bluuebunny/crossref_metadata_2025 huggingface dataset:
Modal analysis of different drivetrain configurations in electric vehicles
Authors: Tuononen Ari J , Lajunen Antti
Published: March 2016

This paper presents a modal analysis of different drivetrain configurations in electric vehicles; 1) an in – wheel motor, 2) direct drive, and 3) an electric motor with a reduction gear and a differential gear. A specific simulation model was developed to analyze the vibrations while taking into account the traction motor, possible mechanical reduction gears, and the driveshaft, as well as a Rigid Ring Model (RRM) to describe the tire. On the basis of the simulation results, the frequency responses were calculated for each drivetrain configuration and also for a non-drive, free-rolling tire. The analyzed results show interesting differences between the different drivetrain configurations. However, most of the negative aspects can be compensated for if identified in the early design phase. For instance, the frequency response of the in-wheel motor configuration indicated that the vibrations that occur might cause negative effects in terms of driving comfort and wheel speed signal noise. The direct drive configuration has an additional mode at 24 Hz, and the differential configuration at 4 Hz. It is possible that these modes would resonate strongly if some drivetrain design parameters were poorly defined.
Cubic B-spline collocation method and its application for anomalous fractional diffusion equations in transport dynamic systems
Authors: Sayevand K , Yazdani A , Arjang F
Published: March 2016

In this paper, we approximate the solution of the initial and boundary value problems of anomalous second- and fourth-order sub-diffusion equations of fractional order. The fractional derivative is used in the Caputo sense. To solve these equations, we will use a numerical method based on B-spline basis functions and the collocation method. It will be shown that the proposed scheme is unconditionally stable and convergent. Three numerical examples are adopted to demonstrate the performance of the proposed scheme.
A new reliability based optimization of tuned mass damper parameters using energy approach
Authors: Mrabet Elyes , Guedri Mohamed , Ichchou Mohamed Najib , Ghanmi Samir , Soula Mohamed
Published: March 2016

In this work a reliability based optimization (RBO) strategy of Tuned Mass Damper (TMD) parameters is presented. The strategy is based on an energetic approach. The strategy consists to optimize the TMD parameters so that we minimize the failure probability (objective function) characterized by the exceedence of the power dissipated in the primary structure of a certain threshold value during some interval time. The evaluation of the objective function is carried out using the classical Rice’s formula. The strategy is, firstly, applied to linear single-degree of freedom (SDOF) system, subjected to seismic motion, and then extended to linear multi-degree of freedom (MDOF) system. The use of the Rice’s formula requires the knowledge of the joint probability density function (PDF) of the considered processes; to this end, exact expression of the joint PDF is presented for the SDOF system and an approximation is presented for the evaluation of the failure probabilities for the MDOF system. By making use of the obtained joint PDF, for the SDOF system, as the a priori joint PDF, the approximation of the joint PDF, for the MDOF system, has been performed using the Minimum cross-entropy method (MinxEnt).

To highlight the good effectiveness of the proposed strategy, a ten-story shear building, subjected to different earthquakes, is considered. The obtained results are compared with other from literature, and it has been shown the superiority of the proposed strategy.
Multivariable control of active vibration compensation modules of a portal milling machine
Authors: Brecher Christian , Fey Marcel , Brockmann Birk , Chavan Prateek
Published: March 2016

The Z-ram of a Portal Milling machine presents a weak point in the dynamic behaviour of the machine tool which makes it prone to the occurrence of chatter vibration. Since chatter vibrations directly limit the maximum allowable cutting depth during machining, an improvement in dynamic behaviour of the machine tools by means of active vibration control of the spindle will result in an increase of maximum cutting depth. An active vibration control of the Tool Center Point of a Portal Milling machine using four hydraulic compensation modules integrated in the Z-ram structure is proposed. A test bench for the Z-ram was constructed at Machine Tools Laboratory (WZL) of RWTH Aachen University and it’s modal analysis revealed the occurring dominant vibration mode. A polyreference-LSCF modal parameter estimation was employed for identification of the measured MIMO Frequency Response Functions (FRF) of the Z-ram test bench. Using this mathematical model, the MIMO controller was synthesized with the Glover-McFarlane [Formula: see text] Loop Shaping Design procedure. The implementation of the controller on the test bench resulted in significant improvement in the compliance behaviour of the Z-ram structure. The dynamic compliance at dominant mode of vibration at 75 Hz was reduced by a factor of 3.5. Furthermore, the attenuation of the maximum negative real part resulted in a direct increase in maximum stable depth of cut by a factor of 2.1.
Repression of Biotin-Related Proteins by Benzo[a]Pyrene-Induced Epigenetic Modifications in Human Bronchial Epithelial Cells
Authors: Xia Bo , Yang Lin-Qing , Huang Hai-Yan , Pang Li , Yang Xi-Fei , Yi You-Jin , Ren Xiao-Hu , Li Jie , Zhuang Zhi-Xiong , Liu Jian-Jun
Published: March 2016

