Pulmonary embolism in the emergency department : a Singaporean nursing case review

Introduction The presentation of pulmonary embolism to the emergency department (ED) can prove challenging because of the myriad of potential disease processes that mimic its signs and symptoms. The incidence of pulmonary embolism and indeed the mortality associated with it is relatively high. Early diagnosis and treatment is crucial in off-setting the potential deleterious effects associated with this condition. The aim of this article is to present a nursing case review of a patient presenting to the ED with a diagnosis of pulmonary embolism. Method We chose to use a case review to highlight the nursing and medical care that was provided for a patient who presented to the emergency department acutely with dyspnoea, chest pain and pyrexia. The use of case reviews are useful in reporting unusual or rare cases and this format is typically seen more in medicine than in nursing. They can naturally take one of two formats—a single case report or a series of case reports; in this case we opted to report on a single case. Discussion The gentleman in question was an ambulance admissionto the ED with a three day history of chest pain, shortness of breath and one episode of syncope which brought him to the ED. Over the course of his admission a variety of treatment modalities were used successfully to alleviate the problem. More notable from a nursing perspective was the use of diagnostic tools as an interpretation to guide his care and provide a platform from which a deeper understanding and appreciation of the intricacies the critically ill patient often presents. Conclusion We found the use of case review very enlightening in understanding the disease process and the decision-making that accompanies this. Whilst our patient was successfully rehabilitated home, we learnt a lot from the experience which has been most beneficial in supporting our understanding of pulmonary embolism.

Lattice basis delegation in fixed dimension and shorter-ciphertext hierarchical IBE

We present a technique for delegating a short lattice basis that has the advantage of keeping the lattice dimension unchanged upon delegation. Building on this result, we construct two new hierarchical identity-based encryption (HIBE) schemes, with and without random oracles. The resulting systems are very different from earlier lattice-based HIBEs and in some cases result in shorter ciphertexts and private keys. We prove security from classic lattice hardness assumptions.

Public sector project delay : the Malaysian perspective and the way forward

Construction delay has been a protracted problem for the Malaysian construction industry. Recent report showed that 80% of public sector projects are behind schedule. This underachieving time performance has led to many problems including public complaints, loss of reputation and revenue for the government and a slump in the industry’s GDP contribution. Research in the area of project delay has mushroomed worldwide with attempts to place mitigation plans, but delay remains a global phenomenon. There is now an urgent need for revolutionizing construction practices and past research, backed up with few successful cases suggests that Supply Chain Management (SCM) could prove beneficial to reduce or eliminate delays in construction. SCM which originated from the automotive manufacturing industry promotes a more collaborative approach to construction management and has recently gained attention of the construction industry. However every country, including Malaysia, would certainly have disparities of their own compared to others being it from the cultural point of view, nature of problems, locality or improvements needed. Therefore, this paper will present part of a Ph.D. research which aims at illustrating the Malaysian construction industry experts’ perception of the Malaysian public sector project delay, provide insight into these dilemmas, highlights the problems with current practices, its effects and the improvements needed. Subsequently, this paper would propose ratification to the problems using SCM. A semi-structured interview has been conducted to practitioners with at least 20 years’ experience in the industry. The findings showed that Malaysia may be unique compared to other countries and that by considering a number of additional factors, SCM could prove beneficial to increase efficiency of the Malaysian public sector projects.

The resistance of PRESENT-80 against related-key differential attacks

We examine the security of the 64-bit lightweight block cipher PRESENT-80 against related-key differential attacks. With a computer search we are able to prove that for any related-key differential characteristic on full-round PRESENT-80, the probability of the characteristic only in the 64-bit state is not higher than 2−64. To overcome the exponential (in the state and key sizes) computational complexity of the search we use truncated differences, however as the key schedule is not nibble oriented, we switch to actual differences and apply early abort techniques to prune the tree-based search. With a new method called extended split approach we are able to make the whole search feasible and we implement and run it in real time. Our approach targets the PRESENT-80 cipher however,with small modifications can be reused for other lightweight ciphers as well.

