Showing papers by "Monash University published in 1998"

Successfully completing case study research: combining rigour, relevance and pragmatism

Abstract: The organizational and social issues associated with the development, implementation and use of computer-based information systems have increasingly attracted the attention of information systems researchers. Interest in qualitative research methods such as action research, case study research and ethnography, which focus on understanding social phenomena in their natural setting, has consequently grown. Case study research is the most widely used qualitative research method in information systems research, and is well suited to understanding the interactions between information technology-related innovations and organizational contexts. Although case study research is useful as a means of studying information systems development and use in the field, there can be practical difficulties associated with attempting to undertake case studies as a rigorous and effective method of research. This paper addresses a number of these difficulties and offers some practical guidelines for successfully completing case study research. The paper focuses on the pragmatics of conducting case study research, and draws from the discussion at a panel session conducted by the authors at the 8th Australasian Conference on Information Systems, September 1997 (ACIS 97), from the authors' practical experiences, and from the case study research literature.

EEA1 links PI(3)K function to Rab5 regulation of endosome fusion

Abstract: GTPases and lipid kinases regulate membrane traffic along the endocytic pathway by mechanisms that are not completely understood. Fusion between early endosomes requires phosphatidylinositol-3-OH kinase (PI(3)K) activity as well as the small GTPase Rab5. Excess Rab5-GTP complex restores endosome fusion when PI(3)K is inhibited. Here we identify the early-endosomal autoantigen EEA1 which binds the PI(3)K product phosphatidylinositol-3-phosphate, as a new Rab5 effector that is required for endosome fusion. The association of EEA1 with the endosomal membrane requires Rab5-GTP and PI(3)K activity, and excess Rab5-GTP stabilizes the membrane association of EEA1 even when PI(3)K is inhibited. The identification of EEA1 as a direct Rab5 effector provides a molecular link between PI(3)K and Rab5, and its restricted distribution to early endosomes indicates that EEA1 may confer directionality to Rab5-dependent endocytic transport.

The effect of an endothelin-receptor antagonist, bosentan, on blood pressure in patients with essential hypertension

Abstract: Background Endothelin is a powerful vasoconstrictor peptide derived from the endothelium. We evaluated the contribution of endothelin to blood-pressure regulation in patients with essential hypertension by studying the effect of an endothelin-receptor antagonist, bosentan. Methods We studied 293 patients with mild-to-moderate essential hypertension. After a placebo run-in period of four to six weeks, patients were randomly assigned to receive one of four oral doses of bosentan (100, 500, or 1000 mg once daily or 1000 mg twice daily), placebo, or the angiotensin-converting–enzyme inhibitor enalapril (20 mg once daily) for four weeks. Blood pressure was measured before and after treatment. Results As compared with placebo, bosentan resulted in a significant reduction in diastolic pressure with a daily dose of 500 or 2000 mg (an absolute reduction of 5.7 mm Hg at each dose), which was similar to the reduction with enalapril (5.8 mm Hg). There were no significant changes in heart rate. Bosentan did not result...

Assessment of Clinical Performance during Simulated Crises Using Both Technical and Behavioral Ratings

Abstract: BackgroundTechniques are needed to assess anesthesiologists' performance when responding to critical events. Patient simulators allow presentation of similar crisis situations to different clinicians. This study evaluated ratings of performance, and the interrater variability of the ratings, made by

Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials

Abstract: Objective: To determine whether intranasal corticosteroids are superior to oral H 1 receptor antagonists (antihistamines) in the treatment of allergic rhinitis. Design: Meta-analysis of randomised controlled trials comparing intranasal corticosteroids with oral antihistamines. Setting: Randomised controlled trials conducted worldwide and published between 1966 and 1997. Subjects: 2267 subjects with allergic rhinitis in 16 randomised controlled trials. Main outcome measures: Nasal blockage, nasal discharge, sneezing, nasal itch, postnasal drip, nasal discomfort, total nasal symptoms, nasal resistance, and eye symptoms and global ratings. Outcomes measured on different scales were combined to determine pooled odds ratios (categorical outcomes) or standardised mean differences (continuous outcomes). Assessment of heterogeneity between studies, and subgroup analyses of eye symptoms, were undertaken. Results: Intranasal corticosteroids produced significantly greater relief than oral antihistamines of nasal blockage (standardised mean difference −0.63, 95% confidence interval −0.73 to −0.53), nasal discharge (−0.5, −0.6 to −0.4), sneezing (−0.49, −0.59 to −0.39), nasal itch (−0.38, −0.49 to −0.21), postnasal drip (−0.24, −0.42 to −0.06), and total nasal symptoms (−0.42, −0.53 to −0.32), and global ratings gave an odds ratio for deterioration of symptoms of 0.26 (0.08 to 0.8). There were no significant differences between treatments for nasal discomfort, nasal resistance, or eye symptoms. The effects on sneezing, total nasal symptoms, and eye symptoms were significantly heterogeneous between studies. Other combined outcomes were homogeneous between studies. Subgroup analysis of the outcome of eye symptoms suggested that the duration of assessment (averaged mean score over the study period versus mean score at end of study period) might have accounted for the heterogeneity. Conclusion: The results of this systematic review, together with data on safety and cost effectiveness, support the use of intranasal corticosteroids over oral antihistamines as first line treatment for allergic rhinitis.

Room-temperature molten salts based on the quaternary ammonium ion

Abstract: The properties of a family of novel quaternary ammonium salts based on the bis(trifluoromethylsulfonyl)imide and triflate anions are reported. Binary phase diagrams for some of their mixtures and their electrochemical windows of stability are also reported. The highest conductivity observed in the pure salt systems at 25 °C was 7 × 10-4 S cm-1. An electrochemical window of stability of up to 5 V was measured on graphite electrodes. The effect of salt structure and solvent on conductivity of the salts is also discussed.

Resistance: a constructive tool for change management

Abstract: Traditionally, resistance has been cast as adversarial ‐ the enemy of change that must be defeated if change is to be successful. While it is apparent that classical management theory viewed resistance in such a manner, recent literature contains much evidence that suggests resistance may indeed be useful and is not to be simply discounted. Present day suggestions and prescriptions for managing resistance have evidently disregarded this research and left little room for utility in resistance. This paper argues that the difficulty of organisational change is often exacerbated by the mismanagement of resistance derived from a simple set of assumptions that misunderstand resistance’s essential nature. It is suggested that management may greatly benefit from techniques that carefully manage resistance to change by looking for ways of utilising it rather than overcoming it.

Parietal neglect and visual awareness.

Abstract: The last decade has seen a resurgence of interest in the neural correlates of conscious vision, with most discussion focused on the 'blindsight' that can follow damage to primary visual cortex, in the occipital lobe. We suggest that new insights into the neural basis of visual awareness may be gleaned from a different neuropsychological phenomenon, namely visual 'neglect' after injury to regions in the parietal lobe. Neglect provides several revealing contrasts with occipital blindsight. Here we summarise four key findings. First, unlike the deficits caused by damage to primary visual cortex, the loss of awareness in parietal neglect is characteristically not strictly retinotopic. Second, visual segmentation processes are preserved in neglect, and can influence what will reach the patient's awareness. Third, extensive unconscious processing takes place for those stimuli on the neglected side which escape awareness, including some degree of object identification. Finally, parietal damage affects initial stages of motor planning as well as perception. These findings are consistent with recent data on single-cell activity in the monkey brain. They also suggest why areas in the inferior parietal lobe may play a prominent role in visual awareness.

Indoor airborne fungal spores, house dampness and associations with environmental factors and respiratory health in children

