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.

Clinical data warehousing

Clinical Data Warehousing: A Business Analytic approach for managing health data

A virtual environment for medical radiation collaborative learning

Asoftware-based environment was developed to provide practical training in medical radiation principles and safety. The Virtual Radiation Laboratory application allowed students to conduct virtual experiments using simulated diagnostic and radiotherapy X-ray generators. The experiments were designed to teach students about the inverse square law, half value layer and radiation protection measures and utilised genuine clinical and experimental data. Evaluation of the application was conducted in order to ascertain the impact of the software on students’ understanding, satisfaction and collaborative learning skills and also to determine potential further improvements to the software and guidelines for its continued use. Feedback was gathered via an anonymous online survey consisting of a mixture of Likert-style questions and short answer open questions. Student feedback was highly positive with 80 % of students reporting increased understanding of radiation protection principles. Furthermore 72 % enjoyed using the software and 87 %of students felt that the project facilitated collaboration within small groups. The main themes arising in the qualitative feedback comments related to efficiency and effectiveness of teaching, safety of environment, collaboration and realism. Staff and students both report gains in efficiency and effectiveness associated with the virtual experiments. In addition students particularly value the visualisation of ‘‘invisible’’ physical principles and increased opportunity for experimentation and collaborative problembased learning. Similar ventures will benefit from adopting an approach that allows for individual experimentation while visualizing challenging concepts.

Lewis's medical-surgical nursing: Assessment and management of clinical problems [ANZ Edition, 4th Ed.]

"Using the nursing process as a framework for practice, the fourth edition has been extensively revised to reflect the rapid changing nature of nursing practice and the increasing focus on key nursing care priorities. Building on the strengths of the third Australian and New Zealand edition and incorporating relevant global nursing research and practice from the prominent US title Medical-Surgical Nursing, 9Th Edition, Lewis’s Medical-Surgical Nursing, 4th Edition is an essential resource for students seeking to understand the role of the professional nurse in the contemporary health environment."--Publisher website

Teaching scenario analysis – An action learning pedagogy

In this paper we provide an introduction to our teaching of scenario analysis. Scenario analysis offers an excellent instructional vehicle for investigating ‘wicked problems’; issues that are complex and ambiguous and require trans-disciplinary inquiry. We outline the pedagogical underpinning based on action learning and provide a critical approach from the intuitive logics school of scenario analysis. We use this in our programme in which student groups engage in semi-structured, but divergent and inclusive analysis of a selected focal issue. They then develop a set of scenario storylines that outline the limits of possibility and plausibility for a selected time-horizon year. The scenarios are portrayed not as narratives, but as vehicles for exploration of the causes and outcomes of the interplay between forces in the contextual environment that drive the unfolding future in the context of the focal issue. In this way, we provide internally-generated challenges to both individual pre-conceptions and group-level thinking.

A blended learning approach to the teaching of professional practice in architecture

This paper reports on a number of blended learning activities conducted in two subjects of a Master of Architecture degree at a major Australian university. The subjects were related to “professional practice” and as such represent a little researched area of architectural curriculum. The research provides some insight into the student perceptions of learning opportunity and engagement associated with on-line delivery modes. Students from these two subjects were surveyed for their perceptions about the opportunity for learning afforded by the on-line components, and also for their perceived level of engagement. Responses to these perceptions of traditional and on-line modes of delivery are compared and analysed for significant differences. While students were generally positive in response to the learning experiences, analysis of the results shows that students found the traditional modes to assist in their learning significantly more than on-line modes. Students were neutral regarding the opportunity for engagement that on-line modes provided. Analysis of the students’ gender, age and hours of paid work was also conducted to ascertain any relationship with attitudes to the flexibility of on-line delivery; no significant relationship was detected. This study has shown that students were generally resistant to on-line engagement opportunities and their ability to support learning.

Weight-related risk perception among healthy and overweight pregnant women: A cross-sectional study

Objective The objective of this study was to evaluate weight-related risk perception in early pregnancy and to compare this perception between women commencing pregnancy healthy weight and overweight. Study design Pregnant women (n=664) aged 29±5 (mean±s.d.) years were recruited from a metropolitan teaching hospital in Australia. A self-administered questionnaire was completed at around 16 weeks of gestation. Height measured at baseline and self-reported pre-pregnancy weight were used to calculate body mass index. Cross-sectional analysis was conducted. Differences between groups were assessed using chi-squared tests for categorical variables and t-tests or Mann–Whitney U tests for continuous variables depending on distribution. Result Excess gestational weight gain (GWG) during pregnancy was more important in leading to health problems for women or their child compared with pre-pregnancy weight. Personal risk perception for complications was low for all women, although overweight women had slightly higher scores than healthy-weight women (2.4±1.0 vs 2.9±1.0; P<0.001). All women perceived their risk for complications to be below that of an average pregnant woman. Conclusion Women should be informed of the risk associated with their pre-pregnancy weight (in the case of maternal overweight) and excess GWG. If efforts to raise risk awareness are to result in preventative action, this information needs to be accompanied by advice and appropriate support on how to reduce risk.