New security notions and relations for public-key encryption

Since their introduction, the notions of indistinguishability and non-malleability have been changed and extended by different authors to support different goals. In this paper, we propose new flavors of these notions, investigate their relative strengths with respect to previous notions, and provide the full picture of relationships (i.e., implications and separations) among the security notions for public-key encryption schemes. We take into account the two general security goals of indistinguishability and non-malleability, each in the message space, key space, and hybrid message-key space to find six specific goals, a couple of them, namely complete indistinguishability and key non-malleability, are new. Then for each pair of goals, coming from the indistinguishability or non-malleability classes, we prove either an implication or a separation, completing the full picture of relationships among all these security notions. The implications and separations are respectively supported by formal proofs (i.e., reductions) in the concrete-security framework and by counterexamples.

Lattice-based threshold changeability for standard shamir sectret-sharing schemes

We consider the problem of increasing the threshold parameter of a secret-sharing scheme after the setup (share distribution) phase, without further communication between the dealer and the shareholders. Previous solutions to this problem require one to start off with a nonstandard scheme designed specifically for this purpose, or to have communication between shareholders. In contrast, we show how to increase the threshold parameter of the standard Shamir secret-sharing scheme without communication between the shareholders. Our technique can thus be applied to existing Shamir schemes even if they were set up without consideration to future threshold increases. Our method is a new positive cryptographic application for lattice reduction algorithms, inspired by recent work on lattice-based list decoding of Reed-Solomon codes with noise bounded in the Lee norm. We use fundamental results from the theory of lattices (geometry of numbers) to prove quantitative statements about the information-theoretic security of our construction. These lattice-based security proof techniques may be of independent interest.

Deleuze and music : a creative approach to the study of music

The work of Gilles Deleuze has influenced an increasing number of music scholars and practicing musicians, particularly those interested in experimental, electronic and popular music. This is despite the notoriously complex nature of his writings, and the specialised theoretical vocabulary that he employs. This thesis both demystifies some of the key terms and concepts of this vocabulary, before demonstrating how Deleuze’s ideas may be put to work in new and fruitful ways; this is achieved with specific reference to the relationships that music has with thought, time and machines. In Chapter 1, Deleuze’s understanding of the power of thought is examined, in particular his approach to communication, transcendence and immanence, and the “powers of thought.” Each of these concepts helps us to understand Deleuze’s work within broad problem of how to think about music immanently: that is, how to maintain that thought and music are both immanent aspects of life and experience. Chapter 2 examines time within a Deleuzian framework, linking his work on cinema with the concept of the “refrain”; both of these areas prove crucial to his understanding of music, as seen in Deleuze’s approach to the work of Varese, Messiaen, and Boulez. In addition, Deleuze’s understanding of time proves fruitful in examining various aspects of music production, as seen in contemporary electronic dance music. Finally, Chapter 3 looks at the concept of the machine, as developed by Deleuze and Guattari, with reference to the sorts of “machinic” connections that a Deleuzian approach encourages us to seek out in music. Once again, examples from contemporary electronic music are presented, in relation to the notions of becoming and subjectivity. Throughout these chapters, Deleuze’s broad understanding of philosophy as the “creation of concepts” is deployed. This means introducing new ideas and specific types of music that encourage creative and novel engagements with the study of music.

Known and chosen key differential distinguishers for block ciphers

In this paper we investigate the differential properties of block ciphers in hash function modes of operation. First we show the impact of differential trails for block ciphers on collision attacks for various hash function constructions based on block ciphers. Further, we prove the lower bound for finding a pair that follows some truncated differential in case of a random permutation. Then we present open-key differential distinguishers for some well known round-reduced block ciphers.

A rapid assessment of the effects of extreme weather on two Great Barrier Reef industries

In coastal areas, extreme weather events, such as floods and cyclones, can have debilitating effects on the social and economic viability of marine-based industries. In March 2011, the Great Barrier Reef Marine Park Authority implemented an Extreme Weather Response Program, following a period of intense flooding and cyclonic activity between December 2010 and February 2011. In this paper, we discuss the results of a project within the Program, which aimed to: (1) assess the impacts of extreme weather events on regional tourism and commercial fishing industries; and (2) develop and road-test an impact assessment matrix to improve government and industry responses to extreme weather events. Results revealed that extreme weather events both directly and indirectly affected all five of the measured categories, i.e. ecological, personal, social, infrastructure and economic components. The severity of these impacts, combined with their location and the nature of their business, influenced how tourism operators and fishers assessed the impact of the events (low, medium, high or extreme). The impact assessment tool was revised following feedback obtained during stakeholder workshops and may prove useful for managers in responding to potential direct and indirect impacts of future extreme weather events on affected marine industries. © 2013 Planning Institute Australia.

