Dying in hospital: medical failure or nature outcome?

The purpose of this study was to describe patterns of medical and nursing practice in the care of patients dying of oncological and hematological malignancies in the acute care setting in Australia. A tool validated in a similar American study was used to study the medical records of 100 consecutive patients who died of oncological or hematological malignancies before August 1999 at The Canberra Hospital in the Australian Capital Territory. The three major indicators of patterns of end-of-life care were documentation of Do Not Resuscitate (DNR) orders, evidence that the patient was considered dying, and the presence of a palliative care intention. Findings were that 88 patients were documented DNR, 63 patients' records suggested that the patient was dying, and 74 patients had evidence of a palliative care plan. Forty-six patients were documented DNR 2 days or less prior to death and, of these, 12 were documented the day of death. Similar patterns emerged for days between considered dying and death, and between palliative care goals and death. Sixty patients had active treatment in progress at the time of death. The late implementation of end-of-life management plans and the lack of consistency within these plans suggested that patients were subjected to medical interventions and investigations up to the time of death. Implications for palliative care teams include the need to educate health care staff and to plan and implement policy regarding the management of dying patients in the acute care setting. Although the health care system in Australia has cultural differences when compared to the American context, this research suggests that the treatment imperative to prolong life is similar to that found in American-based studies.

Influence of task properties and subjectivity on consistency of triage: a simulation study

Aim. This paper reports a study to determine nurses' levels of agreement using a standard 5-point triage scale and to explore the influence of task properties and subjectivity on decision-making consistency.

Background. Triage scales are used to define time-to-treatment in hospital emergency departments. Studies of the inter-rater reliability of these scales using paper-based simulation methods report varying levels of consistency. Understanding how various components of the decision task and individual perceptions of the case influence agreement is critical to the development of strategies to improve consistency of triage.

Method. Simulations were constructed from naturalistic observation, cue types and frequencies were classified. Data collection was conducted in 2002, and the final response rate was 41·3%. Participants were asked to allocate an urgency code for 12 scenarios using the Australasian Triage Scale, and provide estimates of case complexity, levels of certainty and available information. Data were analysed descriptively, agreement between raters was calculated using kappa. The influence of task properties and participants' subjective estimates of case complexity, levels of certainty and available information on agreement were explored using a general linear model.

Findings. Agreement among raters varied from moderate to poor (κ = 0·18–0·64). Participants' subjective estimates of levels of available information were found to influence consistency of triage by statistically significant amounts (F 5·68; ≤0·01).

Conclusions. Strategies employed to optimize consistency of triage should focus on improving the quality of the simulations that are used. In particular, attention should be paid to the development of interactive simulations that will accommodate individual differences in information-seeking behaviour.

From transcriptome to biological function: environmental stress in an ectothermic vertebrate, the coral reef fish Pomacentrus moluccensis

Background
Our understanding of the importance of transcriptional regulation for biological function is continuously improving. We still know, however, comparatively little about how environmentally induced stress affects gene expression in vertebrates, and the consistency of transcriptional stress responses to different types of environmental stress. In this study, we used a multi-stressor approach to identify components of a common stress response as well as components unique to different types of environmental stress. We exposed individuals of the coral reef fish Pomacentrus moluccensis to hypoxic, hyposmotic, cold and heat shock and measured the responses of approximately 16,000 genes in liver. We also compared winter and summer responses to heat shock to examine the capacity for such responses to vary with acclimation to different ambient temperatures.
Results
We identified a series of gene functions that were involved in all stress responses examined here, suggesting some common effects of stress on biological function. These common responses were achieved by the regulation of largely independent sets of genes; the responses of individual genes varied greatly across different stress types. In response to heat exposure over five days, a total of 324 gene loci were differentially expressed. Many heat-responsive genes had functions associated with protein turnover, metabolism, and the response to oxidative stress. We were also able to identify groups of co-regulated genes, the genes within which shared similar functions.
Conclusion
This is the first environmental genomic study to measure gene regulation in response to different environmental stressors in a natural population of a warm-adapted ectothermic vertebrate. We have shown that different types of environmental stress induce expression changes in genes with similar gene functions, but that the responses of individual genes vary between stress types. The functions of heat-responsive genes suggest that prolonged heat exposure leads to oxidative stress and protein damage, a challenge of the immune system, and the re-allocation of energy sources. This study hence offers insight into the effects of environmental stress on biological function and sheds light on the expected sensitivity of coral reef fishes to elevated temperatures in the future.

