Lumbar epidural steroids are not cost effective in sciatica

Background Lumbar Epidural Steroids Injections (ESI’s) have previously been shown to provide some degree of pain relief in sciatica. Number Needed To Treat (NNT) to achieve 50% pain relief has been estimated at 7 from the results of randomised controlled trials. Pain relief is temporary. They remain one of the most commonly provided procedures in the UK. It is unknown whether this pain relief represents good value for money. Methods 228 patients were randomised into a multi-centre Double Blind Randomised Controlled Trial. Subjects received up to 3 ESI’s or intra-spinous saline depending on response and fall off with the first injection. All other treatments were permitted. All received a review of analgesia, education and physical therapy. Quality of life was assessed using the SF36 at 6 points and compared using independent sample t-tests. Follow up was up to 1 yr. Missing data was imputed using last observation carried forward (LOCF). QALY’s (Quality of Life Years) were derived from preference based heath values (summary health utility score). SF-6D health state classification was derived from SF-36 raw score data. Standard gambles (SG) were calculated using Model 10. SG scores were calculated on trial results. LOCF was not used for this. Instead average SG were derived for a subset of patients with observations for all visits up to week 12. Incremental QALY’s were derived as the difference in the area between the SG curve for the active group and placebo group. Results SF36 domains showed a significant improvement in pain at week 3 but this was not sustained (mean 54 Active vs 61 Placebo P<0.05). Other domains did not show any significant gains compared with placebo. For derivation of SG the number in the sample in each period differed. In week 12, average SG scores for active and placebo converged. In other words, the health gain for the active group as measured by SG was achieved by the placebo group by week 12. The incremental QALY gained for a patient under the trial protocol compared with the standard care package was 0.0059350. This is equivalent to an additional 2.2 days of full health. The cost per QALY gained to the provider from a patient management strategy administering one epidural as suggested by results was £25 745.68. This result was derived assuming that the gain in QALY data calculated for patients under the trial protocol would approximate that under a patient management strategy based on the trial results (one ESI). This is above the threshold suggested by some as a cost effective treatment. Conclusions The transient benefit in pain relief afforded by ESI’s does not appear to be cost-effective. Further work is needed to develop more cost-effective conservative treatments for sciatica.

A systematic review of community-based interventions for emerging zoonotic diseases in Southeast Asia

Background Southeast Asia has been at the epicentre of recent epidemics of emerging and re-emerging zoonotic diseases. Community-based surveillance and control interventions have been heavily promoted but the most effective interventions have not been identified. Objectives This review evaluated evidence for the effectiveness of community-based surveillance interventions at monitoring and identifying emerging infectious disease; the effectiveness of community-based control interventions at reducing rates of emerging infectious disease; and contextual factors that influence intervention effectiveness. Inclusion criteria Participants Communities in Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Viet Nam. Types of intervention(s) Non-pharmaceutical, non-vaccine, and community-based surveillance or prevention and control interventions targeting rabies, Nipah virus , dengue, SARS or avian influenza. Types of outcomes Primary outcomes: measures: of infection or disease; secondary outcomes: measures of intervention function. Types of studies Original quantitative studies published in English. Search strategy Databases searched (1980 to 2011): PubMed, CINAHL, ProQuest, EBSCOhost, Web of Science, Science Direct, Cochrane database of systematic reviews, WHOLIS, British Development Library, LILACS, World Bank (East Asia), Asian Development Bank. Methodological quality Two independent reviewers critically appraised studies using standard Joanna Briggs Institute instruments. Disagreements were resolved through discussion. Data extraction A customised tool was used to extract quantitative data on intervention(s), populations, study methods, and primary and secondary outcomes; and qualitative contextual information or narrative evidence about interventions. Data synthesis Data was synthesised in a narrative summary with the aid of tables. Meta-analysis was used to statistically pool quantitative results. Results Fifty-seven studies were included. Vector control interventions using copepods, environmental cleanup and education are effective and sustainable at reducing dengue in rural and urban communities, whilst insecticide spraying is effective in urban outbreak situations. Community-based surveillance interventions can effectively identify avian influenza in backyard flocks, but have not been broadly applied. Outbreak control interventions for Nipah virus and SARS are effective but may not be suitable for ongoing control. Canine vaccination and education is more acceptable than culling, but still fails to reach coverage levels required to effectively control rabies. Contextual factors were identified that influence community engagement with, and ultimately effectiveness of, interventions. Conclusion Despite investment in community-based disease control and surveillance in Southeast Asia, published evidence evaluating interventions is limited in quantity and quality. Nonetheless this review identified a number of effective interventions, and several contextual factors influencing effectiveness. Identification of the best programs will require comparative evidence of effectiveness acceptability, cost-effectiveness and sustainability.

