Causes of injuries resulting in hospitalisation in Australia : assessing coder agreement on external causes

Objective: To assess extent of coder agreement for external causes of injury using ICD-10-AM for injury-related hospitalisations in Australian public hospitals. Methods: A random sample of 4850 discharges from 2002 to 2004 was obtained from a stratified random sample of 50 hospitals across four states in Australia. On-site medical record reviews were conducted and external cause codes were assigned blinded to the original coded data. Code agreement levels were grouped into the following agreement categories: block level, 3-character level, 4-character level, 5th-character level, and complete code level. Results: At a broad block level, code agreement was found in over 90% of cases for most mechanisms (eg, transport, fall). Percentage disagreement was 26.0% at the 3-character level; agreement for the complete external cause code was 67.6%. For activity codes, the percentage of disagreement at the 3-character level was 7.3% and agreement for the complete activity code was 68.0%. For place of occurrence codes, the percentage of disagreement at the 4-character level was 22.0%; agreement for the complete place code was 75.4%. Conclusions: With 68% agreement for complete codes and 74% agreement for 3-character codes, as well as variability in agreement levels across different code blocks, place and activity codes, researchers need to be aware of the reliability of their specific data of interest when they wish to undertake trend analyses or case selection for specific causes of interest.

Combining ganglion cell topology and data of patients with glaucoma to determine a structure-function map

PURPOSE: To introduce techniques for deriving a map that relates visual field locations to optic nerve head (ONH) sectors and to use the techniques to derive a map relating Medmont perimetric data to data from the Heidelberg Retinal Tomograph. METHODS: Spearman correlation coefficients were calculated relating each visual field location (Medmont M700) to rim area and volume measures for 10 degrees ONH sectors (HRT III software) for 57 participants: 34 with glaucoma, 18 with suspected glaucoma, and 5 with ocular hypertension. Correlations were constrained to be anatomically plausible with a computational model of the axon growth of retinal ganglion cells (Algorithm GROW). GROW generated a map relating field locations to sectors of the ONH. The sector with the maximum statistically significant (P < 0.05) correlation coefficient within 40 degrees of the angle predicted by GROW for each location was computed. Before correlation, both functional and structural data were normalized by either normative data or the fellow eye in each participant. RESULTS: The model of axon growth produced a 24-2 map that is qualitatively similar to existing maps derived from empiric data. When GROW was used in conjunction with normative data, 31% of field locations exhibited a statistically significant relationship. This significance increased to 67% (z-test, z = 4.84; P < 0.001) when both field and rim area data were normalized with the fellow eye. CONCLUSIONS: A computational model of axon growth and normalizing data by the fellow eye can assist in constructing an anatomically plausible map connecting visual field data and sectoral ONH data.

Adolescence: A useful concept for this millennium

‘Adolescence’ has become increasingly recognised as a nebulous concept. Previous conceptualisations of adolescence have adopted a ‘deficit’ view, regarding teenagers as ‘unfinished’ adults. The deficit view of adolescence is highly problematic in an era where adulthood itself is difficult to define. The terms ‘kidult’ or ‘adultescent’ have emerged to describe adult-age people whose interests and priorities match those of their teenage counterparts. Rather than relying on ‘lock-step’ models of physical, cognitive and social growth put forward by developmental psychology, adolescence can be more usefully defined by looking at the common experiences of people in their teenage years. Common experiences arise at an institutional level; for example, all adolescents are treated as the same by legal and education systems. The transition from primary to secondary schooling is a milestone for all children, exposing them to a new type of educational environment. Shared experiences also arise from generational factors. Today’s adolescents belong to the millennial generation, characterised by technological competence, global perspectives, high susceptibility to media influence, individualisation and rapid interactions. This generation focuses on teamwork, achievement, modesty and good conduct, and has great potential for significant collective accomplishments. These generational factors challenge educators to provide relevant learning experiences for today’s students. Many classrooms still utilise textbook-based pedagogy more suited to previous generations, resulting in disengagement among millennial students. Curriculum content must also be tailored to generational needs. The rapid pace of change, as well as the fluidity of identity created by dissolving geographical and vocational boundaries, mean that the millennial generation will need more than a fixed set of skills and knowledge to enter adulthood. Teachers must enable their students to think like ‘expert novices’, adept at assimilating new concepts in depth and prepared to engage in lifelong learning.