Benzo[a]pyrene (B[a]P) exposure has been associated with the alteration in epigenetic marks that are involved in cancer development. Biotinidase (BTD) and holocarboxylase synthetase (HCS) are 2 major enzymes involved in maintaining the homeostasis of biotinylation, and the deregulation of this pathway has been associated with a number of cancers. However, the link between B[a]P exposure and the dysregulation of BTD/HCS in B[a]P-associated tumorigenesis is unknown. Here we showed that the expression of both BTD and HCS was significantly decreased upon B[a]P treatment in human bronchial epithelial (16HBE) cells. Benzo[a]pyrene exposure led to the global loss of DNA methylation by immunofluorescence, which coincided with the reduction in acetylation levels on histones H3 and H4 in 16HBE cells. Consistent with decreased histone acetylation, histone deacetylases (HDACs) HDAC2 and HDAC3 were significantly upregulated in a dosage-dependent manner. When DNA methylation or HDAC activity was inhibited, we found that the reduction in BTD and HCS was separately regulated through distinct epigenetic mechanisms. Together, our results suggested the potential link between B[a]P toxicity and deregulation of biotin homeostasis pathway in B[a]P-associated cancer development.
Computed tomography, radiology and echocardiography in cats naturally infected with Aelurostrongylus abstrusus
Authors: Lacava Giuseppe , Zini Eric , Marchesotti Federica , Domenech Oriol , Romano Francesca , Manzocchi Simone , Venco Luigi , Auriemma Edoardo
Published: March 2016

Objectives

The aims of the study were to describe the radiographic and computed tomographic features in cats naturally infected with Aelurostrongylus abstrusus, and to identify signs of pulmonary hypertension with echocardiography.

Methods

Fourteen cats positive on Baermann test for A abstrusus were included in the study. All cats underwent thoracic radiography, CT and echocardiography.

Results

The most common clinical signs were coughing (10/14) and dyspnoea (5/14). Radiographic findings included a generalised unstructured interstitial pulmonary pattern (8/14), mixed bronchointerstitioalveolar pattern (3/14) and bronchointerstitial pattern with bronchial wall thickening (3/14). Sternal lymphadenopathy was detected on thoracic radiographs in six cats. On CT, features were mixed bronchointerstitioalveolar pattern with ground-glass appearance in six cats, interstitioalveolar with multiple pulmonary nodules in five, interstitial ground-glass infiltrates in three, regional lymph node enlargement in 11 (10 sternal, three cranial mediastinal and three tracheobronchial lymph nodes) and subpleural thickening in four. None of the thoracic radiographs revealed subpleural thickening. In all cases, pulmonary vessels were normal in terms of size, shape and attenuation on both radiography and CT. Pulmonary hypertension and cardiac abnormalities were not observed in any cat during echocardiography.

Conclusions and relevance

CT provided a more thorough characterisation of pulmonary and mediastinal lesions compared with thoracic radiographs in cats naturally infected with A abstrusus. Although feline aelurostrongylosis has been previously associated with histopathological lesions in lung arteries, in this cohort clinical evidence of pulmonary hypertension was not documented.
‘It might hurt, but still it’s good’: People with rheumatoid arthritis beliefs and expectations about physical activity interventions
Authors: Larkin Louise , Kennedy Norelee , Fraser Alexander , Gallagher Stephen
Published: March 2016

Many people who have rheumatoid arthritis report low levels of physical activity. We conducted 17 interviews with people who have rheumatoid arthritis to gain insight into how they view physical activity and to explore how their levels of activity may be increased. Interviews were transcribed verbatim and analysed using thematic analysis. Four main themes were generated: being active, barriers and facilitators, information and advice, and supporting physical activity. A lack of information about being active fostered negative emotions limiting physical activity participation. Improved provision of physical activity advice is warranted to promote physical activity in people who have rheumatoid arthritis.
Thick photography
Authors: Deger Jennifer
Published: March 2016

Across remote Aboriginal Australia, phone and tablet photographic technologies are giving rise to vibrant new forms of visual culture. Greenscreen software, montage and .gif effects enable the creation of layered images that literally pulse with meaning and affect. Akin to bark painting – yet deliberately different – such images reveal the spectral depth of Yolngu worlds. At a time when families across Arnhem Land face relentless loss and social stress, the making, sharing and viewing of elaborated family photographs reaffirm, reconstitute, and thicken a world of vitality, resonance and ancestral significance. Through deliberately posed and often highly postproduced photography Yolngu can creatively participate in a profoundly synaesthetic and sentient world, a world enlivened by uncanny encounter, a world that requires the ongoing affirmation and renewal of relationships through imagistic practice. This is a world of sensuous force and inside meanings, a world that far exceeds the registers of what the eye can see, the camera can capture, or, indeed, what the anthropologist will ever know.
Optimum range of slenderness ratio of hollow steel square braces for special concentrically braced frames
Authors: Kumar P C Ashwin , Sahoo Dipti R
Published: March 2016