Analytical modeling of interconnection networks in heterogeneous multi-cluster systems

In data-intensive distributed systems, replication is the most widely used approach to offer high data availability, low bandwidth consumption, increased fault-tolerance and improved scalability of the overall system. Replication-based systems implement replica control protocols that enforce a specified semantics of accessing the data. Also, the performance depends on a number of factors, the chief of which is the protocol used to maintain consistency among object replica. In this paper, we propose a new low-cost and high data availability protocol called the box-shaped grid structure for maintaining consistency of replicated data on networked distributed computing systems. We show that the proposed protocol provides high data availability, low communication costs, and increased fault-tolerance as compared to the baseline replica control protocols.

Passive angle measurement based localization consistency via geometric constraints

In this paper, we examine the geometric relations between various measured parameters and their corresponding errors in angle-measurement based emitter localization scenarios. We derive a geometric constraint formulating the relationship among the measurement errors in such a scenario. Using this constraint, we formulate the localization task as a constrained optimization problem that can be performed on the measurements in order to provide the optimal values such that the solution is consistent with the underlying geometry.

Indexing research: an approach to grounding ingarden's ontological framework

Attempts to produce an adequate and long-lived subject indexing system for information systems research have failed. In this paper we seek to address this by proposing an approach by which the terms expressed in research literature, such as those in the information systems literature, can be systematically and meaningfully categorised. The approach is significant in that it draws upon rigorous and philosophically compatible bodies of work in two areas. Firstly, we draw on work addressing the nature, existence, and categorisation of literary expression found in research papers (Roman Ingarden’s ontological analysis of the scientific work of art). Secondly, we draw from qualitative research methods addressing how meaningful categories can be analysed from text and related to each other (grounded theory). The resulting approach has the potential to be applied in many scientific disciplines beyond information systems, and to form the intellectual core of an information tool in e-research.

Personal-organizational values fit and organizational commitment in Australian domestic and international students

This study examines the relationship between affective organizational commitment and the personal and perceived organizational values of international and domestic students in an Australian university. Results provide support for the values factors found by Abbott, White & Charles, 2005), and consistency with Schwartz's (1992) pan-cultural values hierarchy. Both groups of students rated their personal values as consistent with the rankings of the major pan-cultural values and perceived organizational values were drivers of affective commitment. This study highlights the need for higher education institutions as well as global organizations to address profit for values such as benevolence, self-direction, and universalism to encourage higher levels of student and employee commitment to their organizations and increase effectiveness.

The design and implementation of an active replication scheme for distributing services in a cluster of workstations

Replication is the key to providing high availability, fault tolerance, and enhanced performance in a cluster of workstations (COWs). However, building such a system remains as a difficult and challenging task, mainly due to the difficulty of maintaining data consistency among replicas and the lack of easy and efficient tools supporting the development procedure. In this paper we propose an active replication scheme in which data consistency can be maintained. Based on the active replication scheme, we present an object-oriented design pattern and a constructing tool to simplify the design and implementation of service replications in COWs.

Temporal constraint satisfaction in matrix method

Constraint satisfaction is a challenging problem in Interval Algebra (IA). So there are many efforts to attack this problem. After building a matrix method to deal with temporal reasoning problems, we develop basic techniques for applying the matrix method to constraint satisfaction in this paper. Thus, the propagating rules and the algorithms of 3- and path-consistency are studied. If our matrix method is used, then the temporal constraint satisfaction problem can be transformed into a problem that can be effectively solved.