Adolescence : a useful concept for this millennium

This paper proposes adolescence as a useful concept rather than definitive. It explores the notion of adolescence and its relevance to contemporary society and schooling. We reflect on the purposes for the emergence of research into adolescence during the early 20th century, particularly the particular scientific and societal pressures that served to bring this field to prominence. Recent debate has started to problematise many of the early parameters used to define and provide bounds for understanding adolescents and adolescent experience and for the rationale for some notionally tailored educational contexts. This paper provides an overview of this debate and argues for a reconsideration of some of the basic tenets for definition. In particular we discuss the cultural construction of adolescence in the light of our new globalised society. A possibility for thinking about contemporary adolescents is by considering them in terms of generational characteristics. What makes a new generation? Typically, members of a generation share age, a set of experiences during formative years, and a set of social and economic conditions. The adolescents of today fall into the group known collectively as the ‘Y Generation’, the ‘D (digital) Generation’, Generation C (consumer) and the ‘Millennial’s’. Born after mid-1980, they are characterised as computer and internet competent, multi-taskers, with a global perspective. They respond best to visual language, and are heavily influenced by the media. We consider the generational traits and how this impacts on the teaching and learning.

The S.T.A.B. Trial - Standardised Testing of Artificial Blood. A comparative study of various products that may be used as artificial blood for high fidelity simulation training in the critical care setting

Aim: In the current climate of medical education, there is an ever-increasing demand for and emphasis on simulation as both a teaching and training tool. The objective of our study was to compare the realism and practicality of a number of artificial blood products that could be used for high-fidelity simulation. Method: A literature and internet search was performed and 15 artificial blood products were identified from a variety of sources. One product was excluded due to its potential toxicity risks. Five observers, blinded to the products, performed two assessments on each product using an evaluation tool with 14 predefined criteria including color, consistency, clotting, and staining potential to manikin skin and clothing. Each criterion was rated using a five-point Likert scale. The products were left for 24 hours, both refrigerated and at room temperature, and then reassessed. Statistical analysis was performed to identify the most suitable products, and both inter- and intra-rater variability were examined. Results: Three products scored consistently well with all five assessors, with one product in particular scoring well in almost every criterion. This highest-rated product had a mean rating of 3.6 of 5.0 (95% posterior Interval 3.4-3.7). Inter-rater variability was minor with average ratings varying from 3.0 to 3.4 between the highest and lowest scorer. Intrarater variability was negligible with good agreement between first and second rating as per weighted kappa scores (K = 0.67). Conclusion: The most realistic and practical form of artificial blood identified was a commercial product called KD151 Flowing Blood Syrup. It was found to be not only realistic in appearance but practical in terms of storage and stain removal.

Upper body musculoskeletal disorders among Australian occupational therapy students

Although upper body musculoskeletal disorders (MSDs) represent an increasingly important issue for university students, few if any studies have targeted the occupational therapy faculty. Given this dearth of information, it was considered necessary to investigate a cross-section of Australian occupational therapy students by means of an established questionnaire survey. Completed replies were obtained from 95.7%, 100% and 97.7% (n = 44, 55 and 48) of students in the first, second and fourth years of a large occupational therapy school in northern Queensland, Australia.---------- The 12-month period prevalence of MSDs was as follows: neck (67.4%), shoulder (46.3%) and upper back (39.5%). Three-quarters of all students (75.5%) reported an MSD occurring in at least one of these body regions. Over half (56.5%) reported an MSD over 2 days' duration in the past year. Almost 40% (39.5%) reported an MSD that had affected their daily life, while one-quarter (25.2%) needed some type of treatment.---------- Logistic regression indicated that students aged over 21 years were almost four times more likely to report shoulder-related MSD (OR 3.7, 95%CI: 1.4-10.2). Year of study in the occupational therapy course was another important MSD correlate, with adjusted odds ratios ranging from 3.3 at the upper back (OR 3.3, 95%CI: 1.2-9.6) to 10.9 at the neck (OR 10.9, 95%CI: 3.2-43.8). Computer usage also incurred a certain degree of risk, with students who spent over 5 hours per week on the computer having an increased risk of MSD at the neck (OR 5.0, 95%CI: 1.3-21.5) and shoulder (OR 4.7, 95%CI: 1.4-18.3).---------- Overall, this study suggests that Australian occupational therapy students have a large burden from MSDs in the upper body region, even more so than other student groups and some working populations. Since the distribution of MSD risk is not uniform among them, interventions to help reduce these conditions need to be carefully targeted. Further longitudinal investigations would also be useful in determining the mechanisms and contributory factors for MSDs among this unique student population.

