A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study

Background: Patients with chest pain contribute substantially to emergency department attendances, lengthy hospital stay, and inpatient admissions. A reliable, reproducible, and fast process to identify patients presenting with chest pain who have a low short-term risk of a major adverse cardiac event is needed to facilitate early discharge. We aimed to prospectively validate the safety of a predefined 2-h accelerated diagnostic protocol (ADP) to assess patients presenting to the emergency department with chest pain symptoms suggestive of acute coronary syndrome. Methods: This observational study was undertaken in 14 emergency departments in nine countries in the Asia-Pacific region, in patients aged 18 years and older with at least 5 min of chest pain. The ADP included use of a structured pre-test probability scoring method (Thrombolysis in Myocardial Infarction [TIMI] score), electrocardiograph, and point-of-care biomarker panel of troponin, creatine kinase MB, and myoglobin. The primary endpoint was major adverse cardiac events within 30 days after initial presentation (including initial hospital attendance). This trial is registered with the Australia-New Zealand Clinical Trials Registry, number ACTRN12609000283279. Findings: 3582 consecutive patients were recruited and completed 30-day follow-up. 421 (11•8%) patients had a major adverse cardiac event. The ADP classified 352 (9•8%) patients as low risk and potentially suitable for early discharge. A major adverse cardiac event occurred in three (0•9%) of these patients, giving the ADP a sensitivity of 99•3% (95% CI 97•9–99•8), a negative predictive value of 99•1% (97•3–99•8), and a specificity of 11•0% (10•0–12•2). Interpretation: This novel ADP identifies patients at very low risk of a short-term major adverse cardiac event who might be suitable for early discharge. Such an approach could be used to decrease the overall observation periods and admissions for chest pain. The components needed for the implementation of this strategy are widely available. The ADP has the potential to affect health-service delivery worldwide.

Reclaiming professionalism for geography education : defending our own territory

In a world where governments increasingly attempt to impose regulation on all professional activities, this paper advocates that professional standards for teachers be developed ‘by the profession for the profession’. Foucauldian archaeology is applied to two teacher standards documents recently published in Australia, one developed at national governmental level and the other by geography teachers through their professional associations. The excavation reveals that both students and geography teachers themselves are better served when teachers assert their own definition of professionalism and thus reclaim their professional territory, rather than being compliant with generic governmental agendas. Whilst we use Australia as an illustrative example, our findings are applicable to all other countries where governments attempt to impose external professional standards on the teaching profession.

Control and application of minimally-actuated underwater vehicles

Establishing a persistent presence in the ocean with an Autonomous Underwater Vehicle capable of observing temporal variability of large-scale ocean processes requires a unique sensor platform. In this paper, we examine the utility of Lagrangian profiling floats for such extended deployments. We propose a strategy that utilizes ocean model predictions to facilitate a basic level of autonomy to achieve general control of this minimally-actuated underwater vehicle. We extend experimentally validated techniques for utilising ocean current models to control under-actuated autonomous underwater vehicles by presenting this investigation into the application of these methods on profiling floats. With the appropriate vertical actuation, and utilising spatiotemporal variations in water speed and direction, we show that broad controllability results can be met. First, we apply an A* planner to a local controllability map generated from predictions of ocean currents. This computes a path between start and goal waypoints that has the highest likelihood of successful execution over a given duration. The computed depth plan is generated with a model predictive controller, and selects the depths for the vehicle so that ambient currents guide it toward the goal. Mission constraints are included to simulate and motivate a practical data collection mission. Results are presented in simulation for a mission off the coast of Los Angeles, CA USA, that show surprising results in the ability of a drifting vehicle to maintain a prescribed course and reach a desired location.

Extending persistent monitoring by combining ocean models and Markov decision processes

Ocean processes are complex and have high variability in both time and space. Thus, ocean scientists must collect data over long time periods to obtain a synoptic view of ocean processes and resolve their spatiotemporal variability. One way to perform these persistent observations is to utilise an autonomous vehicle that can remain on deployment for long time periods. However, such vehicles are generally underactuated and slow moving. A challenge for persistent monitoring with these vehicles is dealing with currents while executing a prescribed path or mission. Here we present a path planning method for persistent monitoring that exploits ocean currents to increase navigational accuracy and reduce energy consumption.