Validity of the assessment of quality of life (AQoL) utility instrument in patients with operable and inoperable lung cancer

There have been few longitudinal studies of quality of life in patients with all stages of lung cancer, particularly those that have included measures of utility. The purpose of this study was to examine the psychometric properties of the Assessment of Quality of Life instrument (AQoL) in patients with lung cancer. The AQoL is a health-related quality of life questionnaire and provides a descriptive system for a multi-attribute utility instrument (MAU), so that scores can be used in cost-utility evaluations. In the present study the reliability (internal consistency) of the AQoL was examined and the concurrent validity was assessed using the Medical Outcomes 36-item Short Form Health Survey (SF-36) as the comparator instrument. The sensitivity to different health states of the AQoL and the responsiveness to change over time was also examined. A prospective, non-experimental cohort study was undertaken. Ninety-two participants with all stages of lung cancer were recruited from a tertiary multi-disciplinary lung cancer clinic. Ninety participants had non-small cell lung cancer (NSCLC) and two had limited stage small cell lung cancer. The AQOL and SF-36 surveys were administered concurrently at baseline. In patients with NSCLC the surveys were then repeated 3 and 6 months later. Correlations between the baseline AQoL summary scales and SF-36 summary scales support the divergent and convergent validity of the AQoL. Reliability was also found to be sufficient (Cronbach's Alpha = 0.76). In addition, in patients with inoperable NSCLC, baseline AQoL scores were found to be predictive of survival at 6 months in Cox proportional hazards multivariate analysis. However, the physical components summary score of the SF-36 was more sensitive to differences in health states between patients with different stages of NSCLC at 6 months of follow-up and more responsive to change over time in both operable and inoperable patients with NSCLC than the AQoL. The findings support the construct validity and reliability of the AQoL in this population. However, there remains some uncertainty about whether the AQoL has sufficient sensitivity to different health states in this population. Further studies using other MAU instruments may determine whether alternative instruments are more sensitive to different health states in individuals with lung cancer.

Evaluation of the Chinese version of the disability of the arm, shoulder and hand (DASH-HKPWH): cross-cultural adaptation process, internal consistency and reliability study

Abstract
The Disability of the Arm, Shoulder and Hand (DASH) was translated into Chinese by a physiotherapy team of the Prince of Wales Hospital, Hong Kong (DASH-HKPWH).

Objectives
This study evaluated the cross-cultural adaptation process, face validity, internal consistency and reliability of the DASH-HKPWH.

Method
Language officers and medical professionals from different fields were invited to translate and evaluate the face validity of the DASH-HKPWH. 88 patients were recruited to complete two DASH questionnaires on two occasions 1-2 weeks apart.

Results
Some adjustments were made to the translations based on the cultural and linguistic practice in Hong Kong. The face validity was satisfactory with a mean endorsement score of 3.2. The difference between the mean of DASH scores was not significant (t = −0.35, p = 0.73). The ICC (1,1) and Cronbach's alpha for the 30-item Disability/Symptom of the DASH-HKPWH was 0.77 and 0.94, respectively.

Conclusion
The translation was valid and reliable and acceptably equivalent to the original version. The questionnaire is suitable for measuring changes experienced by patients with any upper extremity disorders.

Multivariate modelling of variability in sheet metal forming

The inherent variability in incoming material and process conditions in sheet metal forming makes quality control and the maintenance of consistency extremely difficult. A single FEM simulation is successful at predicting the formability for a given system, however lacks the ability to capture the variability in an actual production process due to the numerical deterministic nature. This paper investigates a probabilistic analytical model where the variation of five input parameters and their relationship to the sensitivity of springback in a stamping process is examined. A range of sheet tensions are investigated, simulating different operating windows in an attempt to highlight robust regions where the distribution of springback is small. A series of FEM simulations were also performed, to compare with the findings from the analytical model using AutoForm Sigma v4.04 and to validate the analytical model assumptions.

Results show that an increase in sheet tension not only decreases springback, but more importantly reduces the sensitivity of the process to variation. A relative sensitivity analysis has been performed where the most influential parameters and the changes in sensitivity at various sheet tensions have been investigated. Variation in the material parameters, yield stress and n-value were the most influential causes of springback variation, when compared to process input parameters such as friction, which had a small effect. The probabilistic model presented allows manufacturers to develop a more comprehensive assessment of the success of their forming processes by capturing the effects of inherent variation.

