An assessment of Georgia's National Integrity System : the GNISA project

Georgia’s ‘National Integrity Systems’ are the institutions, laws, procedures, practices and attitudes that encourage and support integrity in the exercise of power in modern Georgian society. Integrity systems function to ensure that power is exercised in a manner that is true to the values, purposes and duties for which that power is entrusted to, or held by, institutions and individual office-holders. This report presents the results of the Open Society Institute / Open Society – Georgia Foundation funded project Georgian National Integrity Systems Assessment (GNISA), conducted in 2005–2006 by Caucasus Institute for Peace, Democracy and Development, Transparency International Georgia, Georgian Young Lawyers Association, in close cooperation with Griffith University Institute for Ethics, Governance and Law (Australia), and Tiri Group (UK), into how different elements of integrity systems interact, which combinations of institutions and reforms make for a strong integrity system, and how Georgia’s integrity systems should evolve to ensure coherence, not chaos in the way public integrity is maintained. Nevertheless all participants of the research may not share some conclusions given in the GNISA report.

Vulnerability assessment of reinforced concrete columns subjected to vehicular impacts

Columns are one of the key load bearing elements that are highly susceptible to vehicle impacts. The resulting severe damages to columns may leads to failures of the supporting structure that are catastrophic in nature. However, the columns in existing structures are seldom designed for impact due to inadequacies of design guidelines. The impact behaviour of columns designed for gravity loads and actions other than impact is, therefore, of an interest. A comprehensive investigation is conducted on reinforced concrete column with a particular focus on investigating the vulnerability of the exposed columns and to implement mitigation techniques under low to medium velocity car and truck impacts. The investigation is based on non-linear explicit computer simulations of impacted columns followed by a comprehensive validation process. The impact is simulated using force pulses generated from full scale vehicle impact tests. A material model capable of simulating triaxial loading conditions is used in the analyses. Circular columns adequate in capacity for five to twenty story buildings, designed according to Australian standards are considered in the investigation. The crucial parameters associated with the routine column designs and the different load combinations applied at the serviceability stage on the typical columns are considered in detail. Axially loaded columns are examined at the initial stage and the investigation is extended to analyse the impact behaviour under single axis bending and biaxial bending. The impact capacity reduction under varying axial loads is also investigated. Effects of the various load combinations are quantified and residual capacity of the impacted columns based on the status of the damage and mitigation techniques are also presented. In addition, the contribution of the individual parameter to the failure load is scrutinized and analytical equations are developed to identify the critical impulses in terms of the geometrical and material properties of the impacted column. In particular, an innovative technique was developed and introduced to improve the accuracy of the equations where the other techniques are failed due to the shape of the error distribution. Above all, the equations can be used to quantify the critical impulse for three consecutive points (load combinations) located on the interaction diagram for one particular column. Consequently, linear interpolation can be used to quantify the critical impulse for the loading points that are located in-between on the interaction diagram. Having provided a known force and impulse pair for an average impact duration, this method can be extended to assess the vulnerability of columns for a general vehicle population based on an analytical method that can be used to quantify the critical peak forces under different impact durations. Therefore the contribution of this research is not only limited to produce simplified yet rational design guidelines and equations, but also provides a comprehensive solution to quantify the impact capacity while delivering new insight to the scientific community for dealing with impacts.

The Chronic Heart-Failure Assistance by Telephone (CHAT) Study: Assessment of Telephone Support for Vulnerable Patients with Chronic Disease

Aim: To determine whether telephone support using an evidence-based protocol for chronic heart failure (CHF) management will improve patient outcomes and will reduce hospital readmission rates in patients without access to hospital-based management programs. Methods: The rationale and protocol for a cluster-design randomised controlled trial (RCT) of a semi-automated telephone intervention for the management of CHF, the Chronic Heart-failure Assistance by Telephone (CHAT) Study is described. Care is coordinated by trained cardiac nurses located in Heartline, the national call center of the National Heart Foundation of Australia in partnership with patients’ general practitioners (GPs). Conclusions: The CHAT Study model represents a potentially cost-effective and accessible model for the Australian health system in caring for CHF patients in rural and remote areas. The system of care could also be readily adapted for a range of chronic diseases and health systems. Key words: chronic disease management; chronic heart failure; integrated health care systems; nursing care, rural health services; telemedicine; telenursing

Assessment of retinal structure and visual function in association with diabetic peripheral neuropathy

