Private hospital emergency departments in Australia : challenges and opportunities

BACKGROUND: Public hospital EDs in Australia have become increasingly congested because of increasing demand and access block. Six per cent of ED patients attend private hospital EDs whereas 45% of the population hold private health insurance. OBJECTIVES: This study describes the patients attending a small selection of four private hospital EDs in Queensland and Victoria, and tests the feasibility of a private ED database. METHODS: De-identified routinely collected patient data were provided by the four participating private hospital and amalgamated into a single data set. RESULT: The mean age of private ED patients was 52 years. Males outnumbered females in all age groups except > 80 years. Attendance was higher on weekends and Mondays, and between 08.00 and 20.00 h. There were 6.6% of the patients triaged as categories 1 and 2, and 60% were categories 4 or 5. There were 36.4% that required hospital admission. Also, 96% of the patients had some kind of insurance. Furthermore, 72% were self-referred and 12% were referred by private medical practitioners. Approximately 25% arrived by ambulance. There were 69% that completed their ED treatment within 4 h. CONCLUSION: This study is the first public description of patients attending private EDs in Australia. Private EDs have a significant role to play in acute medical care and in providing access to private hospitals which could alleviate pressure on public EDs. This study demonstrates the need for consolidated data based on a consistent data set and data dictionary to enable system-wide analysis, benchmarking and evaluation

Energy efficient virtual machine placement in data centers

Electricity cost has become a major expense for running data centers and server consolidation using virtualization technology has been used as an important technology to improve the energy efficiency of data centers. In this research, a genetic algorithm and a simulation-annealing algorithm are proposed for the static virtual machine placement problem that considers the energy consumption in both the servers and the communication network, and a trading algorithm is proposed for dynamic virtual machine placement. Experimental results have shown that the proposed methods are more energy efficient than existing solutions.

Hydrogeological framework, conceptual and numerical groundwater flow model of Laidley Creek catchment, Queensland, Australia

This thesis studies the water resources of Laidley Creek catchment within the Lockyer Valley where groundwater is used for intensive irrigation of crops. A holistic approach was used to consider groundwater within the total water cycle. The project mapped the geology, measured stream flows and groundwater levels, and analysed the chemistry of the waters. These data were integrated within a catchment-wide conceptual model, including historic and rainfall records. From this a numerical simulation was produced to test data validity and develop predictions of behaviour, which can support management decisions, particularly in times of variable climate.

Design and interpretation of cell trajectory assays

Cell trajectory data is often reported in the experimental cell biology literature to distinguish between different types of cell migration. Unfortunately, there is no accepted protocol for designing or interpreting such experiments and this makes it difficult to quantitatively compare different published data sets and to understand how changes in experimental design influence our ability to interpret different experiments. Here, we use an individual based mathematical model to simulate the key features of a cell trajectory experiment. This shows that our ability to correctly interpret trajectory data is extremely sensitive to the geometry and timing of the experiment, the degree of motility bias and the number of experimental replicates. We show that cell trajectory experiments produce data that is most reliable when the experiment is performed in a quasi 1D geometry with a large number of identically{prepared experiments conducted over a relatively short time interval rather than few trajectories recorded over particularly long time intervals.

Segmental torso masses and gravity-induced coronal plane joint moments in adolescent idiopathic scoliosis

Introduction: Calculating segmental (vertebral level-by-level) torso masses in Adolescent Idiopathic Scoliosis (AIS) patients allows the gravitational loading on the scoliotic spine during relaxed standing to be estimated. This study used supine CT scans of AIS patients to measure segmental torso masses and explored the joint moments in the coronal plane, particularly at the apex of a scoliotic major curve. Methods: Existing low dose CT data from the Paediatric Spine Research Group was used to calculate vertebral level-by-level torso masses and joint moments occurring in the spine for a group of 20 female AIS patients with right sided thoracic curves. The mean age was 15.0 ± 2.7 years and all curves were classified Lenke Type 1 with a mean Cobb angle 52 ± 5.9°. Image processing software, ImageJ (v1.45 NIH USA) was used to create reformatted coronal plane images, reconstruct vertebral level-by-level torso segments and subsequently measure the torso volume corresponding to each vertebral level. Segment mass was then determined by assuming a tissue density of 1.04x103 kg/m3. Body segment masses for the head, neck and arms were taken from published anthropometric data (Winter 2009). Intervertebral joint moments in the coronal plane at each vertebral level were found from the position of the centroid of the segment masses relative to the joint centres with the segmental body mass data. Results and Discussion: The magnitude of the torso masses from T1-L5 increased inferiorly, with a 150% increase in mean segmental torso mass from 0.6kg at T1 to 1.5kg at L5. The magnitudes of the calculated coronal plane joint moments during relaxed standing were typically 5-7 Nm at the apex of the curve, with the highest apex joint torque of 7Nm. The CT scans were performed in the supine position and curve magnitudes are known to be 7-10° smaller than those measured in standing, due to the absence of gravity acting on the spine. Hence, it can be expected that the moments produced by gravity in the standing individual will be greater than those calculated here.