Message framing : keeping practitioners in the picture

Purpose – The purpose of this paper is to explore how message framing is commonly used by magazine advertisers.

Design/methodology/approach – Following the classification suggested by Levin et al., the frequency and nature of message framing in magazine advertising is explored using a content analysis of 2,864 advertisements in a sample of popular US magazines.

Findings – Results suggest a lack of consistency between marketing practice and academic findings. Contrary to academic recommendations, advertisers used positive framing in almost all advertising messages. Further, the use of attribute framing and combined attribute and goal framing was more popular than pure goal framing

Research limitations/implications – Although the findings are limited by a judgement sample of US magazines, they do suggest the need for academics to conduct more research on the effectiveness of combined attribute and goal framing techniques.

Practical implications – Of equal importance is the need for practitioners to explore the potentiality of negative framing in their advertising content.

Originality/value – Adopting the Levin et al.'s typology, this paper highlights the need for advertising researchers to engage with practitioners to try to understand current industry practice with regard to message framing. The inconsistencies revealed in this paper point to either an insufficient understanding of message framing by one or both parties or the need for better communication between the two.

The use of scoring rubrics to determine clinical performance in the operating suite

Summary : This research evolved out of the need to examine the validity and inter-rater reliability of a set of performance-based scoring rubrics designed to measure competencies within the operating suite.

Method : Both holistic and analytical rubrics were developed aligned to the ACORN Standard [Australian College of Operating Room Nurses Standard NR4, 2004. ACORN Competency Standards for Perioperative Nurses: Standard NR4: The Instrument Nurse in the Perioperative Environment. Australian College of Operating Room Nurses Ltd, Adelaide] and underpinned by the Dreyfus model (1981). Three video clips that captured varying performance of nurses performing as instrument nurses in the operating suite were recorded and used as prompts by expert raters, who judged the performance using the rubrics.

Results : The study found that the holistic rubrics led to more consistent judgments than the analytical rubrics, yet the latter provided more diagnostic information for intervention purposes. Despite less consistency, the Analytical Observation Form had sufficient construct validity to satisfy the requirements of criterion referencing as determined by the Item Separation Index (Rasch, 1960), including high internal consistency and greater inter-rater reliability when average ratings were used.

Conclusion : The study was an empirical investigation of the use of concomitant Analytical and Holistic Rubrics to determine various levels of performance in the operating suite including inter-rater reliability. The methodology chosen was theoretically sound and sufficiently flexible to be used to develop other competencies within the operating suite.

Evaluating quality of life in hip and knee replacement: psychometric properties of the World Health Organization Quality of Life short version instrument

Objective: To evaluate the psychometric properties of the World Health Organization Quality of Life short version instrument (WHOQOL-BREF), and to determine its responsiveness in assessing early outcome after total hip or knee replacement surgery.

Methods: At baseline (entry to an orthopedic waiting list), 279 participants completed the WHOQOL-BREF instrument, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Assessment of Quality of Life (AQOL) instrument, Kessler Psychological Distress (K10) scale, and the modified Health Assessment Questionnaire (MHAQ). A total of 74 patients completed reassessments 3 months after surgery.

Results: The WHOQOL-BREF demonstrated acceptable internal consistency for all domains (Cronbach's = 0.76-0.84) and moderate concurrent validity for the physical and psychological domains (r = 0.67 for physical versus AQOL; r = -0.71 for psychological versus K10). Minimal ceiling or floor effects were identified at baseline or 3 months, except for the social relationships domain. The disease-specific WOMAC subscales were most responsive to change (relative efficiency [RE] 0.66-1.00). Apart from social relationships, all WHOQOL-BREF scores improved significantly after surgery. The physical domain was more responsive than the AQOL (RE 0.50 versus 0.42) and was similar to the MHAQ (RE 0.55 for MHAQ). The responsiveness of the psychological domain was similar to that of the K10 scale (RE 0.11 versus 0.08).

Conclusion: The WHOQOL-BREF has good psychometric properties for use in persons with severe joint disease, and by providing complementary information, it offers clinicians and researchers an additional tool for comprehensively assessing quality of life in this patient group.