Information transfer for multi-trauma patients on discharge from the emergency department : mixed-method narrative review

Aim. This paper is a report of a review conducted to identify (a) best practice in information transfer from the emergency department for multi-trauma patients; (b) conduits and barriers to information transfer in trauma care and related settings; and (c) interventions that have an impact on information communication at handover and beyond. Background. Information transfer is integral to effective trauma care, and communication breakdown results in important challenges to this. However, evidence of adequacy of structures and processes to ensure transfer of patient information through the acute phase of trauma care is limited. Data sources. Papers were sourced from a search of 12 online databases and scanning references from relevant papers for 1990–2009. Review methods. The review was conducted according to the University of York’s Centre for Reviews and Dissemination guidelines. Studies were included if they concerned issues that influenced information transfer for patients in healthcare settings. Results. Forty-five research papers, four literature reviews and one policy statement were found to be relevant to parts of the topic, but not all of it. The main issues emerging concerned the impact of communication breakdown in some form, and included communication issues within trauma team processes, lack of structure and clarity during handovers including missing, irrelevant and inaccurate information, distractions and poorly documented care. Conclusion. Many factors influence information transfer but are poorly identified in relation to trauma care. The measurement of information transfer, which is integral to patient handover, has not been the focus of research to date. Nonetheless, documented patient information is considered evidence of care and a resource that affects continuing care.

Prospective, non-randomized phase 2 clinical trial of carboplatin plus paclitaxel with sequential radical pelvic radiotherapy for uterine papillary serous carcinoma

Objective Uterine Papillary Serous Carcinoma (UPSC) is uncommon and accounts for less than 5% of all uterine cancers. Therefore the majority of evidence about the benefits of adjuvant treatment comes from retrospective case series. We conducted a prospective multi-centre non-randomized phase 2 clinical trial using four cycles of adjuvant paclitaxel plus carboplatin chemotherapy followed by pelvic radiotherapy, in order to evaluate the tolerability and safety of this approach. Methods This trial enrolled patients with newly diagnosed, previously untreated patients with stage 1b-4 (FIGO-1988) UPSC with a papillary serous component of at least 30%. Paclitaxel (175 mg/m2) and carboplatin (AUC 6) were administered on day 1 of each 3-week cycle for 4 cycles. Chemotherapy was followed by external beam radiotherapy to the whole pelvis (50.4 Gy over 5.5 weeks). Completion and toxicity of treatment (Common Toxicity Criteria, CTC) and quality of life measures were the primary outcome indicators. Results Twenty-nine of 31 patients completed treatment as planned. Dose reduction was needed in 9 patients (29%), treatment delay in 7 (23%), and treatment cessation in 2 patients (6.5%). Hematologic toxicity, grade 3 or 4 occurred in 19% (6/31) of patients. Patients' self-reported quality of life remained stable throughout treatment. Thirteen of the 29 patients with stages 1–3 disease (44.8%) recurred (average follow up 28.1 months, range 8–60 months). Conclusion This multimodal treatment is feasible, safe and tolerated reasonably well and would be suitable for use in multi-institutional prospective randomized clinical trials incorporating novel therapies in patients with UPSC.

Multi-version documents : A digitisation solution for textual cultural artefacts

Textual cultural heritage artefacts present two serious problems for the encoder: how to record different or revised versions of the same work, and how to encode conflicting perspectives of the text using markup. Both are forms of textual variation, and can be accurately recorded using a multi-version document, based on a minimally redundant directed graph that cleanly separates variation from content.

Knowledge-based development for cities and societies : integrated multi-level approaches

Over the past twenty years, the conventional knowledge management approach has evolved into a strategic management approach that has found applications and opportunities outside of business, in society at large, through education, urban development, governance, and healthcare, amongst others. Knowledge-Based Development for Cities and Socieities: Integrated Multi-Level Approaches enlightens the concepts and challenges of knowledge management for both urban environments and entire regions, enhancing the expertise and knowledge of scholars, resdearchers, practitioners, managers and urban developers in the development of successful knowledge-based development policies, creation of knowledte cities and prosperous knowledge societies. This reference creates large knowledge base for scholars, managers and urban developers and increases the awareness of the role of knowledge cities and knowledge socieiteis in the knowledge era, as well as of the challenges and opportunities for future research.