How much is that data in the window? Advertising your research data with QUT Library

Queensland University of Technology (QUT) Library offers a range of resources and services to researchers as part of their research support portfolio. This poster will present key features of two of the data management services offered by research support staff at QUT Library. The first service is QUT Research Data Finder (RDF), a product of the Australian National Data Service (ANDS) funded Metadata Stores project. RDF is a data registry (metadata repository) that aims to publicise datasets that are research outputs arising from completed QUT research projects. The second is a software and code registry, which is currently under development with the sole purpose of improving discovery of source code and software as QUT research outputs. RESEARCH DATA FINDER As an integrated metadata repository, Research Data Finder aligns with institutional sources of truth, such as QUT’s research administration system, ResearchMaster, as well as QUT’s Academic Profiles system to provide high quality data descriptions that increase awareness of, and access to, shareable research data. The repository and its workflows are designed to foster better data management practices, enhance opportunities for collaboration and research, promote cross-disciplinary research and maximise the impact of existing research data sets. SOFTWARE AND CODE REGISTRY The QUT Library software and code registry project stems from concerns amongst researchers with regards to development activities, storage, accessibility, discoverability and impact, sharing, copyright and IP ownership of software and code. As a result, the Library is developing a registry for code and software research outputs, which will use existing Research Data Finder architecture. The underpinning software for both registries is VIVO, open source software developed by Cornell University. The registry will use the Research Data Finder service instance of VIVO and will include a searchable interface, links to code/software locations and metadata feeds to Research Data Australia. Key benefits of the project include:improving the discoverability and reuse of QUT researchers’ code and software amongst QUT and the QUT research community; increasing the profile of QUT research outputs on a national level by providing a metadata feed to Research Data Australia, and; improving the metrics for access and reuse of code and software in the repository.

Children's understanding of graphic representations of quantitative data

Children are encountering more and more graphic representations of data in their learning and everyday life. Much of this data occurs in quantitative forms as different forms of measurement are incorporated into the graphics during their construction. In their formal education, children are required to learn to use a range of these quantitative representations in subjects across the school curriculum. Previous research that focuses on the use of information processing and traditional approaches to cognitive psychology concludes that the development of an understanding of such representations of data is a complex process. An alternative approach is to investigate the experiences of children as they interact with graphic representations of quantitative data in their own life-worlds. This paper demonstrates how a phenomenographic approach may be used to reveal the qualitatively different ways in which children in Australian primary and secondary education understand the phenomenon of graphic representations of quantitative data. Seven variations of the children’s understanding were revealed. These have been described interpretively in the article and confirmed through the words of the children. A detailed outcome space demonstrates how these seven variations are structurally related.

Postpartum care for Aboriginal and non-Aboriginal women with Gestational Diabetes Mellitus across urban, rural and remote locations : a protocol for a cohort linkage study

Background: Gestational diabetes mellitus (GDM) is increasing, along with obesity and type 2 diabetes (T2DM), with Aboriginal and Torres Strait Islander people* in Australia particularly affected. GDM causes serious complications in pregnancy, birth, and the longer term, for both women and their infants. Women diagnosed with GDM have an eightfold risk of developing T2DM after pregnancy, compared with women who have not had GDM. Indigenous women have an even higher risk, at a younger age, and progress more quickly from GDM to T2DM, compared to non-Indigenous women. If left undetected and untreated, T2DM can lead to heart disease, stroke, renal disease, kidney failure, amputations and blindness. A GDM diagnosis offers a ‘window of opportunity’ for diabetes health interventions and it is vital that acceptable and effective prevention, treatment, and post-pregnancy care are provided. Low rates of post-pregnancy screening for T2DM are reported among non-Aboriginal women in Australia and among Indigenous women in other countries, however data for Aboriginal women are scarce. Breastfeeding, a healthy diet, and exercise can also help to prevent T2DM, and together with T2DM screening are recommended elements of ‘post-pregnancy care’ for women with GDM, This paper describes methods for a data linkage study to investigate rates of post-pregnancy care among women with GDM. Methods/Design: This retrospective cohort includes all women who gave birth at Cairns Base Hospital in Far North Queensland, Australia, from 2004 to 2010, coded as having GDM in the Cairns Base Hospital Clinical Coding system. Data linkage is being conducted with the Queensland Perinatal Data Collection, and three laboratories. Hospital medical records are being reviewed to validate the accuracy of GDM case ascertainment, and gather information on breastfeeding and provision of dietary advice. Multiple logistic regression is being used to compare post-pregnancy care between Aboriginal and non-Aboriginal women, while adjusting for other factors may impact on post-pregnancy care. Survival analysis is being used to estimate the rates of progression from GDM to T2DM. Discussion: There are challenges to collecting post-pregnancy data for women with GDM. However, research is urgently needed to ensure adequate post-pregnancy care is provided for women with GDM in Australia.