A dual inverter-based supercapacitor direct integration scheme for wind energy conversion systems

Interfacing converters used in connecting energy storage systems like supercapacitors and battery banks to wind power systems introduce additional cost and power losses. This paper therefore presents a direct integration scheme for supercapacitors used in mitigating short-term power fluctuations in wind power systems. This scheme uses a dual inverter topology for both grid connection and interfacing a supercapacitor bank. The main inverter of the dual inverter system is powered by the rectified output of a wind turbine-coupled permanent-magnet synchronous generator. The auxiliary inverter is directly connected to the supercapacitor bank. With this approach, an interfacing converter is not required, and there are no associated costs and power losses incurred. The operation of the proposed system is discussed in detail. Simulation and experimental results are presented to verify the efficacy of the proposed system in suppressing short-term wind power fluctuations.

Simulation-based fully Bayesian experimental design for mixed effects models

In this paper, we present fully Bayesian experimental designs for nonlinear mixed effects models, in which we develop simulation-based optimal design methods to search over both continuous and discrete design spaces. Although Bayesian inference has commonly been performed on nonlinear mixed effects models, there is a lack of research into performing Bayesian optimal design for nonlinear mixed effects models that require searches to be performed over several design variables. This is likely due to the fact that it is much more computationally intensive to perform optimal experimental design for nonlinear mixed effects models than it is to perform inference in the Bayesian framework. In this paper, the design problem is to determine the optimal number of subjects and samples per subject, as well as the (near) optimal urine sampling times for a population pharmacokinetic study in horses, so that the population pharmacokinetic parameters can be precisely estimated, subject to cost constraints. The optimal sampling strategies, in terms of the number of subjects and the number of samples per subject, were found to be substantially different between the examples considered in this work, which highlights the fact that the designs are rather problem-dependent and require optimisation using the methods presented in this paper.

Accelerometer based performance assessment of basic routines in classical ballet

Classical ballet requires dancers to exercise significant muscle control and strength both while stationary and when moving. Following the Royal Academy of Dance (RAD) syllabus, 8 male and 27 female dancers (aged 20.2 + 1.9 yr) in a fulltime university undergraduate dance training program were asked to stand in first position for 10 seconds and then perform 10 repeats of a demi-plié exercise to a counted rhythm. Accelerometer records from the wrist, sacrum, knee and ankle were compared with the numerical scores from a professional dance instructor. The sacrum mounted sensor detected lateral tilts of the torso in dances with lower scores (Spearman’s rank correlation coefficient r = -0.64, p < 0.005). The RMS acceleration amplitude of wrist mounted sensor was linearly correlated to the movement scores (Spearman’s rank correlation coefficient r = 0.63, p < 0.005). The application of sacrum and wrist mounted sensors for biofeedback during dance training is a realistic, low cost option.

Monitoring spatiotemporal dynamics of human movement based on MAC address data

This thesis was a step forward in extracting valuable features from human's movement behaviour in terms of space utilisation based on Media-Access-Control data. This research offered a low-cost and less computational complexity approach compared to existing human's movement tracking methods. This research was successfully applied in QUT's Gardens Point campus and can be scaled to bigger environments and societies. Extractable information from human's movement by this approach can add a significant value to studying human's movement behaviour, enhancing future urban and interior design, improving crowd safety and evacuation plans.

Low-cost railway level crossings - breaking down the barriers

Level crossing risk continues to be a significant safety concern for the security of rail operations around the world. Over the last decade or so, a third of railway related fatalities occurred as a direct result of collisions between road and rail vehicles in Australia. Importantly, nearly half of these collisions occurred at railway level crossings with no active protection, such as flashing lights or boom barriers. Current practice is to upgrade level crossings that have no active protection. However, the total number of level crossings found across Australia exceed 23,500, and targeting the proportion of these that are considered high risk (e.g. public crossings with passive controls) would cost in excess of AU$3.25 billion based on equipment, installation and commissioning costs of warning devices that are currently type approved. Level crossing warning devices that are low-cost provide a potentially effective control for reducing risk; however, over the last decade, there have been significant barriers and legal issues in both Australia and the US that have foreshadowed their adoption. These devices are designed to have significantly lower lifecycle costs compared with traditional warning devices. They often make use of use of alternative technologies for train detection, wireless connectivity and solar energy supply. This paper describes the barriers that have been encountered for the adoption of these devices in Australia, including the challenges associated with: (1) determining requisite safety levels for such devices; (2) legal issues relating to duty of care obligations of railway operators; and (3) issues of Tort liability around the use of less than fail-safe equipment. This paper provides an overview of a comprehensive safety justification that was developed as part of a project funded by a collaborative rail research initiative established by the Australian government, and describes the conceptual framework and processes being used to justify its adoption. The paper provides a summary of key points from peer review and discusses prospective barriers that may need to be overcome for future adoption. A successful outcome from this process would result in the development of a guideline for decision-making, providing a precedence for adopting low-cost level crossing warning devices in other parts of the world. The framework described in this paper also provides relevance to the review and adoption of analogous technologies in rail and other safety critical industries.