Past studies have shown that the slenderness ratio and the width-to-thickness ratio of braces are primarily responsible for achieving the desired cyclic response of special concentrically braced frames. An increase in brace slenderness ratio results in a reduction in its energy dissipation capacity along with a simultaneous increase in the ductility nearing its fracture. Since both energy dissipation capacity and ductility of braces are essential parameters in quantifying the seismic performance of special concentric braced frames, there is a need of establishing the optimum range of brace slenderness ratio and width-to-thickness ratio. Hence, an extensive finite element parametric study has been conducted on a wide range of values of these parameters on braces of hollow steel square section using a commercial software ABAQUS. The finite element models account for the inelastic hysteretic characteristics and the fracture behavior of braces. The results of simulation models matched very well with the past experimental results with respect to the performance points, namely, global buckling, local buckling, fracture initiation, complete fracture, and ductility. Finally, a relationship between the lower limit of slenderness ratio and the width-to-thickness of square braces has been established based on the simulation results.
Classed attitudes and social reform in cross-national perspective: a quantitative analysis using four waves from the International Social Survey Programme (ISSP)
Authors: Deeming Christopher
Published: March 2016

This article attempts to forge new links between social attitudes and social policy change in Australia. Drawing on four survey waves of international social survey data and using multivariable regression analysis, this article sheds new light on the determinants of Australian attitudes towards the welfare state in a comparative perspective. It examines their variations across time and social groupings and then compares Australian welfare attitudes with those found in other leading western economies. While there is popular support for government actions to protect Australian citizens in old age and sickness, views about social protection and labour market policy for the working-age population are divided. The comparative analysis and the focus on class-attitude linkages allows for further critical reflection on the nature of social relations and recent social reforms enacted by the Liberal-National coalition government.
Social networks and perceptions of intergenerational difference among migrant youth in Australia
Authors: Mansouri Fethi , Johns Amelia
Published: March 2016

‘Intergenerational difference’ has become a lens through which to view issues of identity, social connectedness, belonging and agency in migrant youth research, highlighting that differences in the aspirations of migrant youth and their parents shape young people’s experiences. The article will present findings from a mixed methods study of social network participation among three migrant youth cohorts in two Australian cities to address a perceived ‘gap’ among migrant youth and parents’ aspirations for social network formation and participation. The paper will first examine current theoretical approaches to intergenerational challenges in migrant youth research. It will then introduce ‘intersectionality’ as a concept offering a more nuanced understanding of the challenges and hopes of migrant youth for whom social networks can be a gateway towards belonging and connectedness. This, however, requires a negotiation of complex structural, social and cultural factors.
A meta-analysis of factors predicting cyberbullying perpetration and victimization: From the social cognitive and media effects approach
Authors: Chen Liang , Ho Shirley S , Lwin May O
Published: March 2016

Cyberbullying has become a critical social issue, which severely threatens children and adolescents’ physical and psychological health. The current research systematically examined the predictors of cyberbullying from the social cognitive and media effects approach. Specifically, this study identified 16 predictors of cyberbullying perpetration and victimization and examined the magnitude of the effects of these predictors by meta-analyzing 81 empirical studies, which represented a total sample of 99,741 participants and yielded 259 independent correlations. The results revealed that risky information and communications technology (ICT) use, moral disengagement, depression, social norms, and traditional bullying perpetration were the main predictors of cyberbullying perpetration, while risky ICT use and traditional bullying victimization were the major contributors of cyberbullying victimization. According to the moderator analyses, country of the sample, sampling method, age, and media platform were significant moderators of the relationships between some specific predictors and cyberbullying perpetration and victimization. Implications for future cyberbullying research were discussed.
Tourism and protected areas: Comparing the 2003 and 2014 IUCN World Parks Congress
Authors: Spenceley Anna
Published: March 2016

The International Union for the Conservation of Nature World Parks Congress is held once a decade, and brings together thousands of the world’s experts on protected areas. In 2014, the Sydney World Parks Congress and the parallel event, Global Eco, provided a platform for 125 presentations relating to tourism and visitation. This paper presents a synthesis of the body of work shared at Sydney, including some of the cutting-edge issues, best practices, and inspiring initiatives relating to sustainable tourism. In particular, it compares issues that were highlighted at the 2003 World Parks Congress, and how they have evolved and progressed over the past decade. The paper highlights the role of different stakeholders from different corners of the world in promoting sustainable tourism practices. It also considers the relevance of tourism to the themes of the World Parks Congress, and how the sector is reflected within the official records of the 2003 and 2014 World Parks Congress. Looking forward to the next 10 years, the paper reflects on specific challenges, gaps in knowledge, and areas for further research and outreach.
Estimating tourism’s contribution to conservation area financing in Mozambique
Authors: Rylance Andrew
Published: March 2016

