Inter-vertebral rotational deformity after endoscopic anterior scoliosis correction may contribute to rib hump recurrence after two years

Introduction. Endoscopic anterior scoliosis correction has been employed recently as a less invasive and level-sparing approach compared with open surgical techniques. We have previously demonstrated that during the two-year post-operative period, there was a mean loss of rib hump correction by 1.4 degrees. The purpose of this study was to determine whether intra- or inter-vertebral rotational deformity during the post-operative period could account for the loss of rib hump correction. Materials and Methods. Ten consecutive patients diagnosed with adolescent idiopathic scoliosis were treated with an endoscopic anterior scoliosis correction. Low-dose computed tomography scans of the instrumented segment were obtained post-operatively at 6 and 24 months following institutional ethical approval and patient consent. Three-dimensional multi-planar reconstruction software (Osirix Imaging Software, Pixmeo, Switzerland) was used to create axial slices of each vertebral level, corrected in both coronal and sagittal planes. Vertebral rotation was measured using Ho’s method for every available superior and inferior endplate at 6 and 24 months. Positive changes in rotation indicate a reduction and improvement in vertebral rotation. Intra-observer variability analysis was performed on a subgroup of images. Results. Mean change in rotation for vertebral endplates between 6 and 24 months post-operatively was -0.26˚ (range -3.5 to 4.9˚) within the fused segment and +1.26˚ (range -7.2 to 15.1˚) for the un-instrumented vertebrae above and below the fusion. Mean change in clinically measured rib hump for the 10 patients was -1.6˚ (range -3 to 0˚). The small change in rotation within the fused segment accounts for only 16.5% of the change in rib hump measured clinically whereas the change in rotation between the un-instrumented vertebrae above and below the construct accounts for 78.8%. There was no clear association between rib hump recurrence and intra- or inter-vertebral rotation in individual patients. Intra-rater variability was ± 3˚. Conclusions. Intra- and inter-vertebral rotation continues post-operatively both within the instrumented and un-instrumented segments of the immature spine. Rotation between the un-instrumented vertebrae above and below the fusion was +1.26˚, suggesting that the un-instrumented vertebrae improved and de-rotated slightly after surgery. This may play a role in rib hump recurrence, however this remains clinically insignificant.

Cost-informed operational process support

The ability to steer business operations in alignment with the true origins of costs, and to be informed about this on a real-time basis, allows businesses to increase profitability. In most organisations however, high-level cost-based managerial decisions are still being made separately from process-related operational decisions. In this paper, we describe how process-related decisions at the operational level can be guided by cost considerations and how these cost-informed decision rules can be supported by a workflow management system. The paper presents the conceptual framework together with data requirements and technical challenges that need to be addressed to realise cost-informed workflow execution. The feasibility of our approach is demonstrated using a prototype implementation in the YAWL workflow environment.

Health complaints commissions in Australia : Time for a national approach to data collection

Health complaint commissions in Australia: Time for a national approach • There is considerable variation between jurisdictions in the ways complaint data are defined, collected and recorded by the Health complaint commissions. • Complaints from the public are an important accountability mechanism and an indicator of service quality. • The lack of a consistent approach leads to fragmentation of complaint data and a lost opportunity to use national data to assist policy development and identify the main areas causing consumers to complain. • We need a national approach to complaints data collection by the Health complaints commissions in order to better respond to patients’ concerns

Automated marine mammal detection from aerial imagery

This paper presents two algorithms to automate the detection of marine species in aerial imagery. An algorithm from an initial pilot study is presented in which morphology operations and colour analysis formed the basis of its working principle. A second approach is presented in which saturation channel and histogram-based shape profiling were used. We report on performance for both algorithms using datasets collected from an unmanned aerial system at an altitude of 1000 ft. Early results have demonstrated recall values of 48.57% and 51.4%, and precision values of 4.01% and 4.97%.

International tax and the Australian wine industry: Is your client’s product destined to sail the seven seas?