Abstract: Background Children living in a damp house are more likely to suffer from respiratory symptoms and it has been suggested that exposure to fungi is an important contributing factor. However, more knowledge about underlying mechanisms for the association are needed. Objective To identify associations between measures of house dampness, levels of airborne fungal spores, housing factors and health outcomes in children. Methods Eighty households with 148 children between 7 and 14 years of age were recruited in the Latrobe Valley, Victoria, Australia. Some 36% of participating children were asthmatic. Six sampling visits were made to each house between March 1994 and February 1995 on a 2-monthly cycle. Samples for airborne total and viable fungal spores were collected from bedrooms, living rooms, kitchens and outdoors. A detailed dwelling characterization, using a questionnaire and inspection surveys, was carried out. Skin-prick tests were performed with extracts of common aeroallergens and a respiratory questionnaire was completed for each child. Results Large airborne fungal spore concentrations were recorded in association with: musty odour, water intrusion, high indoor humidity, limited ventilation through open windows, few extractor fans and failure to remove indoor mould growth. Visible mould growth or condensation evidence was associated with large concentrationsof Cladosporium spores, but not with large total spore concentrations. Penicillium exposure was a risk factor for asthma, while Aspergillus exposure was a risk factor for atopy. Fungal allergies were more common among children exposed to Cladosporium or Penicillium in winter or to musty odour. Respiratory symptoms were marginally more common with exposure to Cladosporium or total spores in winter. Conclusion Indoor exposure to certain fungal genera in winter was a risk factor for asthma, atopy and respiratory symptoms in children. On the other hand, no significant associations were seen between average viable or total spore concentrations and child health. Actual measurements of fungal spores predict health outcomes better than reported dampness.

Out of Africa and back again: nested cladistic analysis of human Y chromosome variation.

Abstract: We surveyed nine diallelic polymorphic sites on the Y chromosomes of 1,544 individuals from Africa, Asia, Europe, Oceania, and the New World Phylogenetic analyses of these nine sites resulted in a tree for 10 distinct Y haplotypes with a coalescence time of approximately 150,000 years The 10 haplotypes were unevenly distributed among human populations: 5 were restricted to a particular continent, 2 were shared between Africa and Europe, 1 was present only in the Old World, and 2 were found in all geographic regions surveyed The ancestral haplotype was limited to African populations Random permutation procedures revealed statistically significant patterns of geographical structuring of this paternal genetic variation The results of a nested cladistic analysis indicated that these geographical associations arose through a combination of processes, including restricted, recurrent gene flow (isolation by distance) and range expansions We inferred that one of the oldest events in the nested cladistic analysis was a range expansion out of Africa which resulted in the complete replacement of Y chromosomes throughout the Old World, a finding consistent with many versions of the Out of Africa Replacement Model A second and more recent range expansion brought Asian Y chromosomes back to Africa without replacing the indigenous African male gene pool Thus, the previously observed high levels of Y chromosomal genetic diversity in Africa may be due in part to bidirectional population movements Finally, a comparison of our results with those from nested cladistic analyses of human mtDNA and beta-globin data revealed different patterns of inferences for males and females concerning the relative roles of population history (range expansions) and population structure (recurrent gene flow), thereby adding a new sex-specific component to models of human evolution

Systematic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy

Abstract: OBJECTIVE: To review the efficacy of common interventions for shoulder pain. DESIGN: All randomised controlled trials of non-steroidal anti-inflammatory drugs, intra-articular and subacromial glucocorticosteroid injection, oral glucocorticosteroid treatment, physiotherapy, manipulation under anaesthesia, hydrodilatation, and surgery for shoulder pain that were identified by computerised and hand searches of the literature and had a blinded assessment of outcome were included. MAIN OUTCOME MEASURES: Methodological quality (score out of 40), selection criteria, and outcome measures. Effect sizes were calculated and combined in a pooled analysis if study population, end point, and intervention were comparable. RESULTS: Thirty one trials met inclusion criteria. Mean methodological quality score was 16.8 (9.5-22). Selection criteria varied widely, even for the same diagnostic label. There was no uniformity in the outcome measures used, and their measurement properties were rarely reported. Effect sizes for individual trials were small (range -1.4 to 3.0). The results of only three studies investigating "rotator cuff tendinitis" could be pooled. The only positive finding was that subacromial steroid injection is better than placebo in improving the range of abduction (weighted difference between means 35 degrees (95% confidence interval 14 to 55)). CONCLUSIONS: There is little evidence to support or refute the efficacy of common interventions for shoulder pain. As well as the need for further well designed clinical trials, more research is needed to establish a uniform method of defining shoulder disorders and developing outcome measures which are valid, reliable, and responsive in affected people.

