bluuebunny/crossref_metadata_2025 huggingface dataset:
Dose-rate effects in radiation biology and radiation protection
Authors: Rühm W. , Azizova T.V. , Bouffler S.D. , Little M.P. , Shore R.E. , Walsh L. , Woloschak G.E.
Published: March 2016

Quantification of biological effects (cancer, other diseases, and cell damage) associated with exposure to ionising radiation has been a major issue for the International Commission on Radiological Protection (ICRP) since its foundation in 1928. While there is a wealth of information on the effects on human health for whole-body doses above approximately 100 mGy, the effects associated with doses below 100 mGy are still being investigated and debated intensively. The current radiological protection approach, proposed by ICRP for workers and the public, is largely based on risks obtained from high-dose and high-dose-rate studies, such as the Japanese Life Span Study on atomic bomb survivors. The risk coefficients obtained from these studies can be reduced by the dose and dose-rate effectiveness factor (DDREF) to account for the assumed lower effectiveness of low-dose and low-dose-rate exposures. The 2007 ICRP Recommendations continue to propose a value of 2 for DDREF, while other international organisations suggest either application of different values or abandonment of the factor. This paper summarises the current status of discussions, and highlights issues that are relevant to reassessing the magnitude and application of DDREF.
Factors Affecting the Development of an Antibody Response to Hepatitis B Immunization in Children With Intestinal Failure: Before and After Small Bowel Transplantation (With and Without Liver Graft)
Authors: Craggs Helen M. , Jackson Phoebe , Gupte Girish , Hartley Jane , Abdel‐Hady Mona , Morton Rachael , Beath Sue , Hogg Lindsay
Published: March 2016

Background: Small bowel transplant with or without a liver graft (SBTx ± LTx) for children with intestinal failure involves checking their immunity to a range of microorganisms, including hepatitis B virus (HBV), at the time of assessment. HBV vaccination in the United Kingdom is recommended for transplant candidates. The aim of this audit was to find out how many SBTx ± LTx candidates received HBV vaccination before transplantation and how the timing of vaccination influenced the development of immunity. Materials and Methods: Retrospective review of case notes and hospital microbiology database formed the basis of the study. Vaccination history and serology were available in 56 of 87 subjects who had SBTx ± LTx. Results: All patients were seronegative for HBV when assessed for transplant. HBV vaccination was started before transplant in 25 children and after transplant in 31. Eight children died posttransplant before their immunity could be checked, but of the 48 survivors, 20 children developed immunity, of whom 13 (65%) received at least 1 vaccination before SBTx ± LTx (P = .008). Lack of response to HBV vaccine was significantly associated with isolated bowel transplantation and intensification of immune suppression. Of 11 children, 5 lost hepatitis B surface antibody (HbsAb), and 28 never made HBsAb, despite repeated vaccinations. Conclusion: Our study clearly shows that HBV vaccine before transplant is more effective. In line with renal failure patients, we suggest that children with chronic intestinal failure receive HBV vaccine when clinically stable, before referral for transplant. Higher‐dose vaccines, accelerated schedules, and more frequent booster vaccinations are also strategies that may improve HBsAb levels after transplant.
Household Composition and Longitudinal Health Outcomes for Older Mexican Return Migrants
Authors: Mudrazija Stipica , López-Ortega Mariana , Vega William A. , Gutiérrez Robledo Luis Miguel , Sribney William
Published: March 2016

Mexican return migrant population is increasing, yet our knowledge about their lives after resettlement in Mexico remains fragmentary. Using 2001–2012 longitudinal data from the Mexican Health and Aging Study, we investigate difference in household composition for older migrants who returned from the United States compared to nonmigrants. Furthermore, we fit a Cox proportional hazards model to assess the relationship between household composition and health and functional trajectories of return migrants and nonmigrants. The results indicate that return migrants with long duration of U.S. stay have different household composition than nonmigrants or short-term migrants: On average, they have smaller household size, including fewer females who may be available to offer assistance to older adults. Presence of middle-age females in the household has positive effects on health and functional trajectories. We highlight implications of this research for policy makers in Mexico and the United States.
The Effect of Changes in Educational Composition on Adult Female Mortality in Brazil
Authors: Turra Cassio M. , Renteria Elisenda , Guimarães Raquel
Published: March 2016

The last century in Brazil was witness to profound changes. Female life expectancy at birth increased from 34.6 years in 1910 to 77.26 years in 2010. At the same time, the educational composition of the population has changed dramatically. In the 1940s, only 25% of the children aged 5–14 years old were enrolled in school. Currently, nearly all children attend school. We examine the extent to which changes in the age-specific distribution of education have contributed to the decline in adult mortality among women in Brazil. Our analysis follows other applications in the literature to measure the mortality reduction that would occur if exposure to specific risk factors was changed at the counterfactual level. The effects are not trivial: Between 1960 and 2010, about 38% of the increase in life expectancy at age 30 can be attributed to changes in the educational composition of women. An additional 22% increase is expected until 2040.
Mobilities III
Authors: Merriman Peter
Published: March 2016