Source code watermarking based on function dependency oriented sequencing

In the current market, extensive software development is taking place and the software industry is thriving. Major software giants have stated source code theft as a major threat to revenues. By inserting an identity-establishing watermark in the source code, a company can prove it's ownership over the source code. In this paper, we propose a watermarking scheme for C/C++ source codes by exploiting the language restrictions. If a function calls another function, the latter needs to be defined in the code before the former, unless one uses function pre-declarations. We embed the watermark in the code by imposing an ordering on the mutually independent functions by introducing bogus dependency. Removal of dependency by the attacker to erase the watermark requires extensive manual intervention thereby making the attack infeasible. The scheme is also secure against subtractive and additive attacks. Using our watermarking scheme, an n-bit watermark can be embedded in a program having n independent functions. The scheme is implemented on several sample codes and performance changes are analyzed.

A new dynamic accumulator for batch updates

A dynamic accumulator is an algorithm, which gathers together a large set of elements into a constant-size value such that for a given element accumulated, there is a witness confirming that the element was indeed included into the value, with a property that accumulated elements can be dynamically added and deleted into/from the original set such that the cost of an addition or deletion operation is independent of the number of accumulated elements. Although the first accumulator was presented ten years ago, there is still no standard formal definition of accumulators. In this paper, we generalize formal definitions for accumulators, formulate a security game for dynamic accumulators so-called Chosen Element Attack (CEA), and propose a new dynamic accumulator for batch updates based on the Paillier cryptosystem. Our construction makes a batch of update operations at unit cost. We prove its security under the extended strong RSA (es-RSA) assumption

The challenge of defining guanxi : a review

Guanxi has become a common term in the wider business environment and has attracted the increasing attention of researchers. Despite this, a consistent understanding of the concept continues to prove elusive. We review the extant business literature to highlight the major inconsistencies in the way guanxi is currently conceptualized: the breadth, linguistic-cultural depth, temporality, and level of analysis. We conclude with a clearer conceptualization of guanxi which separates the core elements from antecedents and consequences of guanxi. Furthermore, we compare and contrast guanxi with western correlates such as social networks and social capitals to further consolidate our understanding of guanxi.

Identification of a cis-regulatory element by transient analysis of co-ordinately regulated genes

Background Transcription factors (TFs) co-ordinately regulate target genes that are dispersed throughout the genome. This co-ordinate regulation is achieved, in part, through the interaction of transcription factors with conserved cis-regulatory motifs that are in close proximity to the target genes. While much is known about the families of transcription factors that regulate gene expression in plants, there are few well characterised cis-regulatory motifs. In Arabidopsis, over-expression of the MYB transcription factor PAP1 (PRODUCTION OF ANTHOCYANIN PIGMENT 1) leads to transgenic plants with elevated anthocyanin levels due to the co-ordinated up-regulation of genes in the anthocyanin biosynthetic pathway. In addition to the anthocyanin biosynthetic genes, there are a number of un-associated genes that also change in expression level. This may be a direct or indirect consequence of the over-expression of PAP1. Results Oligo array analysis of PAP1 over-expression Arabidopsis plants identified genes co-ordinately up-regulated in response to the elevated expression of this transcription factor. Transient assays on the promoter regions of 33 of these up-regulated genes identified eight promoter fragments that were transactivated by PAP1. Bioinformatic analysis on these promoters revealed a common cis-regulatory motif that we showed is required for PAP1 dependent transactivation. Conclusion Co-ordinated gene regulation by individual transcription factors is a complex collection of both direct and indirect effects. Transient transactivation assays provide a rapid method to identify direct target genes from indirect target genes. Bioinformatic analysis of the promoters of these direct target genes is able to locate motifs that are common to this sub-set of promoters, which is impossible to identify with the larger set of direct and indirect target genes. While this type of analysis does not prove a direct interaction between protein and DNA, it does provide a tool to characterise cis-regulatory sequences that are necessary for transcription activation in a complex list of co-ordinately regulated genes.