Using fossil leaves as paleoprecipitation indicators : an eocene example

Abstract: Estimates of past precipitation are of broad interest for many areas of inquiry, including reconstructions of past environments and topography, climate modeling, and ocean circulation studies. The shapes and sizes of living leaves are highly sensitive to moisture conditions, and assemblages of fossil leaves of flowering plants have great potential as paleoprecipitation indicators. Most quantitative estimates of paleoprecipitation have been based on a multivariate data set of morphological leaf characters measured from samples of living vegetation tied to climate stations. However, when tested on extant forests, this method has consistently overestimated precipitation. We present a simpler approach that uses only the mean leaf area of a vegetation sample as a predictor variable but incorporates a broad range of annual precipitation and geographic coverage into the predictor set. The significant relationship that results, in addition to having value for paleoclimatic reconstruction, refines understanding of the long-observed positive relationship between leaf area and precipitation. Seven precipitation estimates for the Eocene of the Western United States are revised as lower than previously published but remain far wetter than the same areas today. Abundant moisture may have been an important factor in maintaining warm, frost-free conditions in the Eocene because of the major role of water vapor in retaining and transporting atmospheric heat.

Single-versus multiple–dose antimicrobial prophylaxis for major surgery: a systematic review

Abstract: Background: Single-dose antimicrobial prophylaxis for major surgery is widely accepted principle; recommendations have been based on laboratory studies and numerous clinical trials published in the last 25 years. In practice, single-dose prophylaxis has not been universally accepted and multiple-dose regimens are still used in some centres. Moreover, the principle has recently been challenged by the results of an Australian study of vascular surgery. The aim of this current systematic review is to determine the overall efficacy of single versus multiple–dose antimicrobial prophylaxis for major surgery and across surgical disciplines. Methods: Relevant studies were identified in the medical literature using the MEDLINE database and other search strategies. Trials included in the review were prospective and randomized, had the same antimicrobial in each treatment arm and were published in English. Rates of postoperative surgical site infections (SSI) were extracted, 2 × 2 tables prepared and odds ratios (OR) [with 95% confidence intervals (95% CI)] calculated. Data were then combined using fixed and random effects models to provide an overall figure. In this context, high value for the combined OR, with 95% CI > 1.0, indicates superiority of multiple–dose regimens and low OR, with 95% CI < 1.0, suggests the opposite. A combined OR close to 1.0, with narrow 95% CI straddling 1.0, indicates no clear advantage of one regimen over another. Further subgroup analyses were also performed. Results: Combined OR by both fixed (1.06,95% CI, 0.89–1.25) and random effects (1.04, 95% CI, 0.86–1.25) models indicated no clear advantage of either single or multiple-dose regimens in preventing SSI. Likewise, subgroup analysis showed no statistically significant differences associated with type of antimicrobial used (beta-lactam vs other), blinded wound assessment, length of the multiple–dose arm (> 24 h vs 24 h or less) or type of surgery (obstetric and gynaecological vs other). Conclusions: Continued use of single–dose antimicrobial prophylaxis for major surgery is recommended. Further studies are required, especially in previously neglected surgical disciplines.

Are there subgroups within the autistic spectrum? A cluster analysis of a group of children with autistic spectrum disorders.

Abstract: Comprehensive data on the developmental history and current behaviours of a large sample of high-functioning individuals with diagnoses of autism, Asperger's syndrome, or other related disorder were collected via parent interviews. This provided the basis for a taxonomic analysis to search for subgroups. Most participants also completed theory of mind tasks. Three clusters or subgroups were obtained; these differed on theory of mind performance and on verbal abilities. Although subgroups were identified which bore some relationship to clinical differentiation of autistic, Asperger syndrome, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) cases, the nature of the differences between them appeared strongly related to ability variables. Examination of the kinds of behaviours that differentiated the groups suggested that a spectrum of autistic disorders on which children differ primarily in term of degrees of social and cognitive impairments could explain the findings.

Identification and precursor frequency analysis of a common T cell epitope motif in mitochondrial autoantigens in primary biliary cirrhosis.