Financial sustainability of conservation areas is one of the cornerstones for enabling effective conservation management. However, the current status of conservation area funding is widely detached from the need, and this disparity is intensified in developing countries. Therefore, identifying and valuing the revenue streams and finance needs of conservation areas is an important step in the process to become financial sustainable. This paper assesses the revenue potential of conservation areas in Mozambique national parks and reserves. The analysis describes the revenue generation of 93 conservation areas in Mozambique in 2013 to (i) the economy, (ii) the Government of Mozambique and conservation area management authorities, as well as (iii) respective communities bordering conservation areas. The analysis determined that the total annual revenue generation within the conservation area network was USD 24.4 million in 2013 from tourism-linked activities. The component of total revenue that accrued to either national Government of Mozambique or conservation area management was USD 3.33 million in 2013, and USD 606,500 of this accrued to communities surrounding conservation areas. The research has demonstrated that revenue generation of the conservation area network contributes approximately 10% to the tourism sector’s total contribution to the economy of Mozambique. In addition, this research highlights the difficulties of revenue generation from conservation areas in least developed countries and the effects of a lack of data on justifying the value of a conservation area network from an economic perspective.
Can a wildlife tourism company influence conservation and the development of tourism in a specific destination?
Authors: Spenceley Anna , Snyman Susan
Published: March 2016

The evolution of tourism destinations is influenced by a range of factors including the policy and planning framework, the role of destination management organisations, and integration of tourism into the local and national economy. The aim of this paper is to describe how the private sector can influence destination development, by considering a luxury safari lodge (Mombo Camp) and its holding company (Okavango Wilderness Safaris) within the Okavango Delta of Botswana. Through a series of stakeholder interviews and literature review, the research found that Mombo had influenced the destination’s quality standards, how it is marketed and promoted, and also in the conservation of endangered species. Over the course of 30 years, the holding company has also been influential in the development and implementation of tourism and conservation policy, environmental awareness among youth, and also conservation research. The findings of this study suggest that destination planning authorities should encourage reputable private sector operators that have a long-term interest in the destination and promote sustainable tourism practices, including those that can mobilise a network of facilities and attractions, can collaborate with their competitors, and can support and advise government on policy and its implementation.
Innovativeness, market intelligence practices, and firm performance of small- and medium-sized tour operators
Authors: Yap Ching Seng , Cheng Boon Liat , Mohamad Hussain Nurhuzira , Ahmad Rizal
Published: March 2016

The study examines the effect of market intelligence practices on firm performance in the small- and medium-sized tour operators in Malaysia. Specifically, a conceptual model is developed which hypothesizes that firm innovativeness relates positively to market intelligence acquisition and market intelligence utilization which, in turn, affects firm performance. A self-administered questionnaire survey is used to garner responses from a sample of 81 tour operators. The findings indicate that firm performance is positively related to market intelligence practices both in terms of market intelligence acquisition and market intelligence utilization. In addition, it also shows that the relationship between firm innovativeness and market intelligence acquisition is stronger than the relationship between firm innovativeness and market intelligence utilization. These findings may imply that even though market intelligence practices are more prevalent among larger firms, small- and medium-sized tour operators may also benefit from having formal information processing systems and in particular in terms of acquiring and utilizing information. The limitations of the study and recommendations for future research are also discussed.
Why literature students should practise life writing
Authors: Cardell Kylie , Douglas Kate
Published: March 2016

This article considers our experiences teaching a hybrid literature/creative writing subject called “Life Writing.” We consider the value of literature students engaging in creative writing practice—in this instance, the nonfiction subgenre of life writing—as part of their critical literary studies. We argue that in practicing life writing, our literature students are exposed to and gain wider perspective on the practical, critical, creative, and ethical issues that arise from working with literary texts. Such an approach is not with risk. As we discuss in this article, life writing texts can often narrate difficult or traumatic material. However, we want to show how life writing, with its particular focus on actual lives and lived experience, creates a particularly conducive ethical, intellectual, and creative space for learning about and practicing writing.
Comparison of two- and six-minute walk tests in detecting oxygen desaturation in patients with severe chronic obstructive pulmonary disease — A randomized crossover trial
Authors: Gloeckl Rainer , Teschler Sebastian , Jarosch Inga , Christle Jeffrey W , Hitzl Wolfgang , Kenn Klaus
Published: March 2016