The same river twice

This article reviews an exhibition of art works at the Institute for Modern Art that dealt with the idea of history. The review suggests that history is an unstable product of our collective imaginations and is constantly open to revisions and individual perspectives. Each of the artists deal with these issues by reinterpreting past events. The artists were Pierre Huyghe, Thomas Demand, Mike Kelley, paul McCarthy, Jeremy Deller, Danius Kesminas, Gerard Byrne, Emma Kay, and Omer Fast.

Determinants of pre-hospital care non-usage for patients with emergency care needs [including commentary by Snooks H.]

Objective-To establish the demographic, health status and insurance determinants of pre-hospital ambulance non-usage for patients with emergency medical needs. Methods-Triage category, date of birth, sex, marital status, country of origin, method and time of arrival, ambulance insurance status, diagnosis, and disposal were collected for all patients who presented over a four month period (n=10 229) to the emergency department of a major provincial hospital. Data for patients with urgent (n=678) or critical care needs (n=332) who did not use pre-hospital care were analysed using Poisson regression. Results-Only a small percentage (6.6%) of the total sample were triaged as having urgent medical needs or critical care needs (3.2%). Predictors of usage for those with urgent care needs included age greater than 65 years (prevalence ratio (PR)=0.54; 95% confidence interval (CI)= 0.35 to 0.83), being admitted to intensive care or transferred to another hospital (PR=0.62; 95% CI=0.44 to 0.89) or ward (PR=0.72; 95% CI=0.56 to 0.93) and ambulance insurance status (PR=0.67; 95% CI=052 to 0.86). Sex, marital status, time of day and country of origin were not predictive of usage and non-usage. Predictors of usage for those with critical care needs included age 65 years or greater (PR=0.45; 95% CI=0.25 to 0.81) and a diagnosis of trauma (PR=0.49; 95% CI=0.26 to 0.92). A non-English speaking background was predictive of non-usage (PR=1.98; 95% CI=1.06 to 3.70). Sex, marital status, time of day, triage and ambulance insurance status were not predictive of non-usage. Conclusions-Socioeconomic and medical factors variously influence ambulance usage depending on the severity or urgency of the medical condition. Ambulance insurance status was less of an influence as severity of condition increased suggesting that, at a critical level of urgency, patients without insurance are willing to pay for a pre-hospital ambulance service.

Preservice EFL teachers’ beliefs about teaching writing and learning to teach writing before their practicum : a case study in Vietnam

The standard of English as a Foreign Language (EFL) education has prompted calls for reform to preservice EFL teacher education. Field experiences are central to their professional development and for implementing reform measures. This study aims to examine preservice EFL teachers’ attitudes, needs, and experiences about learning to teach writing in English before their practicum in Vietnamese high schools. An open-ended questionnaire collected data from 97 preservice EFL teachers at the beginning of their final practicum. The data suggested that these preservice EFL teachers were motivated to learn to teach English in general and teaching writing in particular but required mentors to model effective teaching practices and share their teaching experiences. They also needed their mentors to be enthusiastic and supportive, and provide constructive feedback. These findings may assist teacher educators and school mentors for motivating and developing preservice EFL teachers’ practices.