Investigating teachers' concerns and experiences in teaching children with special educational needs in Bhutan

This study investigated Bhutanese teachers' concerns and experiences in teaching children with Special Educational Needs in both inclusive and special schools. A mixed method design, combining quantitative and qualitative methods was used to answer the research questions. The aim of collecting quantitative data was to identify the key concerns. The aim of collecting qualitative data was to find out how teachers were experiencing including students with SEN in the classrooms. In doing so, three major issues were highlighted from this study: lack of classroom and human resources, lack of policy and lack of professional development for teachers.

Medical education and law: Withholding/withdrawing treatment from adults without capacity

BACKGROUND Law is increasingly involved in clinical practice, particularly at the end of life, but undergraduate and postgraduate education in this area remains unsystematic. We hypothesised that attitudes to and knowledge of the law governing withholding/withdrawing treatment from adults without capacity (the WWLST law) would vary and demonstrate deficiencies among medical specialists. AIMS We investigated perspectives, knowledge and training of medical specialists in the three largest (populations and medical workforces) Australian states, concerning the WWLST law. METHODS Following expert legal review, specialist focus groups, pre-testing and piloting in each state, seven specialties involved with end-of-life care were surveyed, with a variety of statistical analyses applied to the responses. RESULTS Respondents supported the need to know and follow the law. There were mixed views about its helpfulness in medical decision-making. Over half the respondents conceded poor knowledge of the law; this was mirrored by critical gaps in knowledge that varied by specialty. There were relatively low but increasing rates of education from the undergraduate to continuing professional development (CPD) stages. Mean knowledge score did not vary significantly according to undergraduate or immediate postgraduate training, but CPD training, particularly if recent, resulted in greater knowledge. Case-based workshops were the preferred CPD instruction method. CONCLUSIONS Teaching of current and evolving law should be strengthened across all stages of medical education. This should improve understanding of the role of law, ameliorate ambivalence towards the law, and contribute to more informed deliberation about end-of-life issues with patients and families.

Randomized clinical trial of the timing it right stroke family support program: Research protocol

Background Family caregivers provide invaluable support to stroke survivors during their recovery, rehabilitation, and community re-integration. Unfortunately, it is not standard clinical practice to prepare and support caregivers in this role and, as a result, many experience stress and poor health that can compromise stroke survivor recovery and threaten the sustainability of keeping the stroke survivor at home. We developed the Timing it Right Stroke Family Support Program (TIRSFSP) to guide the timing of delivering specific types of education and support to meet caregivers' evolving needs. The objective of this multi-site randomized controlled trial is to determine if delivering the TIRSFSP across the stroke care continuum improves caregivers' sense of being supported and emotional well-being. Methods/design Our multi-site single-blinded randomized controlled trial will recruit 300 family caregivers of stroke survivors from urban and rural acute care hospitals. After completing a baseline assessment, participants will be randomly allocated to one of three groups: 1) TIRSFSP guided by a stroke support person (health care professional with stroke care experience), delivered in-person during acute care and by telephone for approximately the first six to 12 months post-stroke; 2) caregiver self-directed TIRSFSP with an initial introduction to the program by a stroke support person, or; 3) standard care receiving the educational resource "Let's Talk about Stroke" prepared by the Heart and Stroke Foundation. Participants will complete three follow-up quantitative assessments 3, 6, and 12-months post-stroke. These include assessments of depression, social support, psychological well-being, stroke knowledge, mastery (sense of control over life), caregiving assistance provided, caregiving impact on everyday life, and indicators of stroke severity and disability. Qualitative methods will also be used to obtain information about caregivers' experiences with the education and support received and the impact on caregivers' perception of being supported and emotional well-being. Discussion This research will determine if the TIRSFSP benefits family caregivers by improving their perception of being supported and emotional well-being. If proven effective, it could be recommended as a model of stroke family education and support that meets the Canadian Stroke Best Practice Guideline recommendation for providing timely education and support to families through transitions.