The two-minute walk test (2MWT) is less well validated than the well-known six-minute walk test (6MWT) as a field walking test in patients with chronic obstructive pulmonary disease (COPD). The primary objective of this study was to compare the accuracy of the 2MWT to the 6MWT in detecting exercise-induced oxygen desaturation in patients with severe COPD. Twenty-six patients with COPD (age: 61 ± 10 years, forced expired volume in one second: 37 ± 10%) that were normoxemic at rest performed a 2MWT and a 6MWT under normal ambient conditions on two consecutive days in random order. Oxygen saturation, total walking distance, heart rate, breathing frequency, dyspnea, and leg fatigue were evaluated. Average walking distances were 150 m (95% confidence interval (95% CI): 134–165 m) and 397 m (95% CI: 347–447 m) for the 2MWT and 6MWT, respectively ( r = 0.80, p < 0.0001). The difference in minimum oxygen saturation during the 2MWT (83%, 95% CI: 81–86%) and 6MWT (mean 82%, 95% CI: 80–84%) was not statistically different and the data strongly correlated between the groups ( r = 0.81, p < 0.0001). Other measurements from the 6MWT, including heart rate, breathing rate, and levels of perceived exertion were also comparable in 2MWT. The 2MWT showed comparable validity in detecting exercise-induced oxygen desaturation in patients with severe COPD compared to the 6MWT.
Buzz Agents in a Teen-Driven Social Marketing Campaign
Authors: Struthers Amy , Wang Ming
Published: March 2016

A research team in Nebraska developed a public health campaign for teens focused on obesity prevention, based on social marketing and buzz marketing principles, to test a series of hypotheses postulating that positive attitude toward the campaign among the most engaged members of the target audience, the buzz agents, will lead to positive attitudinal as well as positive self-reported behavioral changes involving fruit and vegetable consumption and physical activity. The team implemented the Whatcha doin? social marketing campaign in a select number of public high schools in Nebraska from 2007 to 2013. Results from 6 years of annual survey data of buzz agents in these schools showed positive associations between attitude toward the campaign and changes in health attitudes and behavior.
Privacy Officer: A Role for Health Information Managers
Authors: Ritchie Julie
Published: March 2016

Health information managers (HIMs) are experts in the protection and management of health information within patient records and information systems. New privacy legislation in Australia has raised the importance of this protection and a new role of Privacy Officer is evolving. HIMs are well positioned to take on this role and its associated responsibilities. Here, a Privacy Officer from Victoria provides an insight into the position and its opportunities.
The Development of CCAM: The New French Coding System of Clinical Procedures
Authors: Trombert-Paviot Beatrice , Rector Alan , Baud Robert , Zanstra Pieter , Martin Caroline , van der Haring Egbert , Clavel Lucienne , Rodrigues Jean Marie
Published: March 2016

A new French coding system of clinical procedures, the Classification Commune Des Actes Medicaux (CCAM), has been developed at the turn of the millennium (between 1996 and 2001). Two methodologies were used: a traditional domain-experts consensus method, and an artificial-intelligence-based semantic representation. An economic evaluation of clinical procedures was also undertaken for the rating for fee-for-service payment. We present the methodologies used and stress how the European Union research project, ‘European Consortium, Generalised Architecture for Languages, Encyclopaedias and Nomenclatures in Medicine’ (GALEN), facilitated the sharing and maintaining of consistent medical knowledge. This country case study highlights the significant cost to individual countries in developing their own classifications in isolation. It also demonstrates the benefits of contributing to international efforts such as GALEN that enable harmonisation, yet still allow for diversity.
Matching GP Terms to the ICD-10-AM Index
Authors: Scott Peter R
Published: March 2016

This article describes some preliminary work done by the National Centre for Classification in Health (NCCH) in response to the recommendations of the General Practice Coding Jury. Terms derived from two Australian general practices, two coordinated care trials and the General Practice Coding Jury were matched to the index of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM) to gauge the content coverage provided by the existing index. Results showed the percentage of good general practice (GP) term/ICD-10-AM Index term matches was 58%. The percentage of acceptable concept matches was 88%. It is concluded that this work provides a useful methodology, and that the ICD-10-AM index may support a level of concept matches, while it will require augmentation to support term matching.
Snomed® CT: The Fit with Classification in Health
Authors: Aschman Diane J
Published: March 2016

Classification systems are the primary means for automated retrieval and analysis of healthcare data from individual patient medical records. This article will provide a brief history and overview of the two most comprehensive and advanced controlled clinical terminologies in the world: the Systematized Nomenclature of Medicine Reference Terminology (SNOMED® RT), and Clinical Terms Version 3 (CTV3). A discussion will follow of the merger of these two terminologies into a single new work, SNOMED® Clinical Terms (SNOMED® CT), as released in early 2002, how it is used to retrieve data, how it differs from a classification, and the opportunities open to health information management professionals to expand their roles as information managers through their knowledge of SNOMED CT.
Nursing Classification and Terminology Systems
Authors: Hovenga Evelyn J S
Published: March 2016