Towards the retrieval of accurate OD matrices from Bluetooth data : lessons learned from 2 years of data

The Bluetooth technology is being increasingly used to track vehicles throughout their trips, within urban networks and across freeway stretches. One important opportunity offered by this type of data is the measurement of Origin-Destination patterns, emerging from the aggregation and clustering of individual trips. In order to obtain accurate estimations, however, a number of issues need to be addressed, through data filtering and correction techniques. These issues mainly stem from the use of the Bluetooth technology amongst drivers, and the physical properties of the Bluetooth sensors themselves. First, not all cars are equipped with discoverable Bluetooth devices and the Bluetooth-enabled vehicles may belong to some small socio-economic groups of users. Second, the Bluetooth datasets include data from various transport modes; such as pedestrian, bicycles, cars, taxi driver, buses and trains. Third, the Bluetooth sensors may fail to detect all of the nearby Bluetooth-enabled vehicles. As a consequence, the exact journey for some vehicles may become a latent pattern that will need to be extracted from the data. Finally, sensors that are in close proximity to each other may have overlapping detection areas, thus making the task of retrieving the correct travelled path even more challenging. The aim of this paper is twofold. We first give a comprehensive overview of the aforementioned issues. Further, we propose a methodology that can be followed, in order to cleanse, correct and aggregate Bluetooth data. We postulate that the methods introduced by this paper are the first crucial steps that need to be followed in order to compute accurate Origin-Destination matrices in urban road networks.

A data mining framework for relevance feature discovery

This thesis is a study for automatic discovery of text features for describing user information needs. It presents an innovative data-mining approach that discovers useful knowledge from both relevance and non-relevance feedback information. The proposed approach can largely reduce noises in discovered patterns and significantly improve the performance of text mining systems. This study provides a promising method for the study of Data Mining and Web Intelligence.