In this final report on mobilities, I discuss research published between late 2014 and early 2016, focusing upon three key themes. I examine how recent work on medical bodies and race advances long-standing concerns with the mobile body. I then trace emerging philosophical and political writings on the themes of speed and ‘accelerationism’, before examining the contributions of mobility historians and transport historians to academic work on mobility. I conclude with some thoughts about the multi-disciplinary nature of contemporary mobilities research and the current state of the field.
Opportunity Costs and Latinas’ Family Formation Attitudes
Authors: Spence Naomi J.
Published: March 2016

Cultural ideals and acculturation influence Latinas’ fertility-related attitudes and family size preferences within the context of the U.S. social and economic structure. In this context, there may be “costs” associated with enacting preferences favoring family building over other opportunities or demands. This article draws on data collected from focus groups conducted with college-educated Latinas in the Bronx, New York ( n = 16) to demonstrate a conflict between cultural values and opportunity costs. The voices of these women not only echo an awareness of opportunity costs associated with childbearing (especially at a young age or having many children) but also acknowledge the influences of culture on the attitudes and behaviors of Latinas. In this conflict, ethnic identities are challenged and signs of internalized racism emerge.
The Impact of a 35-Week Long-Term Exercise Therapy on Psychosocial Health of Children With Benign Epilepsy
Authors: Eom Soyong , Lee Mi Kyung , Park Ji-Hye , Lee Dongpyo , Kang Hoon-Chul , Lee Joon Soo , Jeon Justin Y. , Kim Heung Dong
Published: March 2016

The purpose of this study was to evaluate the feasibility of a 35-week exercise program and its efficacy on neurocognitive and psychological variables in children with benign epilepsy with centrotemporal spikes. Ten children with benign epilepsy with centrotemporal spikes (aged 8 to 12 years) completed a 35-week exercise program consisting of supervised sport activities for 5 weeks and home-based exercise program for 30 weeks. The children and their parents participated in neurocognitive and psychological evaluations including measures of attention, executive function, behaviors, and quality of life at baseline and postexercise follow-up at the 35th week. At postintervention evaluation, significant improvements were seen relative to baseline in neurocognitive domains such as psychomotor speed, sustained attention, divided attention, and inhibition-disinhibition ability, and in psychological domains including internalizing behavior problems, general health, and general quality of life. Long-term exercise intervention may have benefits for some aspects of neurocognitive and psychological function in children with benign epilepsy.
Acoustic performance and flow analysis of a multi-chamber perforated resonator for the intake system of a turbocharged engine
Authors: Guo Rong , Tang Wen-bo , Zhu Wei-wei
Published: March 2016

A multi-chamber perforated resonator is a type of silencer which can attenuate broadband noise. In order to address the noise issues originating from the intake system of a turbocharged engine, measurement tests are carried out to characterize the range and the amplitudes of the noise frequencies. A transfer matrix method and a non-linear least-squares optimization algorithm are combined in order to design the multi-chamber perforated resonator. A transmission loss test facility is designed on the basis of the two-load method so as to validate the acoustic performance of the resonator. Despite the difference between the amplitude of the transmission loss from the tests and the amplitude of the transmission loss obtained by the transfer matrix method, the shapes of the two curves have the same trend, and the measured transmission loss can meet the design target in the frequency range of interest. From the comparison between the intake noise spectrum with the resonator and the intake noise spectrum without the resonator, it can be seen that this resonator can efficiently attenuate the broadband intake noise of the engine. Also, a computational fluid dynamics flow simulation analysis of the intake system with the resonator is made so that its flow characteristics can be studied. The simulation results show that the air pressure drop of this resonator is slightly higher than that of the straight pipes but is still relatively low. It is also noted that the diameter and the curvature of the pipes have a great influence on the air velocity as well as on the pressure drop.
Component sizing and intelligent energy management of a heavy hybrid electric vehicle based on a real drive cycle
Authors: Kebriaei Mohammad , Sandidzadeh Mohammad Ali , Asaei Behzad , Mirabadi Ahmad
Published: March 2016

In this paper, hybridizing a heavy vehicle is developed. A switcher locomotive is considered for hybridization. Due to their low operational speed, the switcher locomotives require much lower power when compared to other types of locomotives. Besides, switcher locomotives have higher loss of energy due to their frequent starting and stopping. Hybrid-powered transit vehicles are considered to be excellent replacements for ordinary transit vehicles, since hybrid powered vehicles are equipped with more than one traction power sources. Therefore, a switcher locomotive’s driving cycle is derived from the measured field data and used to calculate and design the hybrid vehicle’s components. A “fuzzy controller” is used to plan a suitable controller for the designed hybrid locomotive. Comparisons show a substantial decrease, both in the fuel consumption and the pollutions of the designed hybrid switcher locomotive versus the conventional diesel-electric locomotives.
From Time to Action
Authors: Weik Elke
Published: March 2016