The export market for Australian wine continues to grow at a rapid rate, with imported wines also playing a role in market share in sales in Australia. It is estimated that over 60 per cent of all Australian wine is exported, while 12 per cent of wine consumed in Australia has overseas origins. In addition to understanding the size and direction (import or export) of wines, the foreign locales also play an important role in any tax considerations. While the export market for Australian produced alcohol continues to grow, it is into the Asian market that the most significant inroads are occurring. Sales into China of bottled wine over $7.50 per litre recently overtook the volume sold our traditional partners of the United States and Canada. It is becoming easier for even small to medium sized businesses to export their services or products overseas. However, it is vital for those businesses to understand the tax rules applying to any international transactions. Specifically, one of the first tax regimes that importers and exporters need to understand once they decide to establish a presence overseas is transfer pricing. These are the rules that govern the cross-border prices of goods, services and other transactions entered into between related parties. This paper is Part 2 of the seminar presented on transfer pricing and international tax issues which are particularly relevant to the wine industry. The predominant focus of Part 2 is to discuss four key areas likely to affect international expansion. First, the use of the available transfer pricing methodologies for international related party transactions is discussed. Second, the affects that double tax agreements will have on taking a business offshore are considered. Third, the risks associated with aggressive tax planning through tax information exchange agreements is reviewed. Finally, the paper predicts future ‘trip-wires’ and areas to ‘watch out for’ for practitioners dealing with clients operating in the international arena.

Attitudes of future special education teachers toward gifted students and their education

Saudi Arabian education is undergoing substantial reform in the context of a nation transitioning from a resource-rich economy to a knowledge economy. Gifted students are important human resources for such developing countries. However, there are some concerns emanating from the international literature that gifted students have been neglected in many schools due to teachers’ attitudes toward them. The literature shows that future teachers also hold similar negative attitudes, especially those in Special Education courses who, as practicing teachers, are often responsible for supporting the gifted education process. The purpose of this study was to explore whether these attitudes are held by future special education teachers in Saudi Arabia, and how the standard gifted education course, delivered as part of their program, impacts on their attitudes toward gifted students. The study was strongly influenced by the Theory of Reasoned Action (Ajzen, 1980, 2012) and the Theory of Personal Knowledge (Polanyi, 1966), which both suggest that attitudes are related to people’s (i.e. teachers’) beliefs. A mixed methods design was used to collect quantitative and qualitative data from a cohort of students enrolled in a teacher education program at a Saudi Arabian university. The program was designed for students majoring in special education. The quantitative component of the study involved an investigation of a cohort of future special education teachers taking a semester-long course in gifted education. The data were primarily sourced from a standard questionnaire instrument modified in the Arabic language, and supplemented with questions that probed the future teachers’ attitudes toward gifted children. The participants, 90 special education future teachers, were enrolled in an introductory course about gifted education. The questionnaire contained 34 items from the "Opinions about the Gifted and Their Education" (Gagné, 1991) questionnaire, utilising a five-point Likert scale. The quantitative data were analysed through the use of descriptive statistics, Spearman correlation Coefficients, Paired Samples t-test, and Multiple Linear Regression. The qualitative component focussed on eight participants enrolled in the gifted education course. The primary source of the qualitative data was informed by individual semi-structured interviews with each of these participants. The findings, based on both the quantitative and qualitative data, indicated that the majority of future special education teachers held, overall, slightly positive attitudes toward gifted students and their education. However, the participants were resistant to offering special services for the gifted within the regular classroom, even when a comparison was made on equity grounds with disabled students. While the participants held ambivalent attitudes toward ability grouping, their attitudes were positive toward grade acceleration. Further, the majority agreed that gifted students are likely to be rejected by their teachers. Despite such judgments, they considered the gifted to be a valuable resource for Saudi society. Differences within the cohort were found when two variables emerged as potential predictors of attitude: age, experience, and participants’ hometown. The younger (under 25 years old) future special education teachers, with no internship or school practice experience, held more positive attitudes toward the gifted students, with respect to their general needs, than did the older participants with previous school experiences. Additionally, participants from a rural region were more resistant toward gifted education than future teachers from urban areas. The findings also indicated that the attitudes of most of the participants were significantly improved, as a result of the course, toward ability grouping such as special classes and schools, but remained highly concerned about differentiation within regular classrooms with either elitism or time pressure. From the findings, it can be confirmed that a lectured-based course can serve as a starting point from which to focus future teachers’ attention on the varied needs of the gifted, and as a conduit for learning about special services for the gifted. However, by itself, the course appears to have minimal influence on attitudes toward differentiation. As a consequence, there is merit in its redevelopment, and the incorporation of more practical opportunities for future teachers to experience the teaching of the gifted.

