Benefit cost analysis applied to behavioral and engineering safety countermeasures in San Francisco, California

The state of the practice in safety has advanced rapidly in recent years with the emergence of new tools and processes for improving selection of the most cost-effective safety countermeasures. However, many challenges prevent fair and objective comparisons of countermeasures applied across safety disciplines (e.g. engineering, emergency services, and behavioral measures). These countermeasures operate at different spatial scales, are funded often by different financial sources and agencies, and have associated costs and benefits that are difficult to estimate. This research proposes a methodology by which both behavioral and engineering safety investments are considered and compared in a specific local context. The methodology involves a multi-stage process that enables the analyst to select countermeasures that yield high benefits to costs, are targeted for a particular project, and that may involve costs and benefits that accrue over varying spatial and temporal scales. The methodology is illustrated using a case study from the Geary Boulevard Corridor in San Francisco, California. The case study illustrates that: 1) The methodology enables the identification and assessment of a wide range of safety investment types at the project level; 2) The nature of crash histories lend themselves to the selection of both behavioral and engineering investments, requiring cooperation across agencies; and 3) The results of the cost-benefit analysis are highly sensitive to cost and benefit assumptions, and thus listing and justification of all assumptions is required. It is recommended that a sensitivity analyses be conducted when there is large uncertainty surrounding cost and benefit assumptions.

Accelerated professional development and peer consultation : two strategies for continuing professional education for nurses

A comparison was made of accelerated professional development (APD) for nurses (n=64), involving peer consultation and reflective practice, and peer consultation alone (n=30). Although APD participants had a higher completion rate, improvements in caregiver behaviors and work environment were not significantly different.

On the reliability of classifying programming tasks using a Neo-Piagetian theory of cognitive development

Recent research has proposed Neo-Piagetian theory as a useful way of describing the cognitive development of novice programmers. Neo-Piagetian theory may also be a useful way to classify materials used in learning and assessment. If Neo-Piagetian coding of learning resources is to be useful then it is important that practitioners can learn it and apply it reliably. We describe the design of an interactive web-based tutorial for Neo-Piagetian categorization of assessment tasks. We also report an evaluation of the tutorial's effectiveness, in which twenty computer science educators participated. The average classification accuracy of the participants on each of the three Neo-Piagetian stages were 85%, 71% and 78%. Participants also rated their agreement with the expert classifications, and indicated high agreement (91%, 83% and 91% across the three Neo-Piagetian stages). Self-rated confidence in applying Neo-Piagetian theory to classifying programming questions before and after the tutorial were 29% and 75% respectively. Our key contribution is the demonstration of the feasibility of the Neo-Piagetian approach to classifying assessment materials, by demonstrating that it is learnable and can be applied reliably by a group of educators. Our tutorial is freely available as a community resource.

Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010 : a systematic analysis for the Global Burden of Disease Study 2010

Background Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither effort quantified uncertainty in prevalence or years lived with disability (YLDs). Methods Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis. Findings Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350 000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient −0·37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa. Interpretation Rates of YLDs per 100 000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Effective and affordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world. Funding Bill & Melinda Gates Foundation.

Rapid, long-distance dispersal by pumice rafting

Pumice is an extremely effective rafting agent that can dramatically increase the dispersal range of a variety of marine organisms and connect isolated shallow marine and coastal ecosystems. Here we report on a significant recent pumice rafting and long-distance dispersal event that occurred across the southwest Pacific following the 2006 explosive eruption of Home Reef Volcano in Tonga. We have constrained the trajectory, and rate, biomass and biodiversity of transfer, discovering more than 80 species and a substantial biomass underwent a .5000 km journey in 7–8 months. Differing microenvironmental conditions on the pumice, caused by relative stability of clasts at the sea surface, promoted diversity in biotic recruitment. Our findings emphasise pumice rafting as an important process facilitating the distribution of marine life, which have implications for colonisation processes and success, the management of sensitive marine environments, and invasive pest species.

Knowledge unlatched : towards an open and networked future for academic publishing

Specialist book length publications in the humanities and social sciences (including but not exclusively monographs) are experiencing a crisis. It is clear that the current publishing system is failing both the producers and users of scholarship and neglects many of the opportunities associated with networked culture.

Integrated genomic characterization of endometrial carcinoma

We performed an integrated genomic, transcriptomic and proteomic characterization of 373 endometrial carcinomas using array- and sequencing-based technologies. Uterine serous tumours and ∼25% of high-grade endometrioid tumours had extensive copy number alterations, few DNA methylation changes, low oestrogen receptor/progesterone receptor levels, and frequent TP53 mutations. Most endometrioid tumours had few copy number alterations or TP53 mutations, but frequent mutations in PTEN, CTNNB1, PIK3CA, ARID1A and KRAS and novel mutations in the SWI/SNF chromatin remodelling complex gene ARID5B. A subset of endometrioid tumours that we identified had a markedly increased transversion mutation frequency and newly identified hotspot mutations in POLE. Our results classified endometrial cancers into four categories: POLE ultramutated, microsatellite instability hypermutated, copy-number low, and copy-number high. Uterine serous carcinomas share genomic features with ovarian serous and basal-like breast carcinomas. We demonstrated that the genomic features of endometrial carcinomas permit a reclassification that may affect post-surgical adjuvant treatment for women with aggressive tumours.