Although many authors in the field of sociology and social theory have integrated temporal features into their theories, there is still a lack of theories based on time. This is mostly due to the complexity of the phenomenon of time, which not only produces a number of paradoxes, but also spans the complete realm of the natural and social sciences. Moreover, time is often conceptualized in its common sense, Newtonian shape, thus ignoring major theoretical developments of the last century. One philosopher who has attempted to address these shortcomings is A. N. Whitehead. The present contribution draws on his philosophy in order to develop a theory of action based on a post-relativity concept of time.
Experts’ understanding of the public: knowledge control in a risk controversy
Authors: Young Nathan , Matthews Ralph
Published: March 2016

This paper reverses the common emphasis in the literature on public understanding of science by examining “experts’ understanding of the public.” This research uses the case of aquaculture in Canada, a highly contested mode of production that has divided the scientific community and public opinion. Using a survey of 300 aquaculture experts in Canada, we examine three dimensions of experts’ understanding of public “contributions” to this controversy. These are (1) stakeholder participation in aquaculture regulation and policy, (2) the media as an interpreter and communicator of expert claims, and (3) the knowledge and values basis of general public opinion. We find that experts’ views on lay knowledge and participation in the debate swing from strongly positive to strongly negative. Using quantitative and qualitative data from the survey, we argue that these swings in experts’ views of the public coincide with issues of control over knowledge. Experts on all sides of the aquaculture controversy are markedly open to incorporating lay knowledge into scientific practices (a situation where expert control over knowledge is retained), but are highly critical of lay “consumption” of expert claims (a situation where expert control over knowledge is lost).
Empiricist selves and contingent “others”: the performative function of the discourse of scientists working in conditions of controversy
Authors: Burchell Kevin
Published: March 2016

The objective of this article is to report the results of 18 semi-structured interviews, conducted in the UK during the spring of 2003, with scientists working in the locally controversial area of crop genetics. Results suggest that, when talking about their own beliefs and actions, most of the scientists utilized what can be referred to as an empiricist repertoire, in which beliefs and actions are seen to derive from the natural world, an objective and rigorous method, and an ethical framework. By contrast, when talking about the beliefs and actions of four key “others,” most of the scientists relied upon a contrasting contingent repertoire, in which beliefs and actions are seen to derive from personal shortcomings, inclinations and self interest, and to be in contradiction of an ethical framework. It is suggested that the extent to which the discourse of these crop geneticists followed this pattern may be related to the conditions of controversy within which they were working at the time of the interviews. The small number of cases that contradict this pattern are also examined. The implications of this for relationships between science and the public are briefly discussed.
Predictors of trust in the general science and climate science research of US federal agencies
Authors: Myers Teresa A. , Kotcher John , Stenhouse Neil , Anderson Ashley A. , Maibach Edward , Beall Lindsey , Leiserowitz Anthony
Published: March 2016

In this article, we focus on a key strategic objective of scientific organizations: maintaining the trust of the public. Using data from a nationally representative survey of American adults ( n = 1510), we assess the extent to which demographic factors and political ideology are associated with citizens’ trust in general science and climate science research conducted by US federal agencies. Finally, we test whether priming individuals to first consider agencies’ general science research influences trust in their climate science research, and vice versa. We found that federal agencies’ general science research is more trusted than their climate science research—although a large minority of respondents did not have an opinion—and that political ideology has a strong influence on public trust in federal scientific research. We also found that priming participants to consider general scientific research does not increase trust in climate scientific research. Implications for theory and practice are discussed.
Use of Knowledge Management for Competitive Advantage: The Case Study of Max Life Insurance
Authors: Joshi Himanshu , Farooquie Jamal A. , Chawla Deepak
Published: March 2016

In the Asian subcontinent, the insurance business is highly competitive. The Indian insurance industry too witnessed tremendous growth and competition in the last few years. Both public and private insurance companies are currently facing two main challenges: struggling to retain their customer base and knowledge loss resulting from employee turnover. Insurance companies are realizing that efficiently managing its customer and employee knowledge and utilizing the same in designing insurance products and services is a key to survival. While effective knowledge management (KM) has been acknowledged as the key driver for new knowledge and new idea generation, the fact that academics still write about it and organizations are actively pursuing the concept makes us believe that this trend is going to continue in future too. This article discusses the KM planning and implementation journey undertaken by Max Life Insurance Company Limited, India. The company not only has successfully implemented KM but also has plans to roll out the project in other group companies. The case presents instances and examples of how the company has used KM for real business improvements with measurable outcomes. It also investigates the critical success factors for KM implementation using secondary and primary data collected from published literature besides the company under study. The study will be beneficial to organizations that are willing to implement KM but do not have a clear idea of how to proceed with it. It also provides directions for future research and implications for global managers for having KM into place.
Herd outbreak of bovine tuberculosis illustrates that route of infection correlates with anatomic distribution of lesions in cattle and cats
Authors: Fitzgerald Scott D. , Hollinger Charlotte , Mullaney Thomas P. , Bruning-Fann Colleen S. , Tilden John , Smith Rick , Averill James , Kaneene John B.
Published: March 2016