A number of terminologies exist that represent concepts of relevance to nurses, although none of these is in use by Australian nurses. Without consensus, nursing language and definitions incorporated in clinical information systems now being implemented will continue to vary considerably. The result will be an inability to compare nursing practice, or to aggregate data for research purposes, or to collect national statistical data to demonstrate the significance of nurses' contributions to health care. This article provides an international historical overview of nursing terminology developments relative to what is happening in Australia, brief reviews of the many available nursing terminologies, an update of this work relative to activities being undertaken towards the development and adoption of standards, and a discussion about desirable future research and development activities.
Accreditation in Primary Health: RACGP Standards for General Practice
Authors: Hili Halina
Published: March 2016

General Practitioners play a crucial role as “gate-keepers” to the health system. In this context, they have a profound influence on both health outcomes and health expenditure. Since the introduction in 1999 of a formal, peer-driven external accreditation process, over 4,590 Australian general practices have achieved full accreditation. The process of re-ccreditation has commenced, subsequent to a review of the original standards, and with an ongoing focus on continuous quality improvement.

This article describes a typical accreditation survey visit, and explains the accreditation criteria and how they are reviewed by the surveyors. There is discussion also of the impact of this new accreditation system on general practice.
Getting it Right: Meeting the Aged Care Accreditation Standards
Authors: Goddard-Jones Marise , Gevers Leslie
Published: March 2016

The aged care industry in Australia has been faced with many challenges over the last five years, including the introduction of the Aged Care Act 1997 and the Aged Care Accreditation Standards. The purpose of the introduction of the accreditation process was to ensure that residential aged care services were complying with the Accreditation Standards and making a commitment to continuously improve their standard of care and services (Aged Care Standards and Accreditation Agency, 2000). This article describes how one service has implemented a management system approach to ensure compliance with the Aged Care Accreditation Standards.
Coder Educator: The Way Forward
Authors: Logan Ellen , O'Neill Maria , Martin Corrie
Published: March 2016

The introduction of a new Coder Educator position in the Coding Unit at the Princess Alexandra Hospital, Brisbane, Queensland, has been a key strategy in the development and maintenance of a skilled coding workforce, the improvement of the level of knowledge of the coding staff, and the provision of a career structure for clinical coders. In this report, the experience is related from the perspectives of the Coding Manager and the Coder Educator.
Making a Quality Start: A Coder Orientation Program
Authors: Groom Andrea
Published: March 2016

Orienting new clinical coders to the hospital's case mix should be a basic function of the organisation's Coding Service. After much trial and error, Southern Health Coding and Casemix Services has devised an orientation program that brings together, in a structured and logical manner, all the elements a coder needs to know. This article describes the current coding orientation program.
Modelling and Encoding Therapeutic Guidelines: Applying ICD-10-AM and European Article Number Codes
Authors: Lewis Bryn , Harvey Ken , Dartnell Jonathan , Shepheard Jennie
Published: March 2016

This article reports on the assignment of ICD-10-AM and EAN codes to 2500 topics in Therapeutic Guidelines (TG). The analysis of the assignment of ICD-10-AM codes in this project has revealed that ICD-10-AM is not capable of describing the complete clinical information in the guidelines series. It is not likely that any existing single classification scheme will be capable of this and that a combination of schemes will be necessary. The TG data model was integrated with the prototype MCCA data model for drug products. This integration indicates that the representation of drugs, while not ideal, is an appropriate means of linking clinical drug reference information to drug product information.
The Educational Needs of Health Information Managers in an Electronic Environment: What Information Technology and Health Informatics Skills and Knowledge are Required?
Authors: Robertson Merryn , Callen Joanne
Published: March 2016

The profile of health information managers (HIMs) employed within one metropolitan area health service in New South Wales (NSW) was identified, together with which information technology and health informatics knowledge and skills they possess, and which ones they require in their workplace. The subjects worked in a variety of roles: 26% were employed in the area's Information Systems Division developing and implementing point-of-care clinical systems. Health information managers perceived they needed further continuing and formal education in point-of-care clinical systems, decision support systems, the electronic health record, privacy and security, health data collections, and database applications.
The Implications of Data Privacy Legislation for the Development of Hospital Information Systems
Authors: Lederman Reeva
Published: March 2016

This research provides an analysis of the implementation of medical data privacy law in Australia, with emphasis on the Victorian Health Records Act 2001 (HRA). We examine the ability of health organisations to respond to the requirements of this legislation, and similar health privacy legislation elsewhere, and illustrate that this ability is affected by the quality of their patient data and the structure and security of their databases. This article suggests that compliance with the legislative provisions creates implications for information systems development and design, which large public and private hospitals have so far failed to consider or act upon.
Health Informatics and Health Information Management in Maternal and Child Health Services
Authors: Phung Hai , Young Lis , Tran Mai , Win Khin Than , Alcock Carole , Hillman Ken
Published: March 2016