Innovative Practices in the Australian Built Environment Sector : An Information Resource for Industry

PROJECT BRIEF Information provided by the Built Environment Industry Innovation Council as background to this project includes the following information on construction and innovation within the industry. • The construction industry contributes around $67 billion to GDP and employs around 970,000 and generates exports of nearly $150 million. • The industry has one of the lowest innovation rates of any industry in Australia, ranking third last across all Australian industries in terms of its proportion of business expenditure on innovation, and second last in terms of the proportion of income generated from innovation (ABS, 2006). • Key innovation challenges include addressing energy and water use efficiency, and housing costs in preparing for the implementation of the Carbon Pollution Reduction Scheme. The sector will need to build its capability and capacity to deliver the technical and operational expertise required.The broader Built Environment Innovation Project aims to address the following two objectives: 1. Identify current innovative practice across the Built Environment industry. 2. Develop a knowledge exchange strategy for this information to be disseminated to all industry stakeholders. Industry practice issues are critical to the built environment industry’s ability to innovate, and the BRITE project from the CRC for Construction Innovation has previously undertaken work to identify the key factors that drive innovation. Part 1 of the current project aims to extend this work by conducting a stocktake of current and emerging innovative practices within the built environment industry. Part 2 of the project addresses the second of these objectives, that is, to recommend a knowledge exchange strategy for promoting the wider uptake of innovative practices that makes the information identified in Part 1 of the study (on emerging innovative practices) accessible to Australian built environment industry stakeholders. The project brief was for the strategy to include a mechanism to enable this information resource to be updated as new initiatives/practices are developed. A better understanding of the built environment industry’s own knowledge infrastructure also has the potential to enhance innovation outcomes for the industry. This project will develop a coordinated knowledge exchange strategy, informed by the best available information on current innovation practices within the industry and suggest directions for gaining a better understanding of: the industry contexts that lead to innovative practices; the industry (including enterprise and individual) drivers for innovation; and appropriate knowledge exchange pathways for delivering future industry innovation. A deliverable of Part 2 will be a recommendation for a knowledge exchange strategy to accelerate adoption of innovative practices in the built environment industry, including resource implications and how such a recommendation could be taken forward as an ongoing resource.

Collaboration using BIM : results of cooperative research centre for construction innovation projects

This paper discusses the issues with sharing information between different disciplines in collaborative projects. The focus is on the information itself rather than the wider issues of collaboration. A range of projects carried out by the Cooperative Research Centre for Construction Innovation (CRC CI) in Australia is used to illustrate the issues.

Children's self-talk and significant others' positive and negative statements

A sample of 675 elementary school children in Grades 3-7 were administered the Self-talk Inventory and the Significant Others' Statements Inventory. The psychometric properties of both scales were investigated and the relationships between positive and negative self-talk and significant others' (parents, teachers, siblings and peers) positive and negative statements were explored using correlational and multiple regression analyses. Sex and age differences were also examined. The significant relationships and differences are described.

Informe

Much landscape architectural form seems like hackneyed modernism, whether it be orthogonal or biomorphic, 'formal or informal' and doesn't seem to get to grips with the truly complex nature of the landscape, making any project seem potentially simplistic. This is largely because it has inherited languages from architecture that are based around objects, and that therefore can act to make designs self-referential rather than edgy instances in a dialogue much larger than the site itself, connected to systems that are unavoidable, even if one chooses to ignore them. These systems constitute a formal language even if landscape architecture looks to things like GIS to engage with them. Tropospheric Temperament was an Advanced Computing subject, for second-year landscape architecture students at UWA, taught by Julian Raxworthy and Rene Van Meeuwen, which ran in Semester 1, 2004. For this subject, the question was: how can we learn to wield such systems in design terms, even if they are developed through un-self-conscious natural and vernacular forces?

The big blue

For the 1.5 million travellers who annually visit the Blue Mountains to experience the Australian Bush, it just got closer. The Echo Point redevelopment by Tract Consultants is a megastructure in the void.