An outbreak of bovine tuberculosis (TB) in a Michigan dairy herd resulted in quarantine, depopulation, pathology, and epidemiologic investigations. This herd, compared to other TB-infected herds in Michigan, was unusual in the long-term feeding of waste milk to its replacement calves. The herd had 80 cattle with positive results on caudal fold test or gamma interferon testing, which were reclassified as suspects because the herd had never been known to be tuberculous previously. Autopsy revealed striking variation in the anatomic distribution of gross anatomic lesions, microscopic lesions, and culture-positive lymph nodes between the adult cattle, the calves, and the domestic cats present on the farm. Adult cattle had lesions and culture-positive lymph nodes predominantly within the thoracic lymph nodes, whereas cats had 50% of their lesions and culture-positive lymph nodes in their abdomens, and 50% of positive calves had culture-positive lymph nodes in their abdomens. This difference in anatomic distribution correlated with the likely routes of infection, which are believed to be by direct airborne transmission in adult cattle and indirect ingestion of contaminated milk in both calves and cats. Although TB literature over the past 100-plus years states that the route of infection may manifest itself in differences in lesion anatomic distribution, our team has been working with TB for over 20 years, and we have never encountered such striking variation between different groups of animals on the same farm.
Histological and immunohistochemical features of histiocytic sarcoma in four domestic ferrets (Mustela putorius furo)
Authors: Thongtharb Atigan , Uchida Kazuyuki , Chambers James K. , Miwa Yasutsugu , Murata Yousuke , Nakayama Hiroyuki
Published: March 2016

Four cases of histiocytic sarcoma in domestic ferrets ( Mustela putorius furo) are described in the present study. Tumor samples obtained from the abdominal viscera, including the spleen, were submitted for histologic examination. Microscopically, poorly demarcated masses contained numerous round- to pleomorphic-shaped cells with coarsely vacuolated and eosinophilic cytoplasm. Bizarre, binucleated tumor cells and multinucleated giant tumor cells with low phagocytic activity were commonly observed. Immunohistochemically, tumor cells in all of the cases were positive for vimentin, human leukocyte antigen-DR, ionized calcium-binding adapter molecule-1, and lysozyme, but some of them lacked cluster of differentiation (CD)163 or CD208 expression. The survival time after surgical resection was 9 days to 5 months. Histiocytic sarcoma in the ferret is a rare, but highly aggressive, tumor commonly found in the spleen.
Evaluation of cytospin precision in low cellularity canine cerebrospinal fluid
Authors: Krimer Paula M. , Haley Allison C. , Harvey Stephen B. , Schatzberg Scott J.
Published: March 2016

The cell count and differential of cerebrospinal fluid (CSF) cytologic examination classify CSF as inflammatory or not. The cytospin cell yield is related to cell count, but to our knowledge a relationship has not been characterized and cytospin precision is undocumented in any species. The objective of our study was to calculate intra-assay precision of cellular yield and differential on cytocentrifuged canine CSF, determine the factors that may affect precision, and predict the number of cytospins necessary to confirm mild neutrophilic pleocytosis. Ten concurrent replicate cytospins were created from nonhemorrhagic CSF, obtained from 60 dogs in other terminal studies, with either a manual or calibrated pipetting technique. Up to 500 cells per cytospin were counted and classified on each slide. Coefficient of variation (CV), multiple regression, and probabilities were calculated for relationships between cell yield and independent factors including technique, total nucleated cell count, cell differential, and total protein. Manual and calibrated pipetting had similar CVs (average 31%) for total cell yield, but the calibrated technique had fewer foamy macrophages. CV for neutrophil percentage among low cellularity samples with any neutrophils was 146%. Probability based on linear regression showed that 1 cytospin is sufficient to identify samples with >3% neutrophils. Occasional neutrophils, eosinophils, mitotic figures, phagocytic cells, and ependymal cells were seen in many low cellularity canine CSF samples. Canine CSF cytospin cell yield and differential evaluations are imprecise. Calibrated rather than manual pipetting is recommended.
Load frequency control of a two-area multi-source power system using a tilt integral derivative controller
Authors: Topno Pretty Neelam , Chanana Saurabh
Published: March 2016