Cooperative multi-AUV tracking of phytoplankton blooms based on ocean model predictions

In recent years, ocean scientists have started to employ many new forms of technology as integral pieces in oceanographic data collection for the study and prediction of complex and dynamic ocean phenomena. One area of technological advancement in ocean sampling if the use of Autonomous Underwater Vehicles (AUVs) as mobile sensor plat- forms. Currently, most AUV deployments execute a lawnmower- type pattern or repeated transects for surveys and sampling missions. An advantage of these missions is that the regularity of the trajectory design generally makes it easier to extract the exact path of the vehicle via post-processing. However, if the deployment region for the pattern is poorly selected, the AUV can entirely miss collecting data during an event of specific interest. Here, we consider an innovative technology toolchain to assist in determining the deployment location and executed paths for AUVs to maximize scientific information gain about dynamically evolving ocean phenomena. In particular, we provide an assessment of computed paths based on ocean model predictions designed to put AUVs in the right place at the right time to gather data related to the understanding of algal and phytoplankton blooms.

Online alcohol interventions : a systematic review

Background: There has been a significant increase in the availability of online programs for alcohol problems. A systematic review of the research evidence underpinning these programs is timely. Objectives: Our objective was to review the efficacy of online interventions for alcohol misuse. Systematic searches of Medline, PsycINFO, Web of Science, and Scopus were conducted for English abstracts (excluding dissertations) published from 1998 onward. Search terms were: (1) Internet, Web*; (2) online, computer*; (3) alcohol*; and (4) E\effect*, trial*, random* (where * denotes a wildcard). Forward and backward searches from identified papers were also conducted. Articles were included if (1) the primary intervention was delivered and accessed via the Internet, (2) the intervention focused on moderating or stopping alcohol consumption, and (3) the study was a randomized controlled trial of an alcohol-related screen, assessment, or intervention. Results: The literature search initially yielded 31 randomized controlled trials (RCTs), 17 of which met inclusion criteria. Of these 17 studies, 12 (70.6%) were conducted with university students, and 11 (64.7%) specifically focused on at-risk, heavy, or binge drinkers. Sample sizes ranged from 40 to 3216 (median 261), with 12 (70.6%) studies predominantly involving brief personalized feedback interventions. Using published data, effect sizes could be extracted from 8 of the 17 studies. In relation to alcohol units per week or month and based on 5 RCTs where a measure of alcohol units per week or month could be extracted, differential effect sizes to post treatment ranged from 0.02 to 0.81 (mean 0.42, median 0.54). Pre-post effect sizes for brief personalized feedback interventions ranged from 0.02 to 0.81, and in 2 multi-session modularized interventions, a pre-post effect size of 0.56 was obtained in both. Pre-post differential effect sizes for peak blood alcohol concentrations (BAC) ranged from 0.22 to 0.88, with a mean effect size of 0.66. Conclusions: The available evidence suggests that users can benefit from online alcohol interventions and that this approach could be particularly useful for groups less likely to access traditional alcohol-related services, such as women, young people, and at-risk users. However, caution should be exercised given the limited number of studies allowing extraction of effect sizes, the heterogeneity of outcome measures and follow-up periods, and the large proportion of student-based studies. More extensive RCTs in community samples are required to better understand the efficacy of specific online alcohol approaches, program dosage, the additive effect of telephone or face-to-face interventions, and effective strategies for their dissemination and marketing.