Diabetes is an increasingly prevalent disease worldwide. Providing early management of the complications can prevent morbidity and mortality in this population. Peripheral neuropathy, a significant complication of diabetes, is the major cause of foot ulceration and amputation in diabetes. Delay in attending to complication of the disease contributes to significant medical expenses for diabetic patients and the community. Early structural changes to the neural components of the retina have been demonstrated to occur prior to the clinically visible retinal vasculature complication of diabetic retinopathy. Additionally visual functionloss has been shown to exist before the ophthalmoscopic manifestations of vasculature damage. The purpose of this thesis was to evaluate the relationship between diabetic peripheral neuropathy and both retinal structure and visual function. The key question was whether diabetic peripheral neuropathy is the potential underlying factor responsible for retinal anatomical change and visual functional loss in people with diabetes. This study was conducted on a cohort with type 2 diabetes. Retinal nerve fibre layer thickness was assessed by means of Optical Coherence Tomography (OCT). Visual function was assessed using two different methods; Standard Automated Perimetry (SAP) and flicker perimetry were performed within the central 30 degrees of fixation. The level of diabetic peripheral neuropathy (DPN) was assessed using two techniques - Quantitative Sensory Testing and Neuropathy Disability Score (NDS). These techniques are known to be capable of detecting DPN at very early stages. NDS has also been shown as a gold standard for detecting 'risk of foot ulceration'. Findings reported in this thesis showed that RNFL thickness, particularly in the inferior quadrant, has a significant association with severity of DPN when the condition has been assessed using NDS. More specifically it was observed that inferior RNFL thickness has the ability to differentiate individuals who are at higher risk of foot ulceration from those who are at lower risk, indicating that RNFL thickness can predict late-staged DPN. Investigating the association between RNFL and QST did not show any meaningful interaction, which indicates that RNFL thickness for this cohort was not as predictive of neuropathy status as NDS. In both of these studies, control participants did not have different results from the type 2 cohort who did not DPN suggesting that RNFL thickness is not a marker for diagnosing DPN at early stages. The latter finding also indicated that diabetes per se, is unlikely to affect the RNFL thickness. Visual function as measured by SAP and flicker perimetry was found to be associated with severity of peripheral neuropathy as measured by NDS. These findings were also capable of differentiating individuals at higher risk of foot ulceration; however, visual function also proved not to be a maker for early diagnosis of DPN. It was found that neither SAP, nor flicker sensitivity have meaningful associations with DPN when neuropathy status was measured using QST. Importantly diabetic retinopathy did not explain any of the findings in these experiments. The work described here is valuable as no other research to date has investigated the association between diabetic peripheral neuropathy and either retinal structure or visual function.

Bioimpedance in the assessment of unilateral lymphedema of a limb: the optimal frequency

Background: Bioimpedance techniques provide a reliable method of assessing unilateral lymphedema in a clinical setting. Bioimpedance devices are traditionally used to assess body composition at a current frequency of 50 kHz. However, these devices are not transferable to the assessment of lymphedema, as the sensitivity of measuring the impedance of extracellular fluid is frequency dependent. It has previously been shown that the best frequency to detect extracellular fluid is 0 kHz (or DC). However, measurement at this frequency is not possible in practice due to the high skin impedance at DC, and an estimate is usually determined from low frequency measurements. This study investigated the efficacy of various low frequency ranges for the detection of lymphedema. Methods and Results: Limb impedance was measured at 256 frequencies between 3 kHz and 1000 kHz for a sample control population, arm lymphedema population, and leg lymphedema population. Limb impedance was measured using the ImpediMed SFB7 and ImpediMed L-Dex® U400 with equipotential electrode placement on the wrists and ankles. The contralateral limb impedance ratio for arms and legs was used to calculate a lymphedema index (L-Dex) at each measurement frequency. The standard deviation of the limb impedance ratio in a healthy control population has been shown to increase with frequency for both the arm and leg. Box and whisker plots of the spread of the control and lymphedema populations show that there exists good differentiation between the arm and leg L-Dex measured for lymphedema subjects and the arm and leg L-Dex measured for control subjects up to a frequency of about 30 kHz. Conclusions: It can be concluded that impedance measurements above a frequency of 30 kHz decrease sensitivity to extracellular fluid and are not reliable for early detection of lymphedema.