This paper introduces a tilt integral derivative controller as the supplementary controller for load frequency control of a two-area interconnected power system. The optimal value of parameters of the tilt integral derivative controller is evaluated using constrained nonlinear optimization by means of a performance index-based method. The proposed tilt integral derivative control offers superior properties such as simple parameter tuning and its performance does not compromise the occurrence of any parameter variations in the system. To verify these features of the controller, the test system is subjected to step load disturbance and parameter variations that ensure the robustness of the tilt integral derivative controller. Comparative analysis with previously published work indicates that the proposed tilt integral derivative controller gives better performance and holds the property of robustness. Simulations have been performed using Matlab®.
Boundary control for a flexible manipulator with a robust state observer
Authors: Jiang Tingting , Liu Jinkun , He Wei
Published: March 2016

In this paper, a boundary controller for a flexible manipulator is proposed based on a partial differential equation (PDE) robust observer. In the previous work we have proposed a PDE robust observer to estimate the infinite dimensional states of the flexible manipulator with unknown boundary disturbance and spatially distributed disturbance. On the basis of the proposed robust state observer, a boundary controller is designed to achieve the stability control, regulate the joint position and suppress elastic vibration in this paper. The stabilities of the proposed observer and the boundary controller are validated by theoretical analysis. Numerical simulations are provided to demonstrate the effectiveness of the closed-loop system.
More connected, less attached: Factors shaping junior ranks’ perceptions of the Australian media’s coverage of the Australian Defence Force
Authors: Foster Kevin , Pallant Jason
Published: March 2016

This article seeks to understand what Australian Defence Force (ADF) junior ranks think about the Australian media’s coverage of defence issues and ADF operations. Through the analysis of original survey data, it considers how patterns of media use and the opinions of superiors, family and friends influence their views. This article compares these data with the findings from an earlier survey, which used the same survey instrument to examine what mid-ranking officers in the ADF thought about media coverage of the military. It explores the contrasts and continuities between the differing survey cohorts and considers what these suggest about the origins of and influences on their opinions. It concludes that while the surveys reveal a good deal about what ADF personnel think about the media’s coverage of their operations, it raises questions about why they think as they do that can only be answered through further studies.
‘Present yet absent’: Negotiating commitment and intimacy in life with an excessive online role gamer
Authors: Hellman Matilda , Karjalainen Salla-Maria , Majamäki Maija
Published: March 2016

The study examines how persons in a close relationship with a gamer of massively multiplayer online role-playing games (MMORPG) perceive relationship problems caused by the gaming hobby. Revisiting the concept of pure relationships by Anthony Giddens, we analysed eight deep interviews with persons who claim their relationship with the gamer had ended or turned downhill due to the volume of the gaming. The study formulates a conception of the clashes of interest in areas of (1) situational clashes in everyday choreography, (2) shifts in long view prioritizing, (3) deficient communication and (4) understandings of self and autonomy in relation to gaming and relationship. These conceptual paths serve to understand the problems from a sociological perspective. On a more general level, the study demonstrates the timeliness in devoting attention to the premises under which intimacy and commitment are negotiated in offline and online relationship constellations.
‘The ball and the rhythm in her blood’: Racialised imaginaries and football migration from Nigeria to Scandinavia
Authors: Engh Mari Haugaa , Settler Federico , Agergaard Sine
Published: March 2016

This article provides an analysis of how Nigerian women migrants are represented and constructed as racial others by officials in the Scandinavian football clubs that recruit and employ them. Situated against scholarship on race, gender, and sport, within and outside the Scandinavian region, we highlight consistencies in stereotypical representations of black athletes. We use theories of racialisation to draw attention to how ideas about race and gender are mutually imbricated in shaping Scandinavian representations of Nigerian women football migrants. Based on interviews with Scandinavian football club officials, and Nigerian women football migrants, we expose and critique the ways in which Nigerian women’s migration as professionals, and their competencies as athletes, are constantly undermined by racially inscribed representations.
A sound power measurement technique optimised for low-speed fan tones
Authors: Newman Timothy J , Agarwal Anurag , Dowling Ann P , Desvard Ludovic
Published: March 2016

Air-moving devices such as fans are routinely characterised experimentally in terms of their sound power, and sound quality which depends on both broadband and tonal noise levels. The International Organization for Standardization method 5136, widely used in industry and academia, estimates sound power in third-octave bands radiated into a duct. Since the International Organization for Standardization method is not designed for tone measurements and overlooks the unevenness of the modal power distribution, an extended method has been developed and implemented based on mode decomposition. The ‘two-port’ source model is formulated to include higher-order modes and applied for the first three modes which require six independent stationary measurements on each side or ‘port’. The resulting experimental rig is much shorter than the International Organization for Standardization rig and does not require anechoic terminations. Both methods have been used to characterise the same fan, and the results compared to understand tone measurement shortfall of the International Organization for Standardization rig.
Institutional complexity and the meaning of loose coupling: Connecting institutional sayings and (not) doings
Authors: Misangyi Vilmos F.
Published: March 2016

