Enhancing learning in large undergraduate classes using custom made audio-visual cases

This is an exploratory study into the effective use of embedding custom made audiovisual case studies (AVCS) in enhancing the student’s learning experience. This paper describes a project that used AVCS for a large divergent cohort of undergraduate students, enrolled in an International Business course. The study makes a number of key contributions to advancing learning and teaching within the discipline. AVCS provide first hand reporting of the case material, where the students have the ability to improve their understanding from both verbal and nonverbal cues. The paper demonstrates how AVCS can be embedded in a student-centred teaching approach to capture the students’ interest and to enhance a deep approach to learning by providing real-world authentic experience.

The pattern of coupling dynamics between postural motion, isotonic hand movements and physiological tremor

This study was designed to examine differences in the coupling dynamics between upper limb motion, physiological tremor and whole body postural sway in young healthy adults. Acceleration of the hand and fingers, forearm EMG activity and postural sway data were recorded. Estimation of the degree of bilateral and limb motion-postural sway coupling was determined by cross correlation, coherence and Cross-ApEn analyses. The results of the analysis revealed that, under postural tremor conditions, there was no significant coupling between limbs, muscles or sway across all metrics of coupling. In contrast, performing a rapid alternating flexion/extension movement about the wrist joint (with one or both limbs) resulted in stronger coupling between limb motion and postural sway. These results support the view that, for physiological tremor responses, the control of postural sway is maintained independent to tremor in the upper limb. However, increasing the level of movement about a distal segment of one arm (or both) leads to increased coupling throughout the body. The basis for this increased coupling would appear to be related to the enhanced neural drive to task-specific muscles within the upper limb.

Using a theory of planned behaviour framework to explore hand hygiene beliefs at the ‘5 critical moments’ among Australian hospital-based nurses

Background Improving hand hygiene among health care workers (HCWs) is the single most effective intervention to reduce health care associated infections in hospitals. Understanding the cognitive determinants of hand hygiene decisions for HCWs with the greatest patient contact (nurses) is essential to improve compliance. The aim of this study was to explore hospital-based nurses’ beliefs associated with performing hand hygiene guided by the World Health Organization’s (WHO) 5 critical moments. Using the belief-base framework of the Theory of Planned Behaviour, we examined attitudinal, normative, and control beliefs underpinning nurses’ decisions to perform hand hygiene according to the recently implemented national guidelines. Methods Thematic content analysis of qualitative data from focus group discussions with hospital-based registered nurses from 5 wards across 3 hospitals in Queensland, Australia. Results Important advantages (protection of patient and self), disadvantages (time, hand damage), referents (supportive: patients, colleagues; unsupportive: some doctors), barriers (being too busy, emergency situations), and facilitators (accessibility of sinks/products, training, reminders) were identified. There was some equivocation regarding the relative importance of hand washing following contact with patient surroundings. Conclusions The belief base of the theory of planned behaviour provided a useful framework to explore systematically the underlying beliefs of nurses’ hand hygiene decisions according to the 5 critical moments, allowing comparisons with previous belief studies. A commitment to improve nurses’ hand hygiene practice across the 5 moments should focus on individual strategies to combat distraction from other duties, peer-based initiatives to foster a sense of shared responsibility, and management-driven solutions to tackle staffing and resource issues. Hand hygiene following touching a patient’s surroundings continues to be reported as the most neglected opportunity for compliance.

Sharing of clinical data in a maternity setting: How do paper hand-held records and electronic health records compare for completeness?

Background Historically, the paper hand-held record (PHR) has been used for sharing information between hospital clinicians, general practitioners and pregnant women in a maternity shared-care environment. Recently in alignment with a National e-health agenda, an electronic health record (EHR) was introduced at an Australian tertiary maternity service to replace the PHR for collection and transfer of data. The aim of this study was to examine and compare the completeness of clinical data collected in a PHR and an EHR. Methods We undertook a comparative cohort design study to determine differences in completeness between data collected from maternity records in two phases. Phase 1 data were collected from the PHR and Phase 2 data from the EHR. Records were compared for completeness of best practice variables collected The primary outcome was the presence of best practice variables and the secondary outcomes were the differences in individual variables between the records. Results Ninety-four percent of paper medical charts were available in Phase 1 and 100% of records from an obstetric database in Phase 2. No PHR or EHR had a complete dataset of best practice variables. The variables with significant improvement in completeness of data documented in the EHR, compared with the PHR, were urine culture, glucose tolerance test, nuchal screening, morphology scans, folic acid advice, tobacco smoking, illicit drug assessment and domestic violence assessment (p = 0.001). Additionally the documentation of immunisations (pertussis, hepatitis B, varicella, fluvax) were markedly improved in the EHR (p = 0.001). The variables of blood pressure, proteinuria, blood group, antibody, rubella and syphilis status, showed no significant differences in completeness of recording. Conclusion This is the first paper to report on the comparison of clinical data collected on a PHR and EHR in a maternity shared-care setting. The use of an EHR demonstrated significant improvements to the collection of best practice variables. Additionally, the data in an EHR were more available to relevant clinical staff with the appropriate log-in and more easily retrieved than from the PHR. This study contributes to an under-researched area of determining data quality collected in patient records.