Not-for-profit ratios for financial resilience and internal accountability : a study of Australian international aid organisations

Not-for-profit (NFP) financial ratio research has focused primarily on organisational efficiency measurements for external stakeholders. Ratios that also capture information about stability, capacity (liquidity), gearing and sustainability, enable an assessment of financial resilience. They are thus valuable tools that can provide a framework of internal accountability between boards and management. The establishment of an Australian NFP regulator highlights the importance of NFP sustainability, and affirms the timeliness of this paper. We propose a suite of key financial ratios for use by NFP boards and management, and demonstrate its practical usefulness by applying the ratios to financial data from the 2009 reports of ACFID (Australian Council for International Development)-affiliated international aid organisations.

Investigating the potential value of individual parameters of histological grading systems in a sheep model of cartilage damage : the modified Mankin method

A total histological grade does not necessarily distinguish between different manifestations of cartilage damage or degeneration. An accurate and reliable histological assessment method is required to separate normal and pathological tissue within a joint during treatment of degenerative joint conditions and to sub-classify the latter in meaningful ways. The Modified Mankin method may be adaptable for this purpose. We investigated how much detail may be lost by assigning one composite score/grade to represent different degenerative components of the osteoarthritic condition. We used four ovine injury models (sham surgery, anterior cruciate ligament/medial collateral ligament instability, simulated anatomic anterior cruciate ligament reconstruction and meniscal removal) to induce different degrees and potentially 'types' (mechanisms) of osteoarthritis. Articular cartilage was systematically harvested, prepared for histological examination and graded in a blinded fashion using a Modified Mankin grading method. Results showed that the possible permutations of cartilage damage were significant and far more varied than the current intended use that histological grading systems allow. Of 1352 cartilage specimens graded, 234 different manifestations of potential histological damage were observed across 23 potential individual grades of the Modified Mankin grading method. The results presented here show that current composite histological grading may contain additional information that could potentially discern different stages or mechanisms of cartilage damage and degeneration in a sheep model. This approach may be applicable to other grading systems.

Towards the development of a gas sensor system for monitoring pollutant gases in the low troposphere using small unmanned aerial vehicles

The world is facing problems due to the effects of increased atmospheric pollution, climate change and global warming. Innovative technologies to identify, quantify and assess fluxes exchange of the pollutant gases between the Earth’s surface and atmosphere are required. This paper proposes the development of a gas sensor system for a small UAV to monitor pollutant gases, collect data and geo-locate where the sample was taken. The prototype has two principal systems: a light portable gas sensor and an optional electric–solar powered UAV. The prototype will be suitable to: operate in the lower troposphere (100-500m); collect samples; stamp time and geo-locate each sample. One of the limitations of a small UAV is the limited power available therefore a small and low power consumption payload is designed and built for this research. The specific gases targeted in this research are NO2, mostly produce by traffic, and NH3 from farming, with concentrations above 0.05 ppm and 35 ppm respectively which are harmful to human health. The developed prototype will be a useful tool for scientists to analyse the behaviour and tendencies of pollutant gases producing more realistic models of them.

A silver bullet for Australian cinema? Genre movies and the audience debate

There has been a renaissance in Australian genre cinema in recent years. Indeed, not since the 1980s have Australian genre movies across action, adventure, horror, and science-fiction among others, experienced such prominence within production, policy discourse, and industry debate. Genre movies, typically associated with commercial filmmaking and entertainment, have been identified as a strategy to improve the box-office performance of Australian feature films and to attract larger audiences. Much of this conversation has revolved around the question of whether or not genre can deliver on these high expectations and transform the unpredictable local film industry into a popular and profitable commercial production sector. However, this debate for the most part has been disconnected from analysis of Australia’s genre movie heritage in terms of their position within Australian cinema and their reception with domestic audiences, and how this correlates to contemporary trends. As this chapter argues, genre production is not a silver bullet which will single handedly improve the Australian feature film industry’s commercial performance. Genre movies have occupied, and continue to occupy, a difficult position within Australian cinema and face numerous challenges in terms of reception with national audiences, limited production scale and enterprise structures, and ongoing tensions between culture and commerce.