In November 1997, the South Western Sydney Area Health Service launched the Mother and Infant Network (MINET). The key objective of MINET is to develop an integrated clinical data network which has the capacity to inform and support a continuum of care for the population of all mothers, infants and children. The MINET data network integrates in-patient services, ambulatory services, and community-based services. The focus of this article is the development and implementation of MINET with reference to the crucial role of data linkage and health informatics in health outcomes/health services research.
Clinical Coders and Decision Making
Authors: Wooding Andrew
Published: March 2016

Clinical coders operate at six identifiable levels, which can be described as beginner, trainee coder, entry, competent, accredited and advanced levels. In this article these levels are elaborated within the theoretical perspectives of Simon's four-stage and Wilson and Walsh's six-stage models of systematic decision making. The article then examines briefly the importance of understanding how clinical coders make decisions, because of both the coder's crucial role in determining hospital funding, and the reliance of research upon access to accurate data. Finally, future avenues for study in this area are suggested.
The Development of a Quality Assessment Tool for Ambulance Patient Care Records
Authors: Smith Erin , Boyle Mal , MacPherson James
Published: March 2016

A retrospective cohort study of the 2002 Victorian prehospital emergency care documentation completed by ambulance paramedics had the objectives: (i) to design and implement a quality assessment tool to determine the quality of the ambulance patient care record (PCR) information; and (ii) to identify critical demographic and clinical items on the ambulance PCR that needed improvement. The study outcomes included a functioning quality assessment tool and associated user guide for prehospital use, and the identification of three critical PCR components requiring improvement. Ninety percent of PCRs passed the quality assessment; 10% (approximately 5 300) contained measurably poor or incomplete documentation.
A Post-Implementation Audit of Douglas Inquiry Recommendations for Medical Record Structure
Authors: Cheng Kavia , Hart Jade
Published: March 2016

Following the Douglas Inquiry into medical practices and processes, a number of reforms were made to the medical records structure at the King Edward Memorial Hospital for Women (KEMH) in Perth, Western Australia. An audit was undertaken to investigate staff compliance with the new medical record structure, and to identify significant issues arising from the new filing sequence and dividers. The medical record components (correspondence, emergency, outpatient, inpatient and diagnostics) were analysed through random selection of records with recent inpatient and/or outpatient episodes. Interviews with both clinical and clerical staff at KEMH were also conducted to gather general feedback. The main issues identified in the study were a lack of understanding of the operational instructions by staff, incorrect filing procedure, and allocation of inappropriate dividers. The following recommendations were developed to address these issues: revision of all medical record forms (in particular unauthorised medical record forms); education of both clinical and clerical staff; expansion of the operational instructions into a comprehensive guide for staff; development of a new process for signing any results or reports; and compilation of a sample medical record as a reference for staff.
Patients' Perceptions of General Practitioners Using Computers during the Patient-Doctor Consultation
Authors: Callen Joanne , Bevis Megan , McIntosh Jean
Published: March 2016

In this study 85 adult patients attending a Sydney general practice were asked for their views on computer-assisted consultations; 77 (91%) agreed to participate. In general, patients agreed they could still talk easily with their doctor, and felt listened to, while the doctor used the computer (87% & 75% respectively). More than half the patients felt the computer contributed to better treatment, although a quarter believed consultations were prolonged. About half the patients agreed that the doctor did not often explain the role of the computer. Given the national plans for increasing computerisation of health records (Health Connect), this research suggests that more attention should be given to involving patients in e-health developments.
A Framework for Evaluating Health Classifications
Authors: Bramley Michelle
Published: March 2016

Evaluation is important to evidence-based policy and practice in Health Information Management. Health classifications are important components of information systems and should be evaluated to determine their suitability for the task required. This paper provides a framework for evaluating health classifications that are used for statistical and reporting purposes. The framework revises and updates the fundamental principles that make health classifications effective. It also draws on other frameworks, where relevant, to reflect the influence that informatics has had on nosology. Principles are illustrated with examples, topical issues associated with some principles are discussed, and examples of evaluation in practice are provided.
A Comparison of Two Sources of Data on Fungaemia in Two Hospitals
Authors: Nguyen Quoc , Reid Beth
Published: March 2016

Fungal bloodstream infection (BSI) is of increasing concern in the hospital environment. This study compared routine hospital discharge data at two inner Sydney hospitals with a pathology database over a 6-year period. A high level of underreporting was found, with only 42% of the pathology database cases assigned an appropriate code in the hospital discharge data despite evidence of the infection being found in 97% of the medical records identified from the pathology database. The location of the evidence in the medical record had an impact on whether or not the infection was assigned a code. There was a greater likelihood that a code would be assigned if the infection was documented on the front sheet of the medical record. Improvements can be made to the reporting of fungal BSI if clinicians record it on the front sheet and if coders review the whole medical record before coding.
Does the Electronic Patient Record Support the Discharge Process? A Study on Physicians' Use of Clinical Information Systems during Discharge of Patients with Coronary Heart Disease
Authors: Sørby Inger Dybdahl , Nytrø Øystein
Published: March 2016