Radiographer commenting of trauma radiographs : a survey of the benefits, barriers and enablers to participation in an Australian healthcare setting

Introduction Radiographer abnormality detection systems that highlight abnormalities on trauma radiographs (‘red dot’ system) have been operating for more than 30 years. Recently, a number of pitfalls have been identified. These limitations initiated the evolution of a radiographer commenting system, whereby a radiographer provides a brief description of abnormalities identified in emergency healthcare settings. This study investigated radiographers' participation in abnormality detection systems, their perceptions of benefits, barriers and enablers to radiographer commenting, and perceptions of potential radiographer image interpretation services for emergency settings. Methods A cross-sectional survey was implemented. Participants included radiographers from four metropolitan hospitals in Queensland, Australia. Conventional descriptive statistics, histograms and thematic analysis were undertaken. Results Seventy-three surveys were completed and included in the analysis (68% response rate); 30 (41%) of respondents reported participating in abnormality detection in 20% or less of examinations, and 26(36%) reported participating in 80% or more of examinations. Five overarching perceived benefits of radiographer commenting were identified: assisting multidisciplinary teams, patient care, radiographer ability, professional benefits and quality of imaging. Frequently reported perceived barriers included ‘difficulty accessing image interpretation education’, ‘lack of time’ and ‘low confidence in interpreting radiographs’. Perceived enablers included ‘access to image interpretation education’ and ‘support from radiologist colleagues’. Conclusions A range of factors are likely to contribute to the successful implementation of radiographer commenting in addition to abnormality detection in emergency settings. Effective image interpretation education amenable to completion by radiographers would likely prove valuable in preparing radiographers for participation in abnormality detection and commenting systems in emergency settings.

Supernatants of acquired immunodeficiency syndrome-related Kaposi's sarcoma cells induce endothelial cell chemotaxis and invasiveness

Kaposi's sarcoma (KS) in general, and acquired immunodeficiency syndrome-related KS (AIDS-KS) in particular, is a highly invasive and intensely angiogenic neoplasm of unknown cellular origin. We have recently established AIDS-KS cells in long term culture and reported the development of KS-like lesions in nude mice inoculated with these cells. Here, we have examined the in vitro invasiveness of basement membrane by AIDS-KS cells, as well as the effect(s) of their supernatants on the migration and invasiveness of human vascular endothelial cells. AIDS-KS cells were highly invasive in the Boyden chamber invasion assay and formed invasive, branching colonies in a 3-dimensional gel (Matrigel). Normal endothelial cells form tube-like structures on Matrigel. AIDS-KS cell-conditioned media induced endothelial cells to form invasive clusters in addition to tubes. KS-cell-conditioned media, when placed in the lower compartment of the Boyden chamber, stimulated the migration of human and bovine vascular endothelial cells across filters coated with either small amounts of collagen IV (chemotaxis) or a Matrigel barrier (invasion). Basic fibroblast growth factor could also induce endothelial cell chemotaxis and invasion in these assays. However, when antibodies to basic fibroblast growth factor were used the invasive activity induced by the AIDS-KS-cell-conditioned media was only marginally inhibited, suggesting that the large quantities of basic fibroblast growth factor-like material released by the AIDS-KS cells are not the main mediators of this effect. Specific inhibitors of laminin and collagenase IV action, which represent critical determinants of basement membrane invasion, blocked the invasiveness of the AIDS-KS cell-activated endothelial cells in these assays. These data indicate that KS cells appear to be of smooth muscle origin but secrete a potent inducer of endothelial cell chemotaxis and invasiveness which could be responsible for angiogenesis and the resulting highly vascularized lesions. These assays appear to be a model to study the invasive spread and angiogenic capacity of human AIDS-related KS and should prove useful in the identification of molecular mediators and potential inhibitors of neoplastic neovascularization.