Parent-teacher engagement : a coteaching and cogenerative dialoguing approach

The accumulated evidence from more than four decades of education research strongly suggests that parent involvement in schools carries significant benefits for students as well as for the success of schools (e.g., Henderson & Mapp, 2002). Governments in Australia and overseas have supported parent involvement in schools with a range of initiatives while parent groups have indicated a strong desire for expanded school roles that include participation in formal educational processes namely curriculum, pedagogy, and assessment. Research has also signalled the need for teachers to engage parents rather than adopt traditional parent-school involvement practices so that parents can participate as joint educators in their children's schooling alongside teachers (Pushor, 2001). Actually improving the quality of contact and relationships between parents and teachers to enable engagement however remains problematic. Coteaching and cogenerative dialoguing originally emerged as an innovative approach in the context of teaching secondary school science. Coteaching brings together the collective expertise of several individuals to expand learning opportunities for students while cogenerative dialogues refer to sessions in which participants talk, listen, and learn from one another about the process (Roth & Tobin, 2002a). Coteaching and cogenerative dialoguing reportedly benefits students academically and socially while rewarding educators professionally and emotionally through the support and collaboration they receive from fellow coteachers. These benefits ensue because coteaching theoretically positions teachers at one another's elbows, providing new and different understandings about teaching based on first-hand perspectives and shared goals for assisting students to learn. This thesis proposes that coteaching and cogenerative dialoguing may provide a vehicle for improving quality of contact and relationships between parents and teachers. To investigate coteaching and cogenerative dialoguing as a parent-teacher engagement mechanism, interpretive ethnographic case study research was conducted involving two parents and a secondary school teacher. Sociological ideas, namely Bourdieu's (1977) fields, habitus, and capitals, together with multiple dialectical concepts such as agency|structure (Sewell, 1992) and agency|passivity (Roth, 2007b, 2010) were assembled into a conceptual framework to examine parent-teacher relationships by describing and explaining cultural production and identity construction throughout the case study. Video and audio recordings of cogenerative dialogues and cotaught lessons comprised the chief data sources. Data were analysed using qualitative techniques such as discourse and conversation analysis to identify patterns and contradictions (Roth & Tobin, 2002a). The use of quality criteria detailed by Guba and Lincoln (2005) gives credence to the way in which ethical considerations infused the planning and conduct of this research. From the processes of data collection and analyses, three broad assertions were proffered. The findings highlight the significance of using multiple coordinated dialectical concepts for analysing the affordances and challenges of coteaching and cogenerative dialogues that include parents and teachers. Adopting the principles and purposes of coteaching and cogenerative dialoguing promoted trusting respectful relationships that generated an equitable culture. The simultaneous processes and tensions between logistics and ethics (i.e., the logistics|ethics dialectic) were proposed as a new way to conceptualise how power was redistributed among the participants. Knowledge of positive emotional energy and ongoing capital exchange conceived dialectically as the reciprocal interaction among cultural, social, and symbolic capitals (i.e., the dialectical relationship of cultural|social|symbolic capital) showed how coteaching and cogenerative dialoguing facilitated mutual understandings, joint decision-making, and group solidarity. The notion of passivity as the dialectical partner of agency explained how traditional roles and responsibilities were reconfigured and individual and collective agency expanded. Complexities that surfaced when implementing the coteaching and cogenerative dialoguing approach were outweighed by the multiple benefits that accrued for all involved. These benefits included the development of community-relevant and culturally-significant curricula that increased student agency and learning outcomes, heightened parent self-efficacy for participating in and contributing to formal educational processes, and enhanced teacher professionalism. This case study contributes to existing theory, knowledge and practice, and methodology in the research areas of parent-teacher relationships, specifically in secondary schools, and coteaching and cogenerative dialoguing. The study is particularly relevant given the challenges schools and teachers increasingly face to meaningfully connect with parents to better meet the needs of educational stakeholders in times of continual, complex, and rapid societal change.

Development and evaluation of a program to improve clinician and patient communication during a telehealth consultation : C.R.I.S.P. Telehealth

Introduction: The delivery of health care in the 21st century will look like no other in the past. The fast paced technological advances that are being made will need to transition from the information age into clinical practice. The phenomenon of e-Health is the over-arching form of information technology and telehealth is one arm of that phenomenon. The uptake of telehealth both in Australia and overseas, has changed the face of health service delivery to many rural and remote communities for the better, removing what is known as the tyranny of distance. Many studies have evaluated the satisfaction and cost-benefit analysis of telehealth across the organisational aspects as well as the various adaptations of clinical pathways and this is the predominant focus of most studies published to date. However, whilst comments have been made by many researchers about the need to improve and attend to the communication and relationship building aspects of telehealth no studies have examined this further. The aim of this study was to identify the patient and clinician experiences, concerns, behaviours and perceptions of the telehealth interaction and develop a training tool to assist these clinicians to improve their interaction skills. Methods: A mixed methods design combining quantitative (survey analysis and data coding) and qualitative (interview analysis) approaches was adopted. This study utilised four phases to firstly qualitatively explore the needs of clients (patients) and clinicians within a telehealth consultation then designed, developed, piloted and quantitatively and qualitatively evaluated the telehealth communication training program. Qualitative data was collected and analysed during Phase 1 of this study to describe and define the missing 'communication and rapport building' aspects within telehealth. This data was then utilised to develop a self-paced communication training program that enhanced clinicians existing skills, which comprised of Phase 2 of this study to develop the interactive program. Phase 3 included evaluating the training program with 26 clinicians and results were recorded pre and post training, whilst phase 4 was the pilot for future recommendations of this training program using a patient group within a Queensland Health setting at two rural hospitals. Results: Comparisons of pre and post training data on 1) Effective communication styles, 2) Involvement in communication training package, 3) satisfaction pre and post training, and 4) health outcomes pre and post training indicated that there were differences between pre and post training in relation to effective communication style, increased satisfaction and no difference in health outcomes between pre and post training for this patient group. The post training results revealed over half of the participants (N= 17, 65%) were more responsive to non-verbal cues and were better able to reflect and respond to looks of anxiousness and confusion from a 'patient' within a telehealth consultation. It was also found that during post training evaluations, clinicians had enhanced their therapeutic communication with greater detail to their own body postures, eye contact and presentation. There was greater time spent looking at the 'patient' with an increase of 35 second intervals of direct eye contact and less time spent looking down at paperwork which decreased by 20 seconds. Overall 73% of the clinicians were satisfied with the training program and 61% strongly agreed that they recognised areas of their communication that needed improving during a telehealth consultation. For the patient group there was significant difference post training in rapport with a mean score from 42 (SD = 28, n = 27) to 48 (SD = 5.9, n = 24). For communication comfort of the patient group there was a significant difference between the pre and post training scores t(10) = 27.9, p = .002, which meant that overall the patients felt less inhibited whilst talking to the clinicians and more understood. Conclusion: The aim of this study was to explore the characteristics of good patient-clinician communication and unmet training needs for telehealth consultations. The study developed a training program that was specific for telehealth consultations and not dependent on a 'trainer' to deliver the content. In light of the existing literature this is a first of its kind and a valuable contribution to the research on this topic. It was found that the training program was effective in improving the clinician's communication style and increased the satisfaction of patient's within an e-health environment. This study has identified some historical myths that telehealth cannot be part of empathic patient centred care due to its technology tag.