Quantification of functional hand grip using electromyography and inertial sensor-derived accelerations: Clinical implications

Background Assessing hand injury is of great interest given the level of involvement of the hand with the environment. Knowing different assessment systems and their limitations generates new perspectives. The integration of digital systems (accelerometry and electromyography) as a tool to supplement functional assessment allows the clinician to know more about the motor component and its relation to movement. Therefore, the purpose of this study was the kinematic and electromyography analysis during functional hand movements. Method Ten subjects carried out six functional movements (terminal pinch, termino-lateral pinch, tripod pinch, power grip, extension grip and ball grip). Muscle activity (hand and forearm) was measured in real time using electromyograms, acquired with the Mega ME 6000, whilst acceleration was measured using the AcceleGlove. Results Electrical activity and acceleration variables were recorded simultaneously during the carrying out of the functional movements. The acceleration outcome variables were the modular vectors of each finger of the hand and the palm. In the electromyography, the main variables were normalized by the mean and by the maximum muscle activity of the thenar region, hypothenar, first interosseous dorsal, wrist flexors, carpal flexors and wrist extensors. Conclusions Knowing muscle behavior allows the clinician to take a more direct approach in the treatment. Based on the results, the tripod grip shows greater kinetic activity and the middle finger is the most relevant in this regard. Ball grip involves most muscle activity, with the thenar region playing a fundamental role in hand activity. Clinical relevance Relating muscle activation, movements, individual load and displacement offers the possibility to proceed with rehabilitation by individual component.

A kinematic analysis of the hand function

Background The evaluation of the hand function is an essential element within the clinical practice. The usual assessments are focus on the ability to perform activities of daily life. The inclusion of instruments to measure kinematic variables provides a new approach to the assessment. Inertial sensors adapted to the hand could be used as a complementary instrument to the traditional assessment. Material: clinimetric assessment (Upper Limb Functional Index, Quick Dash), antrophometric variables (eight and weight), dynamometry (palm preasure) was taken. Functional analysis was made with Acceleglove system for the right hand and computer system. The glove has six acceleration sensor, one on each finger and another one on the reverse palm. Method Analytic, transversal approach. Ten healthy subject made six task on evaluation table (tripod pinch, lateral pinch and tip pinch, extension grip, spherical grip and power grip). Each task was made and measure three times, the second one was analyze for the results section. A Matlab script was created for the analysis of each movement and detection phase based on module vector. Results The module acceleration vector offers useful information of the hand function. The data analysis obtained during the performance of functional gestures allows to identify five different phases within the movement, three static phase and tow dynamic, each module vector was allied to one task. Conclusion Module vector variables could be used for the analysis of the different task made by the hand. Inertial sensor could be use as a complement for the traditional assessment system.

Cost-effectiveness of a national initiative to improve hand hygiene compliance using the outcome of healthcare associated staphylococcus aureus bacteraemia

Background The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included. Methods The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011–2012. Findings No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER) of $29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of $1,030 and $8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26% chance for South Australia with an ICER of $64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits. Conclusions The Australian National Hand Hygiene Initiative was cost-effective against an Australian threshold of $42,000 per life year gained. The return on investment varied among the states and territories of Australia.

A common stochastic accumulator with effector-dependent noise can explain eye-hand coordination

The computational architecture that enables the flexible coupling between otherwise independent eye and hand effector systems is not understood. By using a drift diffusion framework, in which variability of the reaction time (RT) distribution scales with mean RT, we tested the ability of a common stochastic accumulator to explain eye-hand coordination. Using a combination of behavior, computational modeling and electromyography, we show how a single stochastic accumulator to threshold, followed by noisy effector-dependent delays, explains eye-hand RT distributions and their correlation, while an alternate independent, interactive eye and hand accumulator model does not. Interestingly, the common accumulator model did not explain the RT distributions of the same subjects when they made eye and hand movements in isolation. Taken together, these data suggest that a dedicated circuit underlies coordinated eye-hand planning.