An understanding of decoupling in complex institutional fields remains elusive. In such fields, a multiplicity of logics engenders many possible institutional intentions as well as the likelihood of the co-occurrence of decoupled and coupled practices. In this study, I adopt Weick’s dialectical view of loose coupling and integrate it with theory on institutional logics and vocabularies of motive to posit that the meaning of the decoupling (and coupling) of practices when a formal program is adopted in a complex institutional field can be found in the connection(s) that the (de)couplings have with the various available institutional intentions for such adoptions. I used the fuzzy-set approach to comparative case analysis to explore this issue among 28 business facilities that adopted an environmental management system. I found very different systematic connections between the coupling and decoupling of expected environmental management system program practices and the multiple institutional intentions given for the environmental management system adoptions. Moreover, these connections showed that the decoupling of certain practices were pivotal to understanding the meaning of the program adoptions.
The Implementation of New Morbidity Classifications in Canada
Authors: Moskal Lori
Published: March 2016

Canada is in the midst of a staggered implementation of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA) and the Canadian Classification of Health Interventions (CCI). These classifications are more comprehensive than historical standards and their capacity extends beyond the scope of their predecessor classifications. Canada is the first country to produce the new classifications in a database, with the final product in an infobase format. The Canadian Institute for Health Information (CIHI) was responsible for the enhancement of ICD-10-CA, the development of CCI, the education of coders, and the provision of post-implementation support.
Researching Hospital Patient Data to Enhance Operational Management
Authors: Heslop Liza , Gardner Brendon , Athan Dean , Diers Donna , Taylor Catherine
Published: March 2016

For the purposes of funding and policy development, the Victorian Department of Human Services expects Victorian health care institutions to capture patient data at all levels. These data can be extracted from hospital information systems and potentially offer a business role within a health service organisation. However, there are many issues to be addressed at the organisational level in order that operational directors can be enabled to use hospital data to solve health service operational problems. In this paper, we discuss some of those considerations and give practical examples of how patient data can be used for research and management purposes.
A Profile of Coding Staff in Sydney Metropolitan Public Hospitals
Authors: McIntosh Jean , Dimitropoulos Vera , Bramley Michelle
Published: March 2016

This survey assessed the profiles of ICD-10-AM coding staff employed in 13 major, acute care public hospitals in Sydney, Australia, during a two-week period in 1999. Approximately 90% (56/61) of respondents gave their job title as Clinical Coder or Coding Clerk; of these, 20 (36%) were qualified Health Information Managers, of whom 10 coded for ≥90% of their work-time and three for <75% of the time. One quarter of all Clinical Coders/Coding Clerks spent >25% of their work time performing duties other than coding. Five Health Information Management (HIM) Clinical Coders/Coding Clerks were paid under the Clerical, rather than the HIM, Award.
The Effects on Clinical Coding of the Critical Pathway Recording Methodology
Authors: Cameron Moira , Robinson Kerin
Published: March 2016

A two-stage study aimed to identify the effects of the critical pathway recording methodology on clinical coding practice and to determine coders' participation in pathway development. Critical pathways were found to be in widespread use, with low coder participation in pathway development and poor education on pathway data extraction. Coders favoured the traditional medical record format; private sector coders predominated amongst those who preferred to code from records containing pathways because of poor private sector clinical documentation. The documentation factors that most affected the clinical coding process were consistent with those identified previously and were primarily doctor-related.
Predicting the Influence of the Electronic Health Record on Clinical Coding Practice in Hospitals
Authors: Robinson Kerin , Shepheard Jennie
Published: March 2016

The key drivers of change to clinical coding practice are identified and examined, and a major shift is predicted. The traditional purposes of the coding function have been the provision of data for research and epidemiology, in morbidity data reporting and, latterly, for casemix-based funding. It is contended that, as the development of electronic health records progresses, the need for an embedded nomenclature will force major change in clinical coding practice. Clinical coders must become expert in information technology and analysis, change their work practices, and become an integral part of the clinical team.
Health Privacy: The Draft Australian National Health Privacy Code and the Shared Longitudinal Electronic Health Record
Authors: Paterson Moira , Iacovino Livia
Published: March 2016

An explicit distinction between shared electronic health records and those at the point of care is required when referring to electronic health records. The former raises particular privacy issues discussed in this paper in relation to Health Connect and the Draft Australian National Health Privacy Code. In addition to a number of revisions to the code, the analysis recommends that related legislation such as archival and freedom of information law should be reconciled as much as possible within the code, so that a long-term view of the uses, retention and preservation of the longitudinal electronic health record is balanced with privacy, confidentiality and public interest.
New Informatics-Based Work Flow Paradigms in Radiation Oncology: The Potential Impact on Epidemiological Cancer Research
Authors: Miller Andrew
Published: March 2016