A social matching system : using implicit and explicit information for personalized recommendation in online dating service

Online dating websites enable a specific form of social networking and their efficiency can be increased by supporting proactive recommendations based on participants' preferences with the use of data mining. This research develops two-way recommendation methods for people-to-people recommendation for large online social networks such as online dating networks. This research discovers the characteristics of the online dating networks and utilises these characteristics in developing efficient people-to-people recommendation methods. Methods developed support improved recommendation accuracy, can handle data sparsity that often comes with large data sets and are scalable for handling online networks with a large number of users.

XML clustering and its application to XML transformation

The continuous growth of the XML data poses a great concern in the area of XML data management. The need for processing large amounts of XML data brings complications to many applications, such as information retrieval, data integration and many others. One way of simplifying this problem is to break the massive amount of data into smaller groups by application of clustering techniques. However, XML clustering is an intricate task that may involve the processing of both the structure and the content of XML data in order to identify similar XML data. This research presents four clustering methods, two methods utilizing the structure of XML documents and the other two utilizing both the structure and the content. The two structural clustering methods have different data models. One is based on a path model and other is based on a tree model. These methods employ rigid similarity measures which aim to identifying corresponding elements between documents with different or similar underlying structure. The two clustering methods that utilize both the structural and content information vary in terms of how the structure and content similarity are combined. One clustering method calculates the document similarity by using a linear weighting combination strategy of structure and content similarities. The content similarity in this clustering method is based on a semantic kernel. The other method calculates the distance between documents by a non-linear combination of the structure and content of XML documents using a semantic kernel. Empirical analysis shows that the structure-only clustering method based on the tree model is more scalable than the structure-only clustering method based on the path model as the tree similarity measure for the tree model does not need to visit the parents of an element many times. Experimental results also show that the clustering methods perform better with the inclusion of the content information on most test document collections. To further the research, the structural clustering method based on tree model is extended and employed in XML transformation. The results from the experiments show that the proposed transformation process is faster than the traditional transformation system that translates and converts the source XML documents sequentially. Also, the schema matching process of XML transformation produces a better matching result in a shorter time.

Satiety responsiveness in toddlerhood predicts energy intake and weight status at four years of age

The aim of this study was to examine whether maternal-report of child eating behaviour at two years predicted self-regulation of energy intake and weight status at four years. Using an ‘eating in the absence of hunger’ paradigm, children’s energy intake (kJ) from a semi-standardized lunch meal and a standardized selection of snacks were measured. Participants were 37 mother-child dyads (16 boys, Median child age = 4.4 years, Inter-quartile range = 3.7-4.5 years) recruited from an existing longitudinal study (NOURISH randomised controlled trial). All participants were tested in their own home. Details of maternal characteristics, child eating behaviours (at age two years) reported by mothers on a validated questionnaire, and measured child height and weight (at age 3.5-4 years) were sourced from existing NOURISH trial data. Correlation and partial correlation analyses were used to examine longitudinal relationships. Satiety responsiveness and Slowness in eating were inversely associated with energy intake of the lunch meal (partial r = -.40, p =.023, and partial r = -.40, p = .023) and the former was also negatively associated with BMI-for-age Z score (partial r = -.42, p = .015). Food responsiveness and Enjoyment of food were not related to energy intake or BMI Z score. None of the eating behaviours were significantly associated with energy intake of the snacks (i.e., eating in the absence of hunger). The small and predominantly ‘healthy weight’ sample of children may have limited the ability to detect some hypothesized effects. Nevertheless, the study provides evidence for the predictive validity of two eating behaviours and future research with a larger and more diverse sample should be able to better evaluate the predictive validity of other children’s early eating behaviour styles.