Proportioning variability in the dispensation of hand-mixed dental cements

Objectives: The purpose of this investigation was to determine for dispensed multiples (1 through 4) of powder (P) and liquid (L) in hand-mixed dental cement whether: (1) the mean (P/L) ratio (m/m) and (2) the maximum difference in (P/L) ratio is dependent on the number of multiples dispensed. The Null hypotheses were: (a) mean (P/L) ratio is independent of the number of multiples dispensed and (b) maximum difference in (P/L) ratio is independent of the number of multiples dispensed.
Methods: The materials investigated are listed in the Table. The masses of dispensed aliquots of powder and liquid were measured by a single operator (n=10, for multiples 1 through 4) on a 4-place analytical balance. All measurements were made independently and all possible (P/L) ratios calculated for each sample. The effect of multiple dispensations on (P/L) ratios and maximum (P/L) differences was by one-way ANOVA and linear regression, respectively, with the Tukey post-hoc correction for multiple comparisons.MULTIPLE DISPENSEDDISPENSED MU(x1)(x2)(x3)(x4)Zinc phosphateHeraeus12.271(0.691)a13.051(1.269)b13.215(0.824)b13.118(1.149)bFuji IXGC4.209(0.373)a4.085(0.275)b4.095(0.226)b4.095(0.217)bIRMDentsply7.933(0.767)a7.430(0.451)b7.977(0.729)a8.186(0.929)aKetac-Cem3M Espe9.6206(0.613)a9.714(0.523)a9.298(0.314)b9.321(0.292)bMean (SD) powder/liquid ratio (m/m). Superscript letters represent significances (α = 0.05) within each material
Results: Mean (SD) (P/L) ratios are presented in the Table. Null hypothesis (a) is rejected: either (x1) or (x2) dispensation yields a different (P/L) ratio to (x3) or (x4) (p < 0.05). Null hypothesis (b) is rejected: a negative correlation is observed in max (P/L) ratio difference with dispensed multiple for Ketac Cem (p = 0.029).
Conclusion: For hand-mixed dental cements: (1) more consistent (P/L) ratios may be observed with multiple dispensations of powder & liquid; (2) maximum differences in (P/L) ratio may be negatively correlated with dispensation multiple in some materials.

Cinematic motion by hand

The general goal of my research is to find out what is questioned whenever an animated film is made by an author who chooses to have maximum control over the device automatisms. I am trying to understand in what ways that specific kind of film relates with Cinema and the History of Art as a whole and, more specifically, how its filmic discourse is built within cinematic codes, workings and machinery. This paper, in particular, aims to establish that each time an author makes a film by suspending both automatic ‘motion’ and image recording functions—that which is often known as “cameraless” film—a process is initiated that simultaneously questions not only Cinema, within both expression and technology, but also the ontological position this same technology occupies in current media.

License no. 144 of season 1872/73 made out to S.D. Woodruff for 36 square miles in berth no. 192

License no. 144 of season 1872/73 made out to S.D. Woodruff for 36 square miles in berth no. 192. This document is slightly torn and stained along the right hand side. This does not affect the text, April 7, 1873.

Diagrams (charts and graphs) made into a booklet with a newspaper cover

Diagrams (charts and graphs) made into a booklet with a newspaper cover. This booklet contains cross sections of the back ditch on the south side of the Welland Canal feeder, west of the Marshville culverts (45 pages, hand drawn). This was created by Fred Holmes, Oct. 3, 1857.

Case studies to demonstrate the range of applications of the Southampton Hand Assessment Procedure

The Southampton Hand Assessment Procedure (SHAP) was devised to assess quantitatively the functional range of injured and healthy adult hands. It was designed to be a practical tool for use in a busy clinical setting; thus, it was made simple to use and easy to interpret. This paper describes four examples of its use: before and after a surgical procedure, to observe the impact of an injury, use with prostheses, and during recovery following a fracture. The cases show that the SHAP is capable of monitoring progress and recovery, identifying functional abilities in prosthetic hands and comparing the capabilities of different groups of injuries.