This study has been performed in order to categorise and measure usage of different information sources and types in a well defined stage of clinical work. The underlying motivation is to improve computer-supported presentation and retrieval of relevant information and to be able to evaluate the functionality of a future improved interface to the electronic patient record (EPR). By observing 52 discharge processes and categorising information types and sources, we have observed that the paper chart is used as a primary source of information about recent events and procedures, while the EPR is mostly used for retrieving background information and verification. Direct communication with other clinicians and the patient is also important during the discharge process. Results from an additional survey show that the physicians report greater use of the EPR than the result from the observational study. The study clearly indicates that there is a large potential for improved EPR systems that support the physicians in their work regarding discharge of patients, especially in the future planning part of the discharge.
International Developments in OpenEHR Archetypes and Templates
Authors: Leslie Heather
Published: March 2016

Electronic Health Records (EHRs) are a complex knowledge domain. The ability to design EHRs to cope with the changing nature of health knowledge, and to be shareable, has been elusive. A recent pilot study1 tested the applicability of the CEN 13606 as an electronic health record standard. Using openEHR archetypes and tools2, 650 clinical content specifications (archetypes) were created (e.g. for blood pressure) and re-used across all clinical specialties and contexts. Groups of archetypes were aggregated in templates to support clinical information gathering or viewing (e.g. 80 separate archetypes make up the routine antenatal visit record). Over 60 templates were created for use in the emergency department, antenatal care and delivery of an infant, and paediatric hearing loss assessment. The primary goal is to define a logical clinical record architecture for the NHS but potentially, with archetypes as the keystone, shareable EHRs will also be attainable. Archetype and template development work is ongoing, with associated evaluation occurring in parallel.
Introduction of Enhancement Technologies into the Intensive Care Service, Royal Prince Alfred Hospital, Sydney
Authors: Ryan Angela , Patrick Jon , Herkes Robert
Published: March 2016

In order to achieve the full potential of information technology in healthcare, information systems must have the ability to share and exchange data, which requires the support of standardised medical terminology, such as Systematised Nomenclature of Medicine – Clinical Terms (SNOMED-CT). The Royal Prince Alfred Intensive Care Service and the School of Information Technologies, University of Sydney have been collaborating for over two years, developing pioneering software initiatives for clinical information systems (CIS). More recently, the collaboration resulted in the development of two prototype systems. The Ward Round Information System (WRIS) has been designed to convert clinicians' clinical notes into the formal medical encoding ontology SNOMED-CT, thus enabling more consistent descriptions of patient conditions and allowing large-scale retrieval and analysis from the narrative part of the patient record. In addition, a Clinical Data Analytics Language (CDAL) system has also been developed and is designed to answer questions of the data stored in the CIS. It will assist clinicians in the management of vast amounts of complex information generated during an ICU admission and ultimately improve the quality and efficiency of care. CDAL provides clinicians with the ability to frame any question about their data in their database and get the answer almost immediately. Both systems went live in October 2007, and this report summarises the background, purpose, and progress thus far.
The Royal Hobart Hospital Digital Medical Records Success Story
Authors: Upton Mark
Published: March 2016

Due to ever increasing space restrictions, the Royal Hobart Hospital implemented a Digital Medical Record (DMR) in July 2006. The aims of the system were to allow improved access to all patient histories for authorised staff, reduce storage space issues and improve the ability of staff to access all hospital clinical information databases via a single electronic link (e.g. pathology, radiology). As a tertiary hospital with many years of clinical information stored in the traditional way (paper in file) it was imperative that we ensured the changeover was systematic, simple and did not adversely affect the running of the hospital. This article describes the processes involved in implementation of the electronic health record, including change management procedures and scanning of older paper-based records for inclusion in the new system.
Recorded Categories of Non-Principal Diagnoses in Victorian Public Hospital Transient Ischaemic Attack and Stroke Admissions
Authors: Nadathur Shyamala G
Published: March 2016

Information about the number and types of non-principal diagnoses (NPDs) would make an important contribution to prediction of outcome and hence patient management. The study reported here is based on analysis of three fiscal years of the Victorian public hospital transient ischaemic attack (TIA) and stroke admissions. The incidence of NPDs and co-occurrence of NPD-associated prefix categories (that identify the onset or relevance of each condition to the episode) are described in each of the broad stroke subtypes. The distributions of length of stay and in-hospital deaths in the cohorts without and with NPDs and in the various prefix categories are determined. The study also compares the age and gender distribution in the various subpopulations of interest. The importance of collecting complete and accurate data on nature of NPDs and its potential in describing the complexity of presentation are discussed.