Optimal voltage support mechanism in distribution networks

Optimal scheduling of voltage regulators (VRs), fixed and switched capacitors and voltage on customer side of transformer (VCT) along with the optimal allocaton of VRs and capacitors are performed using a hybrid optimisation method based on discrete particle swarm optimisation and genetic algorithm. Direct optimisation of the tap position is not appropriate since in general the high voltage (HV) side voltage is not known. Therefore, the tap setting can be determined give the optimal VCT once the HV side voltage is known. The objective function is composed of the distribution line loss cost, the peak power loss cost and capacitors' and VRs' capital, operation and maintenance costs. The constraints are limits on bus voltage and feeder current along with VR taps. The bus voltage should be maintained within the standard level and the feeder current should not exceed the feeder-rated current. The taps are to adjust the output voltage of VRs between 90 and 110% of their input voltages. For validation of the proposed method, the 18-bus IEEE system is used. The results are compared with prior publications to illustrate the benefit of the employed technique. The results also show that the lowest cost planning for voltage profile will be achieved if a combination of capacitors, VRs and VCTs is considered.

A qualitative investigation of socio-cultural factors influencing binge-drinking : a multi-country study

Despite substantial investment by governments in social marketing campaigns and the introduction of various legislative and supply controls on alcohol, the binge drinking phenomenon amongst young people continues unabated in many countries and appears to be spreading to others. This paper examines drinking behaviour amongst university students from 50 countries across Europe, North America and the Asia Pacific region and argues that more needs to be done in understanding socio-cultural factors. To date, little is known of the specific socio-cultural factors that are common in countries that have high drinking behaviour compared to countries that have moderate bingedrinking behaviour. Using a marketing systems approach, this exploratory study identifies two key themes that distinguish these countries, namely family influences and peer influences.

An assessment system for evaluation of driving competencies

Automobiles have deeply impacted the way in which we travel but they have also contributed to many deaths and injury due to crashes. A number of reasons for these crashes have been pointed out by researchers. Inexperience has been identified as a contributing factor to road crashes. Driver’s driving abilities also play a vital role in judging the road environment and reacting in-time to avoid any possible collision. Therefore driver’s perceptual and motor skills remain the key factors impacting on road safety. Our failure to understand what is really important for learners, in terms of competent driving, is one of the many challenges for building better training programs. Driver training is one of the interventions aimed at decreasing the number of crashes that involve young drivers. Currently, there is a need to develop comprehensive driver evaluation system that benefits from the advances in Driver Assistance Systems. A multidisciplinary approach is necessary to explain how driving abilities evolves with on-road driving experience. To our knowledge, driver assistance systems have never been comprehensively used in a driver training context to assess the safety aspect of driving. The aim and novelty of this thesis is to develop and evaluate an Intelligent Driver Training System (IDTS) as an automated assessment tool that will help drivers and their trainers to comprehensively view complex driving manoeuvres and potentially provide effective feedback by post processing the data recorded during driving. This system is designed to help driver trainers to accurately evaluate driver performance and has the potential to provide valuable feedback to the drivers. Since driving is dependent on fuzzy inputs from the driver (i.e. approximate distance calculation from the other vehicles, approximate assumption of the other vehicle speed), it is necessary that the evaluation system is based on criteria and rules that handles uncertain and fuzzy characteristics of the driving tasks. Therefore, the proposed IDTS utilizes fuzzy set theory for the assessment of driver performance. The proposed research program focuses on integrating the multi-sensory information acquired from the vehicle, driver and environment to assess driving competencies. After information acquisition, the current research focuses on automated segmentation of the selected manoeuvres from the driving scenario. This leads to the creation of a model that determines a “competency” criterion through the driving performance protocol used by driver trainers (i.e. expert knowledge) to assess drivers. This is achieved by comprehensively evaluating and assessing the data stream acquired from multiple in-vehicle sensors using fuzzy rules and classifying the driving manoeuvres (i.e. overtake, lane change, T-crossing and turn) between low and high competency. The fuzzy rules use parameters such as following distance, gaze depth and scan area, distance with respect to lanes and excessive acceleration or braking during the manoeuvres to assess competency. These rules that identify driving competency were initially designed with the help of expert’s knowledge (i.e. driver trainers). In-order to fine tune these rules and the parameters that define these rules, a driving experiment was conducted to identify the empirical differences between novice and experienced drivers. The results from the driving experiment indicated that significant differences existed between novice and experienced driver, in terms of their gaze pattern and duration, speed, stop time at the T-crossing, lane keeping and the time spent in lanes while performing the selected manoeuvres. These differences were used to refine the fuzzy membership functions and rules that govern the assessments of the driving tasks. Next, this research focused on providing an integrated visual assessment interface to both driver trainers and their trainees. By providing a rich set of interactive graphical interfaces, displaying information about the driving tasks, Intelligent Driver Training System (IDTS) visualisation module has the potential to give empirical feedback to its users. Lastly, the validation of the IDTS system’s assessment was conducted by comparing IDTS objective assessments, for the driving experiment, with the subjective assessments of the driver trainers for particular manoeuvres. Results show that not only IDTS was able to match the subjective assessments made by driver trainers during the driving experiment but also identified some additional driving manoeuvres performed in low competency that were not identified by the driver trainers due to increased mental workload of trainers when assessing multiple variables that constitute driving. The validation of IDTS emphasized the need for an automated assessment tool that can segment the manoeuvres from the driving scenario, further investigate the variables within that manoeuvre to determine the manoeuvre’s competency and provide integrated visualisation regarding the manoeuvre to its users (i.e. trainers and trainees). Through analysis and validation it was shown that IDTS is a useful assistance tool for driver trainers to empirically assess and potentially provide feedback regarding the manoeuvres undertaken by the drivers.