Validity of hand-to-foot measurement of bioimpedance: Standing compared with lying position

Objective: To assess the reliability of the standing measurement of hand-to-foot bioimpedance compared with measurements made in the lying position.Research Methods and Procedures: In 205 volunteers 6 to 89 years of age, 111 males and 94 females from six ethnic groups, effects of posture, time, and age on hand-to-foot resistance were studied over a range of body size. The effect of time in a position on resistance was also recorded in a small subset (n = 10), and repeat measurements over 3 days at the same time of the day were recorded in another subset (n = 12).Results: Lying impedance was consistently higher than standing, with the relationship (resistance lying/resistance standing) for the children (5 to 14 years) being 1.031, progressing to a ratio of 1.016 in those >60 years. The time spent static in either position did change resistance measurements - a decrease of up to 9 Omega (mean 5 Omega, 1.0%) over 10 minutes of standing and an increase of up to 7 Omega (mean 3 Omega, 0.7%) with lying.Discussion: In the field, measurements of hand-to-foot bioimpedance can be made in the standing position, and, with appropriate adjustment, previously validated recumbent equations can be used. Given that errors in the measurement of height and weight also affect the reliability of the derivation of body fat from bioelectrical conductance, the errors that may arise from a more practical standing measurement rather than lying are minimal.

Biomimetic bilayer membranes made from polymers and lipids

Amphiphile Blockcopolymere sind in der Lage in Wasser Morphologien auszubilden, die analog sind zur hydrophil-hydrophob-hydrophil-Struktur von natürlichen Lipiddoppelschichten. In dieser Arbeit wird zum ersten Mal die Präparation und Charakterisierung von oberflächengestützten Polymerdoppelschichten aus Polybutadien-b-Polyethylenoxid (PB-PEO) beschrieben. Für die Herstellung dieser Strukturen wurden zwei unterschiedliche Präparationsstrategien verfolgt. Der erste Weg besteht aus einer zweistufigen Methode, bei der im ersten Schritt organisierte Monoschichten mittels Langmuir-Blodgett-Transfer auf Gold übertragen und kovalent angebunden werden. Im zweiten Schritt werden hydrophobe Wechselwirkungen ausgenutzt, um über Langmuir-Schaefer-Transfer eine weitere Schicht aufzubringen. Somit wurden homogene Architekturen erzeugt, die oberflächengestützten Lipiddoppelschichten gleichen. Als alternativer, einstufiger Ansatz zur Herstellung von Polymerdoppelschichten wurde das Spreiten von Polymervesikeln auf Gold verfolgt. Auch hierdurch ließen sich Doppelschichtstrukturen mit einer vollständigen Oberflächenbedeckung erzeugen. Die hergestellten Polymerdoppelschichten besitzen eine Dicke von 11-14 nm, die von der Präparationsmethode abhängt. Die Polymerstrukturen weisen bei Trocknung für 1.5 h eine Stabilität gegenüber Luft auf. Bei längeren Trocknungszeiten von ca. 12 h kommt es zu einer Reorganisation der Oberfläche. Dies deutet darauf hin, dass Wasser dazu notwendig ist die Strukturen auf lange Sicht zu stabilisieren. Um die Biokompatibilität der Polymerschichten nachzuweisen, wurden die Wechselwirkungen mit dem membranaktiven Peptid Polymyxin B und dem Transmembranprotein α-Haemolysin gezeigt. Mobilität ist ein wichtiger Faktor für die korrekte Funktion vieler Transmembranproteine. Um die laterale Diffusionsdynamik innerhalb der künstlichen Strukturen zu untersuchen, wurde die Mobilität eines integralen Modellpeptids und von fluoreszierenden Membransonden gemessen. Es konnte mit einzelmolekülempfindlichen Techniken gezeigt werden, dass das α-helikale Peptid und die kleinen Fluoreszenzfarbstoffe frei im hydrophoben Kern der Polymerdoppelschicht diffundieren können. Die Diffusion von beiden Spezies scheint stark von der Fluidität der Polymermatrix beeinflusst zu sein. Ein weiterer Teil dieser Arbeit widmet sich der Entwicklung eines angemessenen, lipidbasierten Referenzsystems für zukünftige Proteinuntersuchungen. Hierzu wurde eine neue Methode zu Herstellung von peptidgestützten Lipiddoppelschichtmembranen entwickelt. Dies wurde durch kovalente Befestigung eines Thiopeptids an einen Goldfilm und darauffolgende Anbindung eines Lipids erreicht. Zur Ausbildung der Lipiddoppelschicht auf dem Lipopeptidunterbau wurder der Rapid Solvent Exchange verwendet. Die Ausbildung der Lipiddoppelschicht wurde sowohl auf microskopischer als auch auf makroskopischer Ebene nachgewiesen. Im letzten Schritt wurde die Anwendbarkeit des Modelsystems für elektrochemische Messungen durch den funktionalen Einbau des Ionentransporters Valinomycin unter Beweis gestellt.