Diversity and Differentiation

New ways of working are being embraced by early childhood educators as they cope with demands from national reforms and changing communities. While reformers are pressing for social equity and improved outcomes for families and children, communities are diverging in terms of ethnicity, culture, language and socioeconomic status. As a consequence, early childhood educators are being challenged to expand their existing repertoire of practices in order to more effectively provide quality learning experiences for every child in their care. Practice enhancement and differentiated pedagogy are needed to address the additional needs of an increasing number of diverse learners. Community expectations are particularly focused on better educational supports for children in five cluster areas: • Culturally diverse and Indigenous backgrounds • ‘at risk’ because of socio-economic and abuse conditions • Communicative, emotional and behavioural disorders • Disabilities and learning difficulties and • Recognised gifts and talents This chapter focuses on some everyday ractices that can be used strategically to better support all children, including those with additional educational needs. All practices are well supported in the literature and are substantiated by either research findings or strong, socially determined values. They also very ‘doable’ and sustainable in today’s dynamic and multifaceted early childhood settings. Seven keys practices will be introduced, together with examples of how they can be applied to both enhance the learning of individual children and to strengthen a sense of group belonging. The practices are: • Having positive beliefs about all children • Learning about each child • Building meaningful relationships around the child • Creating supportive learning environments for the child • Providing engaging learning experiences for the child • Differentiating instruction for the child • Using child progress data to improve learning and teaching

Verification of patient position and delivery of IMRT by electronic portal imaging

Background and purpose: The purpose of the work presented in this paper was to determine whether patient positioning and delivery errors could be detected using electronic portal images of intensity modulated radiotherapy (IMRT). Patients and methods: We carried out a series of controlled experiments delivering an IMRT beam to a humanoid phantom using both the dynamic and multiple static field method of delivery. The beams were imaged, the images calibrated to remove the IMRT fluence variation and then compared with calibrated images of the reference beams without any delivery or position errors. The first set of experiments involved translating the position of the phantom both laterally and in a superior/inferior direction a distance of 1, 2, 5 and 10 mm. The phantom was also rotated 1 and 28. For the second set of measurements the phantom position was kept fixed and delivery errors were introduced to the beam. The delivery errors took the form of leaf position and segment intensity errors. Results: The method was able to detect shifts in the phantom position of 1 mm, leaf position errors of 2 mm, and dosimetry errors of 10% on a single segment of a 15 segment IMRT step and shoot delivery (significantly less than 1% of the total dose). Conclusions: The results of this work have shown that the method of imaging the IMRT beam and calibrating the images to remove the intensity modulations could be a useful tool in verifying both the patient position and the delivery of the beam.

The use of electronic portal imaging to verify patient position during intensity-modulated radiotherapy delivered by the dynamic MLC technique

Purpose: The precise shape of the three-dimensional dose distributions created by intensity-modulated radiotherapy means that the verification of patient position and setup is crucial to the outcome of the treatment. In this paper, we investigate and compare the use of two different image calibration procedures that allow extraction of patient anatomy from measured electronic portal images of intensity-modulated treatment beams. Methods and Materials: Electronic portal images of the intensity-modulated treatment beam delivered using the dynamic multileaf collimator technique were acquired. The images were formed by measuring a series of frames or segments throughout the delivery of the beams. The frames were then summed to produce an integrated portal image of the delivered beam. Two different methods for calibrating the integrated image were investigated with the aim of removing the intensity modulations of the beam. The first involved a simple point-by-point division of the integrated image by a single calibration image of the intensity-modulated beam delivered to a homogeneous polymethyl methacrylate (PMMA) phantom. The second calibration method is known as the quadratic calibration method and required a series of calibration images of the intensity-modulated beam delivered to different thicknesses of homogeneous PMMA blocks. Measurements were made using two different detector systems: a Varian amorphous silicon flat-panel imager and a Theraview camera-based system. The methods were tested first using a contrast phantom before images were acquired of intensity-modulated radiotherapy treatment delivered to the prostate and pelvic nodes of cancer patients at the Royal Marsden Hospital. Results: The results indicate that the calibration methods can be used to remove the intensity modulations of the beam, making it possible to see the outlines of bony anatomy that could be used for patient position verification. This was shown for both posterior and lateral delivered fields. Conclusions: Very little difference between the two calibration methods was observed, so the simpler division method, requiring only the single extra calibration measurement and much simpler computation, was the favored method. This new method could provide a complementary tool to existing position verification methods, and it has the advantage that it is completely passive, requiring no further dose to the patient and using only the treatment fields.