Abstract: The immunodominant antimitochondrial antibody response in patients with primary biliary cirrhosis (PBC) is directed against the E2 component of the pyruvate dehydrogenase complex (PDC-E2). Based on our earlier observations regarding peripheral blood mononuclear cell (PBMC) T cell epitopes, we reasoned that a comparative analysis of the precursor frequencies of PDC-E2 163-176-specific T cells isolated from PBMC, regional hepatic lymph nodes, and from the liver of PBC patients would provide insight regarding the role of T cells in PBC. Results showed a disease-specific 100-150-fold increase in the precursor frequency of PDC-E2 163-176-specific T cells in the hilar lymph nodes and liver when compared with PBMC from PBC patients. Interestingly, autoreactive T cells and autoantibodies from PBC patients both recognize the same dominant epitope. In addition, we demonstrated cross-reactivity of PDC-E2 peptide 163-176-specific T cell clones with PDC-E2 peptide 36-49 and OGDC-E2 peptide 100-113 thereby identifying a common T cell epitope "motif" ExETDK. The peptide 163-176-specific T cell clones also reacted with purified native PDC-E2, suggesting that this epitope is not a cryptic determinant. These data provide evidence for a major role for PDC-E2 peptide 163-176 and/or peptides bearing a similar motif in the pathogenesis of PBC.

Sudden death in psychiatric patients.

Abstract: BACKGROUND The present study investigated histories of prior psychiatric treatment in cases of sudden death reported to the coroner. METHODS A matching survey linked the register of deaths reported to the coroner with a comprehensive statewide psychiatric case register covering both in-patient and community-based services. RESULTS Sudden death was five times higher in people with histories of psychiatric contact. Suicide accounted for part of this excess mortality but deaths from natural causes and accidents were also elevated. Schizophrenic and affective disorders had similar suicide rates. Comorbid substance misuse doubled the risk of sudden death in affective and schizophrenic disorders. CONCLUSIONS The rates of sudden death are sufficiently elevated to raise questions about current priorities in mental health care. There is a need both for greater attention to suicide risk, most notably among young people with schizophrenia, to the early detection of cardiovascular disorders and to the vigorous management of comorbid substance misuse.

FTIR microspectroscopic study of cell types and potential confounding variables in screening for cervical malignancies

Abstract: FTIR microscopy was applied to the analysis of cell types and other variables present in Pap smears to ascertain the limitations of infrared spectroscopy in the diagnosis of cervical cancer and dysplasia. It was found that leukocytes, and in particular lymphocytes, have spectral features in the phosphodiester region (1300-900 cm[-1]) suggestive of what has previously been described as changes indicative of malignancy. Endocervical cells and fibroblasts have similar spectral features to HeLa cells and consequently could also confound diagnosis. The use of ethanol as a fixative and dehydrating agent results in retention of glycogen in cervical cell types and thus minimizes spectral changes in the glycogen region due to sampling technique. Spectra of seminal fluids exhibit strong bands in the phosphodiester/carbohydrate region; however, sperm contamination should be easily detectable by the presence of a distinctive doublet at 981/968 cm(-1). Erythrocyte spectra exhibit a reduction in glycogen band intensity, but can be discerned by a relatively low-intensity nu(s) PO2- band. Endocervical mucin spectra exhibit a reduction in glycogen bands and a very pronounced nu(s) PO2- band, which is similar in intensity to the corresponding band in HeLa cells. Thrombocytes have strong bands in the phosphodiester region, but thrombocytes can be discerned from other cell types by the presence of two small broad bands at 980 and 935 cm(-1). Candida albicans is characterized by strong bands in the polysaccharide region which could potentially obscure diagnostic bands if C. albicans is present in large numbers. Spectra of bacteria common to the female genital tract, in general, also have strong absorptions in the polysaccharide region; however, bacterial contamination is usually minimal and would not be expected to obscure cervical cell spectra. Nylon threads and bristles from cervical sampling implements produce characteristic IR profiles which allow for easy identification. Given the number of potential confounding variables associated with cervical cytology, a multivariate statistical or neural network analysis would appear to be necessary before the implementation of FTIR technology in clinical laboratories.

Developing Co-operative Buyer–Supplier Relationships: A Case Study of Toyota

Abstract: Over recent years many businesses have recognized that there are strong competitive advantages in developing co-operative partnerships with suppliers. An important challenge for many companies is to identify the factors to enable them to move from relationships characterized by strong buyer power and bargaining position, to partnerships based on trust and co-operation. The purpose of this paper is to consider factors that may influence the development of co-operative buyer–supplier relationships. A case study is presented which illustrates the developing relationship between an automotive manufacturer, Toyota Australia, and its suppliers, as part of a new supplier strategy. Several factors are proposed which provide areas for further research. These include the consideration of similarities between the industry and technologies of buyer and suppliers, prior experiences of change among suppliers, effective communications between buyer and suppliers, and the importance of experiential learning in the acceptance of change.