Configurable multi-perspective business process models

A configurable process model provides a consolidated view of a family of business processes. It promotes the reuse of proven practices by providing analysts with a generic modelling artifact from which to derive individual process models. Unfortunately, the scope of existing notations for configurable process modelling is restricted, thus hindering their applicability. Specifically, these notations focus on capturing tasks and control-flow dependencies, neglecting equally important ingredients of business processes such as data and resources. This research fills this gap by proposing a configurable process modelling notation incorporating features for capturing resources, data and physical objects involved in the performance of tasks. The proposal has been implemented in a toolset that assists analysts during the configuration phase and guarantees the correctness of the resulting process models. The approach has been validated by means of a case study from the film industry.

Interpreting regional frequencies from synchronized phasor measurement in multi-area power systems

In this paper a new approach is proposed for interpreting of regional frequencies in multi machine power systems. The method uses generator aggregation and system reduction based on coherent generators in each area. The reduced system structure is able to be identified and a kalman estimator is designed for the reduced system to estimate the inter-area modes using the synchronized phasor measurement data. The proposed method is tested on a six machine, three area test system and the obtained results show the estimation of inter-area oscillations in the system with a high accuracy.

Development of a software model of a heavy vehicle suspension for research

A Simulink Matlab control system of a heavy vehicle suspension has been developed. The aim of the exercise presented in this paper was to develop a Simulink Matlab control system of a heavy vehicle suspension. The objective facilitated by this outcome was the use of a working model of a heavy vehicle (HV) suspension that could be used for future research. A working computer model is easier and cheaper to re-configure than a HV axle group installed on a truck; it presents less risk should something go wrong and allows more scope for variation and sensitivity analysis before embarking on further "real-world" testing. Empirical data recorded as the input and output signals of a heavy vehicle (HV) suspension were used to develop the parameters for computer simulation of a linear time invariant system described by a second-order differential equation of the form: (i.e. a "2nd-order" system). Using the empirical data as an input to the computer model allowed validation of its output compared with the empirical data. The errors ranged from less than 1% to approximately 3% for any parameter, when comparing like-for-like inputs and outputs. The model is presented along with the results of the validation. This model will be used in future research in the QUT/Main Roads project Heavy vehicle suspensions – testing and analysis, particularly so for a theoretical model of a multi-axle HV suspension with varying values of dynamic load sharing. Allowance will need to be made for the errors noted when using the computer models in this future work.