Epidemiological research is worthless without verifiable source data. Much of this data is common to the clinical environment. Currently, substantial resources are allocated to data management bureaucracies in attempts to ensure data accuracy. These bureaucracies developed in the era of paper records, but in the present health information climate, the ability to share electronic data presents exciting possibilities, while placing new responsibilities on the gatherers of information and challenging them to develop new work flow paradigms. Radiation oncologists have a pivotal role to play in the processing of oncological data for future epidemiological research because of the substantial overlap in data requirements.
Population Prevalence Rates of Birth Defects: A Data Management and Epidemiological Perspective
Authors: Riley Merilyn
Published: March 2016

The Victorian Birth Defects Register (VBDR) is a population-based surveillance system with a primary function of monitoring trends in birth defects. This paper outlines the processes undertaken in Victoria, Australia, to obtain population prevalence rates of birth defects and investigates the effect on the prevalence rates of variations in collection and processing tasks. It includes all birth defects that were notified to the VBDR by 31 December 2004.

The overall prevalence rate of birth defects in Victoria for 2003 was 4.0%, with an overall accuracy rate of 88%. However, this proportion varied according to what birth defects were included, the age by which birth defects were diagnosed, changes to sources of ascertainment, inclusion of terminations of pregnancy, or reporting by cases rate (infants affected) or birth defect rate (individual birth defects). Taking all of these factors into consideration, we are confident that 4.0% is an accurate population prevalence rate of birth defects in Victoria for 2003.
Information Environments for Supporting Consistent Registrar Medical Handover
Authors: Alem Leila , Joseph Michele , Kethers Stefanie , Steele Cathie , Wilkinson Ross
Published: March 2016

This study was two-fold in nature. Initially, it examined the information environment and the use of customary information tools to support medical handovers in a large metropolitan teaching hospital on four weekends (i.e. Friday night to Monday morning). Weekend medical handovers were found to involve sequences of handovers where patients were discussed at the discretion of the doctor handing over; no reliable discussion of all patients of concern occurred at any one handover, with few information tools being used; and after a set of weekend handovers, there was no complete picture on a Monday morning without an analysis of all patient progress notes. In a subsequent case study, three information tools specifically designed as intervention that attempted to enrich the information environment were evaluated. Results indicate that these tools did support greater continuity in who was discussed but not in what was discussed at handover. After the intervention, if a doctor discussed a patient at handover, that patient was more likely to be discussed at subsequent handovers. However, the picture at Monday morning remained fragmentary. The results are discussed in terms of the complexities inherent in the handover process
An Evaluation of the Quality of Obstetric Morbidity Coding Using an Objective Assessment Tool, the Performance Indicators for Coding Quality (PICQ)
Authors: Lam Mary K , Innes Kerry , Saad Patricia , Rust Julie , Dimitropoulos Vera , Cumerlato Megan
Published: March 2016

The Performance Indicators for Coding Quality (PICQ) is a data quality assessment tool developed by Australia's National Centre for Classification in Health (NCCH). PICQ consists of a number of indicators covering all ICD-10-AM disease chapters, some procedure chapters from the Australian Classification of Health Intervention (ACHI) and some Australian Coding Standards (ACS). The indicators can be used to assess the coding quality of hospital morbidity data by monitoring compliance of coding conventions and ACS; this enables the identification of particular records that may be incorrectly coded, thus providing a measure of data quality. There are 31 obstetric indicators available for the ICD-10-AM Fourth Edition. Twenty of these 31 indicators were classified as Fatal, nine as Warning and two Relative. These indicators were used to examine coding quality of obstetric records in the 2004–2005 financial year Australian national hospital morbidity dataset. Records with obstetric disease or procedure codes listed anywhere in the code string were extracted and exported from the SPSS source file. Data were then imported into a Microsoft Access database table as per PICQ instructions, and run against all Fatal and Warning and Relative ( N=31) obstetric PICQ 2006 Fourth Edition Indicators v.5 for the ICD-10-AM Fourth Edition. There were 689,905 gynaecological and obstetric records in the 2004–2005 financial year, of which 1.14% were found to have triggered Fatal degree errors, 3.78% Warning degree errors and 8.35% Relative degree errors. The types of errors include completeness, redundancy, specificity and sequencing problems. It was found that PICQ is a useful initial screening tool for the assessment of ICD-10-AM/ACHI coding quality. The overall quality of codes assigned to obstetric records in the 2004–2005 Australian national morbidity dataset is of fair quality.
Rehabilitation and Disability Services' Quality Projects: A Comparison against the Australian Council on Healthcare Standards' Clinical Criteria
Authors: Briggs Christina
Published: March 2016