Socially critical pedagogy and the 'production of skilled performers': Further considerations of teaching and learning in physical education

The growing call for physical educators to move beyond the bounds of performance has been a powerful discourse. However, it is a discourse that has tended to be heavy on theory but light on practical application. This paper discusses recent work in the area of skill acquisition and what this might mean for pedagogical practices in physical education. The acquisition of motor skill has traditionally been a core objective for physical educators, and there has been a perception that child-centred pedagogies have failed in the achievement of this traditional yardstick. However, drawing from the work of Rovegno and Kirk (1995) and Langley (1995; 1997), and making links with current work in the motor learning area, it is possible to show that skill acquisition is not necessarily compromised by child-centred pedagogy. Indeed, working beyond Mosston's discovery threshold and using models such as Games for Understanding, can provide deeper skill-learning experiences as well as being socially just.

The YOU CALL-WE CALL randomized clinical trial: Impact of a multimodal support intervention after a mild stroke

Background Comparison of a multimodal intervention WE CALL (study initiated phone support/information provision) versus a passive intervention YOU CALL (participant can contact a resource person) in individuals with first mild stroke. Methods and Results This study is a single-blinded randomized clinical trial. Primary outcome includes unplanned use of health services (participant diaries) for adverse events and quality of life (Euroquol-5D, Quality of Life Index). Secondary outcomes include planned use of health services (diaries), mood (Beck Depression Inventory II), and participation (Assessment of Life Habits [LIFE-H]). Blind assessments were done at baseline, 6, and 12 months. A mixed model approach for statistical analysis on an intention-to-treat basis was used where the group factor was intervention type and occasion factor time, with a significance level of 0.01. We enrolled 186 patients (WE=92; YOU=94) with a mean age of 62.5±12.5 years, and 42.5% were women. No significant differences were seen between groups at 6 months for any outcomes with both groups improving from baseline on all measures (effect sizes ranged from 0.25 to 0.7). The only significant change for both groups from 6 months to 1 year (n=139) was in the social domains of the LIFE-H (increment in score, 0.4/9±1.3 [95% confidence interval, 0.1–0.7]; effect size, 0.3). Qualitatively, the WE CALL intervention was perceived as reassuring, increased insight, and problem solving while decreasing anxiety. Only 6 of 94 (6.4%) YOU CALL participants availed themselves of the intervention. Conclusions Although the 2 groups improved equally over time, WE CALL intervention was perceived as helpful, whereas YOU CALL intervention was not used.

Effective clinical decision-making from practice-based evidence

This is an ongoing research investigating the use of health information technologies (HIT) to improve clinical decision-making processes. Effective and timely clinical decision-making can lead to positive improvements in patient’s health outcome...

A summary of the 'Engineering Education for Sustainable Development:Toolkit of Information & Teaching Material'

This paper reflects on the critical need for an urgent transformation of higher education curriculum globally, to equip society with professionals who can address our 21st Century sustainable living challenges. Specifically it discusses a toolkit called the ‘Engineering Sustainable Solutions Program’, which is a freely available, rigorously reviewed and robust content resource for higher education institutions to access content on innovations and opportunities in the process of evolving the curriculum...

External knowledge and query strategies in active learning: A study in clinical information extraction

This paper presents a new active learning query strategy for information extraction, called Domain Knowledge Informativeness (DKI). Active learning is often used to reduce the amount of annotation effort required to obtain training data for machine learning algorithms. A key component of an active learning approach is the query strategy, which is used to iteratively select samples for annotation. Knowledge resources have been used in information extraction as a means to derive additional features for sample representation. DKI is, however, the first query strategy that exploits such resources to inform sample selection. To evaluate the merits of DKI, in particular with respect to the reduction in annotation effort that the new query strategy allows to achieve, we conduct a comprehensive empirical comparison of active learning query strategies for information extraction within the clinical domain. The clinical domain was chosen for this work because of the availability of extensive structured knowledge resources which have often been exploited for feature generation. In addition, the clinical domain offers a compelling use case for active learning because of the necessary high costs and hurdles associated with obtaining annotations in this domain. Our experimental findings demonstrated that 1) amongst existing query strategies, the ones based on the classification model’s confidence are a better choice for clinical data as they perform equally well with a much lighter computational load, and 2) significant reductions in annotation effort are achievable by exploiting knowledge resources within active learning query strategies, with up to 14% less tokens and concepts to manually annotate than with state-of-the-art query strategies.