Social support promotes psychological well-being following a natural disaster

Receiving emotional support has consistently been demonstrated as an important factor associated with mental health but sparse research has investigated giving support in addition to receiving it or the types of support that predict well-being. In this paper the relationship between giving and receiving instrumental and emotional social support and psychological well-being during and following a natural disaster is investigated. A survey administered between four and six months after fatal floods was conducted with 200 community members consisting of men (n = 68) and women (n = 132) aged between 17 and 87 years. Social support experiences were assessed using the 2-Way Social Support Scale (2-Way SSS; Shakespeare-Finch & Obst, 2011) and eudemonic well-being was measured using the Psychological Well-Being Scale (PWBS; Ryff & Keyes, 1995). Hierarchical multiple regression analyses were used to examine expected relationships and to explore the differential effects of the four factors of the 2-Way SSS. Results indicated that social support shared significant positive associations with domains of psychological well-being, especially with regards to interpersonal relationships. Receiving and giving emotional support were respectively the strongest unique predictors of psychological well-being. However, receiving instrumental support predicted less autonomy. Results highlight the importance of measuring social support as a multidimensional construct and affirm that disaster response policy and practice should focus on emotional as well as instrumental needs in order to promote individual and community psychosocial health following a flooding crisis.

An investigation of the lived experiences of Intensive Care Paramedics

Intensive Care Paramedics (ICPs) attend to only the most clinically challenging of emergency medical cases, often working in a chaotic and frenetic atmosphere. They are regularly exposed to human tragedy and with that, the potential to experience traumatic events is not uncommon. There is very little known about the well-being of ICPs; how they cope with the demands of their role, or about their mental health in general. Nineteen experienced ICPs (4 female, 15 male) participated in a semi-structured interview. Themes were extracted from the data using an Interpretive Phenomenological Analysis approach. All participants discussed a work-related event they attended that traumatized them, usually experienced in the earlier parts of their career. Some spoke of an immediate overwhelming of their capacity to cope and others of a gradual onset of traumatic stress when reflecting on the event at a later time. More than half of the participants described events that involved children as the most difficult. Data revealed four superordinate themes: Social Support, Cognitive Coping, Proactive Coping, and Long Term Effects. Each superordinate theme comprised a number of constituent themes which are presented in this paper and exemplified with participant quotes. Although ongoing distress was described by some participants, all of the ICPs interviewed discussed positive aspects of their job; things that made the role worthwhile and fulfilling. This research highlights the important factors involved in coping with, and growing from, the extraordinary events that ICPs face. Results have implications for employing organizations and staff support services as well as for paramedics more broadly as they learn to cope with events inherent in their career. Findings indicate that positive adaptation and personal growth as a result of exposure to extremely high levels of potentially traumatic experiences is not only possible, but highly probable.

Young people and the social exclusion of their public and private space

This paper explores the concept of social exclusion as it impacts on young people within their local communities and the wider British, European and Australian context in terms of surveillance and other control measures.

Aboriginal and Torres Strait Islander cookbooks : promoting Indigenous foodways or reinforcing Western traditions?

This article examines the recent emergence of cookbooks written for Aboriginal and Torres Strait Islander people in Australia. The cookbooks are health promotion initiatives, developed through a desire to improve the health status of Indigenous Australians. They focus on nutritious, family meals that can be cooked on a low budget. In this article, the authors argue that the cookbooks designed for Aboriginal and Torres Strait Islander people are developed within a Western paradigm of health and nutrition that subtly reinforces Western approaches to food and disregards traditional diets. While the authors recognize the value of the cookbooks as health promotion tools, they suggest that cookbooks centred around Indigenous foodways – with a focus on traditional ingredients and traditional cooking methods – may be more appropriate for improving the health of Indigenous people and helping Indigenous cultures to thrive. They advocate for a decolonizing approach to food and nutrition, that specifically promotes Indigenous traditions and culture, and incorporates traditional foodways into modern recipes.