The Australian Council on Healthcare Standards (ACHS) Evaluation, Quality and Improvement (EQuIP 4)1 standards provide a useful clinical and corporate framework for the analysis of quality projects by both health and disability services. Two ACHS EQuIP 4 clinical standards were used to compare quality projects conducted by community-based and on-site rehabilitation and disability services, as generated by a commercial database. Reliable information is a major asset for healthcare organisations, and the use of the ACHS clinical standards to interpret quality project data can overcome a lack of conceptual framework to interpret data. Key differences in the types of quality projects entered in the database by the rehabilitation and disability services may be attributed to the rehabilitation services' relationship with the client (patient), which is time-limited according to the clients' rehabilitation progress, while in comparison, disability services provide life-long support.
Duty of Confidentiality and HIV/AIDS
Authors: Mair Judith
Published: March 2016

The duty to maintain patient confidentiality is an ethical and legal priority for all health professionals. There is a common law duty in addition to statutory duties imposed by various privacy statutes. An ethical dilemma can arise when a patient is diagnosed with HIV/AIDS because a practitioner becomes aware that third parties can be placed at risk of a serious infection if the patient passes the disease on to those parties. The question arises as to what extent a medical practitioner, should he or she suspect a patient to be a risk of being HIV positive, is legally and ethically obliged to counsel the patient to undergo HIV antibody testing. In a case heard in the New South Wales Supreme Court in 1999, BT v Oei (1999) NSWSC 1082, a medical practitioner was held to owe a duty of care to the sexual partner/s of a patient whom he should have counselled to have HIV testing, who in fact tested positive after a period of time and had in turn infected his wife.
Professional Practice and Innovation: Transformation of Emergency Department Processes of Care with EHR, CPOE, and ER Event Tracking Systems
Authors: Vartak Smruti , Crandall Donald K , Brokel Jane M , Wakefield Douglas S , Ward Marcia M
Published: March 2016

Mercy Medical Center – North Iowa implemented electronic health records (EHR), computerised provider order entry (CPOE) and event tracking systems in the emergency department (ED) as part of hospital-wide implementation of clinical information systems. This case study examines the changes in outcomes and processes in the ED following implementation. Although the system was designed to enhance efficiency, there was a significant increase in the mean length of stay (about 17 minutes, or 15%) in the ED after implementation. This surprising finding was examined in relationship to the multiple process-of-care changes in the ED.
Using ICD-10-AM Codes to Characterise Hospital-Acquired Complications
Authors: Michel Jude L , Nghiem Hong Son , Jackson Terri J
Published: March 2016

This paper describes the limitations of using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) to characterise patient harm in hospitals. Limitations were identified during a project to use diagnoses flagged by Victorian coders as hospital-acquired to devise a classification of 144 categories of hospital acquired diagnoses (the Classification of Hospital Acquired Diagnoses or CHADx). CHADx is a comprehensive data monitoring system designed to allow hospitals to monitor their complication rates month-to-month using a standard method. Difficulties in identifying a single event from linear sequences of codes due to the absence of code linkage were the major obstacles to developing the classification. Obstetric and perinatal episodes also presented challenges in distinguishing condition onset, that is, whether conditions were present on admission or arose after formal admission to hospital. Used in the appropriate way, the CHADx allows hospitals to identify areas for future patient safety and quality initiatives. The value of timing information and code linkage should be recognised in the planning stages of any future electronic systems.
The Impact of Health Information Technology on the Quality of Medical and Health Care: A Systematic Review
Authors: Jamal Aziz , McKenzie Kirsten , Clark Michele
Published: March 2016

The aim of this study was to systematically review the published evidence of the impact of health information technology (HIT) or health information systems (HIS) on the quality of healthcare, focusing on clinicians' adherence to evidence-based guidelines and the corresponding impact this had on patient clinical outcomes. The review covered the use of health information technologies and systems in both medical care (i.e. clinical and surgical) and other areas such as allied health and preventive services. Studies were included in the review if they examined the impact of Electronic Health Record (EHR), Computerised Provider Order-Entry (CPOE), or Decision Support System (DS); and if the primary outcomes of the studies were focused on the level of compliance with evidence-based guidelines among clinicians. Measurements considered relevant to the review were either of changes in clinical processes resulting from a change of the providers' behaviour, or of specific patient outcomes that demonstrated the effectiveness of a particular treatment given by providers. Of 23 studies included in the current review, 17 assessed the impact of HIT/HIS on health care practitioners' performance. A positive improvement, in relation to their compliance with evidence-based guidelines, was seen in 14 studies. Studies that included an assessment of patient outcomes, however, showed insufficient evidence of either clinically or statistically important improvements. Although the number of studies reviewed was relatively small, the findings demonstrated consistency with similar previous reviews of this nature in that wide scale use of HIT has been shown to increase clinician's adherence to guidelines.