Sport and active recreation injuries in Australia: evidence from emergency department presentations.

Abstract: OBJECTIVE: Despite the rise in specialist clinical services for the management of sports and active recreation injury, many patients attend hospital emergency departments for treatment. The purpose of this study was to describe sports injury cases presented to selected hospital emergency departments around Australia for the period 1989-1993. METHODS: Routinely collected emergency department injury presentation data from the Australian National Injury Surveillance Unit were examined. Data on 98,040 sports and active recreation emergency department presentations were analysed. Sports and active recreation activities were ranked according to frequency of presentation. Relative proportions of injury type and body region injured were determined. Data are presented separately for children ( 15 years of age). RESULTS: Among the 10 activities that most commonly led to a sports or active recreation injury presentation for all ages were cycling, Australian football, basketball, soccer, cricket, netball, and rugby. For children, injuries were also commonly associated with roller skating/blading, skateboarding, and trampolining. Hockey, martial arts, and dancing injuries were frequent in adults. Most sporting injuries occurred during organised competition or practice whereas the active recreation injuries occurred in a variety of settings. Fractures, strains, and sprains, particularly to the lower and upper extremities, were common types of injury. CONCLUSION: The rich, but nevertheless limited, information available about sports and active recreation injuries from data collected in emergency departments indicates that these activities are a common context for injury at the community level in Australia.

The Nature and Dimensions of Precarious Employment in Australia

Abstract: The quality of employment is often neglected in policy debates in Australia. Non-standard employment forms are dominating job generation in Australia. While the non-standard category is heterogeneous, it contains many jobs that exhibit characteristics of precariousness. Moreover, though precariousness is concentrated in non-standard employment, it is by no means confined to non-standard employment. Precariousness also affects parts of standard employment itself. This article is exploratory, aimed at taking up and applying the concept of precariousness to employment in Australia. It discusses the concept of precariousness, emphasising the importance of varied dimensions of labour insecurity. It then outlines the nature, spread and implications of precarious employment in Australia.

Surgical and medical treatment of adenomyosis

Abstract: The treatment of adenomyosis has been limited by the difficulty and delay associated with the diagnosis, often not until after hysterectomy. Magnetic resonance imaging, high resolution vaginal ultrasound and uterine biopsy have improved early detection of adenomyosis. Drug therapy may be effective in controlling symptoms but the frequent coexistence of endometriosis and the lack of controlled studies make their efficacy difficult to quantify. Conservative surgery involving endomyometrial ablation, laparoscopic myometrial electrocoagulation or excision has proven to be effective in >50% of patients, although follow-up has been restricted to 3 years. Hysterectomy will still be necessary in severe cases of adenomyosis. Early diagnosis may improve treatment. Investigations are indicated in women with menstrual pain or menorrhagia not responding to drug therapy.

Time–Frequency Variability of ENSO and Stochastic Simulations

Abstract: The time-frequency spectral structure of El Nino-Southern Oscillation (ENSO) time series holds much information about the physical dynamics of the ENSO system. The authors have analyzed changes of the spectrum with time of three ENSO indices: the conventional Southern Oscillation index (SOI), Nino3 sea surface temperatures, and a tropical Pacific rain index, over the period 1871-1995. Three methods of time-frequency analysis-windowed Fourier transform, wavelet analysis, and windowed Prony's method-were used, and the results are in good agreement. The time-frequency spectra of all the series show strong multidecadal variations over the past century. In particular, there was reduced activity of ENSO in the 2-3-yr periodicity range during the period 1920-60, compared with both the earlier and later periods. The dominant frequencies in the spectra do not appear to be constrained to certain frequency bands, and there is no evidence that the ENSO system has fixed modes of oscillation. The qualitative behavior of the real SOI time series has been compared with that of time series simulated by an autoregressive stochastic process of order 3 and time series created by phase-randomizing the spectral components of the SOI. The decadal variability of the amplitude and time-frequency spectra was found to be very similar between the observed and simulated SOIs. This suggests that the decadal variability of ENSO can be well simulated by a stochastic model and that stochastic forcing may be an important component of ENSO dynamics.