus occurred overall on 75 statements, and within groups on another 24. Most statements (n = 86) reached the importance benchmark.

Conclusions. When rigorous methods of participant selection, group composition, participant feedback, and determination of consensus and importance are employed, the Delphi technique is a reliable, cost-effective means of obtaining and prioritizing experts judgements.

Enablers and barriers to accessing mental health services for adults with high prevalence psychological disorders in South West Victoria

Knowing what services are available and how to access them can be challenging in rural areas. The aim of the South West Mental Health Mapping project was to identify the level, accessibility and effectiveness of mental health services for high prevalence psychological disorders amongst the adult population in the South West region of Victoria. This study includes data from a number of sources: regional records of the number and location of health professionals; a telephone survey of 1297 people in five Local Government Areas in the region; and a social network analysis of contact points. Additional qualitative interviews and surveys were conducted with 25 service recipients and 37 health professionals to identify issues from different perspective. This paper will focus on the social network analysis of the project. It highlights the relative prominence of each type of service provider within the overall network. The social network map shows the centrality of the General Practitioner and the wide range of agencies that become involved in supporting people with mental health issues. The discussion identifies primary contact points for people seeking help and places of referral. The main barrier acknowledged by people requiring assistance was lack of knowledge about where to go for help. Enablers included Medicare Better Access funded schemes. The findings show that there is a reasonable range of mental health professionals across the region, although there are challenges with recruitment and retention of staff. Even with available services, a major problem is communicating this information to potential consumers

Practice into theory : working collaboratively with clinicians to articulate mental health triage practice

Learning objectives: To contribute to mental health nurses understanding and knowledge of mental health triage practice through the presentation of current research findings on the topic. A specific focus of the paper will be an overview of how mental health triage practice differs across the lifespan.

Mental health triage is a highly specialised area of clinical practice for mental health nursing that is in its infancy in terms of articulating practice and theory. This paper addresses the conference theme of mental health nursing practice: new roles, new challenges by presenting the findings of a qualitative research project that investigated mental health triage/duty/intake practices across the five community mental health agencies of The Alfred Hospital, Melbourne. The overall aim of the project was to work collaboratively with clinicians to further develop the quality and consistency of mental health triage, duty, and intake clinical practice across all arms of Alfred Psychiatry. The project was designed to facilitate the expansion of the mental health triage knowledge base, and thus contribute to the further development of triage clinical practice. One of the unique aspects of the project was its triangulation across the adult triage service (acute), the two Continuing Care Teams, and the specialist psychiatric services such as the Child and Adolescent Mental Health Service, the Homeless and Outreach Psychiatric Service, and the Mobile Aged Psychiatric Service. The project employed focus group method to collect in-depth, qualitative data. A series of nine focus groups were conducted at each site, which concentrated on eliciting data on the core areas of mental health triage practice such as telephone consultation skills, mental status examination, risk assessment, decision-making, negotiation, crisis assessment, secondary consultation, and documentation. The investigation produced a considerable amount of high quality, in-depth data that was analysed using content analysis methods. The project produced data that will make a significant contribution to the expanding body of knowledge on mental health triage practice.