Measuring reef complexity and rugosity from monocular video bathymetric reconstruction

Topographic structural complexity of a reef is highly correlated to coral growth rates, coral cover and overall levels of biodiversity, and is therefore integral in determining ecological processes. Modeling these processes commonly includes measures of rugosity obtained from a wide range of different survey techniques that often fail to capture rugosity at different spatial scales. Here we show that accurate estimates of rugosity can be obtained from video footage captured using underwater video cameras (i.e., monocular video). To demonstrate the accuracy of our method, we compared the results to in situ measurements of a 2m x 20m area of forereef from Glovers Reef atoll in Belize. Sequential pairs of images were used to compute fine scale bathymetric reconstructions of the reef substrate from which precise measurements of rugosity and reef topographic structural complexity can be derived across multiple spatial scales. To achieve accurate bathymetric reconstructions from uncalibrated monocular video, the position of the camera for each image in the video sequence and the intrinsic parameters (e.g., focal length) must be computed simultaneously. We show that these parameters can be often determined when the data exhibits parallax-type motion, and that rugosity and reef complexity can be accurately computed from existing video sequences taken from any type of underwater camera from any reef habitat or location. This technique provides an infinite array of possibilities for future coral reef research by providing a cost-effective and automated method of determining structural complexity and rugosity in both new and historical video surveys of coral reefs.

Transforming organizational leadership : a schema change perspective

Successful organizational transformation typically requires transformed leadership; that is, fundamental changes in the implicit leadership schema that underpin observed organizational leadership practice. The purpose of this study is to elaborate leadership schema change theory by investigating a case study in which the CEO of a public infrastructure organization sought to transform traditional organizational leadership to facilitate wider organization transformation. Data were generated through focus groups and semi-structured interviews at four points over a three-year period. Our findings suggest that (a) change leader initiatives do not necessarily activate the cognitive processing required to achieve leadership schema change, (b) collective schema change, defined in terms of the system of beliefs and values underlying the new leading-managing schema did not occur, however, (c) sub-schema change did occur. The research contributes to existing literature on implicit leadership schema change in three main ways. First, we provide a schema change framework to guide current and future research on schema change. Second, we highlight the role that both change leader initiatives and individual and social processing play in schema change. Finally, we stress the role of teleological processes in leadership schema change.

Eruption of Soufrière Hills (1995–2009) from an offshore perspective : insights from repeated swath bathymetry surveys

This contribution provides an analysis of the 1995–2009 eruptive period of Soufrière Hills volcano (Montserrat) from a unique offshore perspective. The methodology is based on five repeated swath bathymetric surveys. The difference between the 2009 and 1999 bathymetry suggests that at least 395 Mm3 of material has entered the sea. This proximal deposit reaches 95 m thick and extends ∼7km from shore. However, the difference map does not include either the finer distal part of the submarine deposit or the submarine part of the delta close to the shoreline. We took both contributions into account by using additional information such as that from marine sediment cores. By March 2009, at least 65% of the material erupted throughout the eruption has been deposited into the sea. This work provides an excellent basis for assessing the future activity of the Soufrière Hills volcano (including potential collapse), and other volcanoes on small islands.

Submarine pyroclastic deposits formed at the Soufrière Hills volcano, Montserrat (1995–2003) : what happens when pyroclastic flows enter the ocean?

The Soufrière Hills volcano, Montserrat, West Indies, has undergone a series of dome growth and collapse events since the eruption began in 1995. Over 90% of the pyroclastic material produced has been deposited into the ocean. Sampling of these submarine deposits reveals that the pyroclastic flows mix rapidly and violently with the water as they enter the sea. The coarse components (pebbles to boulders) are deposited proximally from dense basal slurries to form steep-sided, near-linear ridges that intercalate to form a submarine fan. The finer ash-grade components are mixed into the overlying water column to form turbidity currents that flow over distances >30 km from the source. The total volume of pyroclastic material off the east coast of Montserrat exceeds 280 × 106 m3, with 65% deposited in proximal lobes and 35% deposited as distal turbidites.