Utilizing least significant bit-planes of RONI pixels for medical image watermarking

We propose a computationally efficient image border pixel based watermark embedding scheme for medical images. We considered the border pixels of a medical image as RONI (region of non-interest), since those pixels have no or little interest to doctors and medical professionals irrespective of the image modalities. Although RONI is used for embedding, our proposed scheme still keeps distortion at a minimum level in the embedding region using the optimum number of least significant bit-planes for the border pixels. All these not only ensure that a watermarked image is safe for diagnosis, but also help minimize the legal and ethical concerns of altering all pixels of medical images in any manner (e.g, reversible or irreversible). The proposed scheme avoids the need for RONI segmentation, which incurs capacity and computational overheads. The performance of the proposed scheme has been compared with a relevant scheme in terms of embedding capacity, image perceptual quality (measured by SSIM and PSNR), and computational efficiency. Our experimental results show that the proposed scheme is computationally efficient, offers an image-content-independent embedding capacity, and maintains a good image quality

Fresh frozen cadavers as a tool to educate student paramedics in procedural skills

Objectives – To describe the development of an educational workshop to develop procedural skills in undergraduate Paramedic students using fresh frozen cadavers and to report the student’s assessment of the program. Methods – A six-hour anatomy based workshop was developed using fresh frozen cadavers to teach a range of airway and invasive procedural skills to second year undergraduate paramedic students. Embedded QUAN (qual) methodology will be utilised to evaluate the student’s satisfaction, perception and quality of teaching as compared to other existing clinical teaching techniques such as high fidelity simulation. Students will be asked to complete an anonymous validated survey (10 questions formulated on a 5 point Likert scale) and provide a qualitative feedback pre and post the six-hour workshop. Results – This is a prospective study planned for September 2013. Low-risk human research ethics are being sought. Teaching evaluation results from the inaugural 2012 workshop (undergraduate and postgraduate Paramedic students) and interim results for 2013 will be presented. Conclusions – Clinical teaching using fresh frozen cadavers thus far has predominately been used in the education of medical and surgical trainees. A number of studies have found them to be effective and in some cases superior to traditional high fidelity simulation teaching strategies. Fresh frozen cadavers are said to provide perfect anatomy, normal tissue consistency and a realistic operative training experience (Lloyd, Maxwell-Armstrong et al. 2011). The authors believe that this study will show that the use of fresh frozen cadavers offers a safe and effective mode to teach procedural skills to student paramedics that will help bridge the skills gap and increase confidence prior to students undertaking such interventions on living patients. A modified training program may be formulated for general practitioners undertaking Emergency Medicine Advanced Rural Skills.

Effect of atmospheric ageing on volatility and ROS of biodiesel exhaust nano-particles

Generally, the magnitude of pollutant emissions from diesel engines is ultimately coupled to the structure of fuel molecules. The presence of oxygen, level of unsaturation and the carbon chain length of respective molecules influence the combustion chemistry. It is speculated that increased oxygen content in the fuel may lead to the increased oxidative potential (Stevanovic, S. 2013). Also, upon the exposure to UV and ozone in the atmosphere, the chemical composition of the exhaust is changed. The presence of an oxidant and UV is triggering the cascade of photochemical reactions as well as the partitioning of semi-volatile compounds between the gas and particle phase. To gain an insight into the relationship between the molecular structures of the esters, their volatile organic content and the potential toxicity of diesel exhaust particulate matter, measurements were conducted on a modern common rail diesel engine. This research also investigates the contribution of atmospheric conditions on the transfer of semi-volatile fraction of diesel exhaust from the gas phase to the particle phase and the extent to which semi-volatile compounds (SVOCs) are related to the oxidative potential, expressed through the concentration of reactive oxygen species (ROS) (Stevanovic, S. 2013)...