Peer state assessment of TxDOT maintenance program and practices : workshop and road rally findings

In an effort to evaluate and improve their practices to ensure the future excellence of the Texas highway system, the Texas Department of Transportation (TxDOT) sought a forum in which experts from other state departments of transportation could share their expertise. Thus, the Peer State Review of TxDOT Maintenance Practices project was organized and conducted for TxDOT by the Center for Transportation Research (CTR) at The University of Texas at Austin. The goal of the project was to conduct a workshop at CTR and in the Austin District that would educate the visiting peers on TxDOT’s maintenance practices and invite their feedback. CTR and TxDOT arranged the participation of the following directors of maintenance: Steve Takigawa, CA; Roy Rissky, KS; Eric Pitts, GA; Jim Carney, MO; Jennifer Brandenburg, NC; and David Bierschbach, WA. One of the means used to capture the peer reviewers’ opinions was a carefully designed booklet of 15 questions. The peers provided TxDOT with written responses to these questions, and the oral comments made during the workshop were also captured. This information was then compiled and summarized in the following report. An examination of the peers’ comments suggests that TxDOT should use a more holistic, statewide approach to funding and planning rather than funding and planning for each district separately. Additionally, the peers stressed the importance of allocating funds based on the actual conditions of the roadways instead of on inventory. The visiting directors of maintenance also recommended continuing and proliferating programs that enhance communication, such as peer review workshops.

Multiculturalism, education for sustainable development (ESD) and the shifting discursive landscape of social inclusion

Australia has a long and sometimes turbulent relationship with the migrant Other. This paper examines a component of this relationship via the window of contemporary multicultural policy. The paper begins with an analysis of the political and social conditions that enabled a national and bipartisan policy of multiculturalism to emerge as formalised federal policy during the late 1960s and early 1970s. The paper re-problematises the influences that helped shape Australia's articulation of race and ethnicity and argues that multiculturalism, within a post-September 11 environment, can no longer be framed solely within its traditional framework of social justice. The paper positions education for sustainable development (ESD) as an emerging discursive field that provides educators with an alternative road map for critiquing Australia's fluid relationship with the migrant Other. By linking the tenets of multiculturalism with ESD, this paper suggests pre-service teacher educators are presented with a productive, and at the same time politically palatable, means for regaining pedagogical traction for a semi-dormant agenda of social inclusion.

Post-operative CT assessment of interbody fusion two years after thoracoscopic scoliosis surgery

The relationship between radiologic union and clinical outcome in thoracoscopic scoliosis surgery is not clear, as apparent non-union of a spinal fusion does not always correspond to a poor clinical result. The aim of this study was to evaluate CT fusion rates 24 months after thoracoscopic anterior scoliosis surgery, and to explore the relationship between fusion scores and; (i) rod diameter, (ii) graft type, (iii) fusion level, (iv) occurrence of post-operative implant failure, and (v) lateral position of the fusion mass in the intervertebral disc space. We propose that moderate fusion scores on the Sucato scale secure successful clinical outcomes in thoracoscopic scoliosis surgery.

Postoperative low dose CT assessment of interbody fusion two years after thoracoscopic scoliosis surgery

The relationship between radiologic union and clinical outcomes in thoracoscopic scoliosis surgery is not clear, as apparent non-union of a spinal fusion does not always correspond to a poor clinical result. The aim of this study was to evaluate for the first time the interbody fusion rates using low dose CT scans at minimum 24 months after thoracoscopic scoliosis surgery, and to explore the relationship between fusion scores and; (i) rod diameter, (ii) graft type, (iii) fusion level, (iv) implant failure, and (v) lateral position in the disc space. The study found that moderate fusion scores on the Sucato scale secure successful clinical outcomes in thoracoscopic scoliosis surgery.

The geometric modelling of social frames and contexts

How do humans respond to their social context? This question is becoming increasingly urgent in a society where democracy requires that the citizens of a country help to decide upon its policy directions, and yet those citizens frequently have very little knowledge of the complex issues that these policies seek to address. Frequently, we find that humans make their decisions more with reference to their social setting, than to the arguments of scientists, academics, and policy makers. It is broadly anticipated that the agent based modelling (ABM) of human behaviour will make it possible to treat such social effects, but we take the position here that a more sophisticated treatment of context will be required in many such models. While notions such as historical context (where the past history of an agent might affect its later actions) and situational context (where the agent will choose a different action in a different situation) abound in ABM scenarios, we will discuss a case of a potentially changing context, where social effects can have a strong influence upon the perceptions of a group of subjects. In particular, we shall discuss a recently reported case where a biased worm in an election debate led to significant distortions in the reports given by participants as to who won the debate (Davis et al 2011). Thus, participants in a different social context drew different conclusions about the perceived winner of the same debate, with associated significant differences among the two groups as to who they would vote for in the coming election. We extend this example to the problem of modelling the likely electoral responses of agents in the context of the climate change debate, and discuss the notion of interference between related questions that might be asked of an agent in a social simulation that was intended to simulate their likely responses. A modelling technology which could account for such strong social contextual effects would benefit regulatory bodies which need to navigate between multiple interests and concerns, and we shall present one viable avenue for constructing such a technology. A geometric approach will be presented, where the internal state of an agent is represented in a vector space, and their social context is naturally modelled as a set of basis states that are chosen with reference to the problem space.