Creating flexible mappings between building information models and cost information

During the early design stages of construction projects, accurate and timely cost feedback is critical to design decision making. This is particularly challenging for cost estimators, as they must quickly and accurately estimate the cost of the building when the design is still incomplete and evolving. State-of-the-art software tools typically use a rule-based approach to generate detailed quantities from the design details present in a building model and relate them to the cost items in a cost estimating database. In this paper, we propose a generic approach for creating and maintaining a cost estimate using flexible mappings between a building model and a cost estimate. The approach uses queries on the building design that are used to populate views, and each view is then associated with one or more cost items. The benefit of this approach is that the flexibility of modern query languages allows the estimator to encode a broad variety of relationships between the design and estimate. It also avoids the use of a common standard to which both designers and estimators must conform, allowing the estimator added flexibility and functionality to their work.

Structure-controlled, vertical graphene-based, binder-free electrodes from plasma-reformed butter enhance supercapacitor performance

Vertical graphene nanosheets (VGNS) hold great promise for high-performance supercapacitors owing to their excellent electrical transport property, large surface area and in particular, an inherent three-dimensional, open network structure. However, it remains challenging to materialise the VGNS-based supercapacitors due to their poor specific capacitance, high temperature processing, poor binding to electrode support materials, uncontrollable microstructure, and non-cost effective way of fabrication. Here we use a single-step, fast, scalable, and environmentally-benign plasma-enabled method to fabricate VGNS using cheap and spreadable natural fatty precursor butter, and demonstrate the controllability over the degree of graphitization and the density of VGNS edge planes. Our VGNS employed as binder-free supercapacitor electrodes exhibit high specific capacitance up to 230 F g−1 at a scan rate of 10 mV s−1 and >99% capacitance retention after 1,500 charge-discharge cycles at a high current density, when the optimum combination of graphitic structure and edge plane effects is utilised. The energy storage performance can be further enhanced by forming stable hybrid MnO2/VGNS nano-architectures which synergistically combine the advantages from both VGNS and MnO2. This deterministic and plasma-unique way of fabricating VGNS may open a new avenue for producing functional nanomaterials for advanced energy storage devices.

Minimum cost of transport in human running is not ubiquitous

Purpose This study explores recent claims that humans exhibit a minimum cost of transport (CoTmin) for running which occurs at an intermediate speed, and assesses individual physiological, gait and training characteristics. Methods Twelve healthy participants with varying levels of fitness and running experience ran on a treadmill at six self-selected speeds in a discontinuous protocol over three sessions. Running speed (km[middle dot]hr-1), V[spacing dot above]O2 (mL[middle dot]kg-1[middle dot]km-1), CoT (kcal[middle dot]km-1), heart rate (beats[middle dot]min-1) and cadence (steps[middle dot]min-1) were continuously measured. V[spacing dot above]O2 max was measured on a fourth testing session. The occurrence of a CoTmin was investigated and its presence or absence examined with respect to fitness, gait and training characteristics. Results Five participants showed a clear CoTmin at an intermediate speed and a statistically significant (p < 0.05) quadratic CoT-speed function, while the other participants did not show such evidence. Participants were then categorized and compared with respect to the strength of evidence for a CoTmin (ClearCoTmin and NoCoTmin). The ClearCoTmin group displayed significantly higher correlation between speed and cadence; more endurance training and exercise sessions per week; than the NoCoTmin group; and a marginally non-significant but higher aerobic capacity. Some runners still showed a CoTmin at an intermediate speed even after subtraction of resting energy expenditure. Conclusion The findings confirm the existence of an optimal speed for human running, in some but not all participants. Those exhibiting a COTmin undertook a higher volume of running, ran with a cadence that was more consistently modulated with speed, and tended to be aerobically fitter. The ability to minimise the energetic cost of transport appears not to be ubiquitous feature of human running but may emerge in some individuals with extensive running experience.

A novel matrix converter based resonant dual active bridge for V2G applications

Dual-active bridges (DABs) can be used to deliver isolated and bidirectional power to electric vehicles (EVs) or to the grid in vehicle-to-grid (V2G) applications. However, such a system essentially requires a two-stage power conversion process, which significantly increases the power losses. Furthermore, the poor power factor associated with DAB converters further reduces the efficiency of such systems. This paper proposes a novel matrix converter based resonant DAB converter that requires only a single-stage power conversion process to facilitate isolated bi-directional power transfer between EVs and the grid. The proposed converter comprises a matrix converter based front end linked with an EV side full-bridge converter through a high frequency isolation transformer and a tuned LCL network. A mathematical model, which predicts the behavior of the proposed system, is presented to show that both the magnitude and direction of the power flow can be controlled through either relative phase angle or magnitude modulation of voltages produced by converters. Viability of the proposed concept is verified through simulations. The proposed matrix converter based DAB, with a single power conversion stage, is low in cost, and suites charging and discharging in single or multiple EVs or V2G applications.

ZnO layers for opto-electronic applications from solution-based and low-temperature processing of an organometallic precursor

As printed and flexible plastic electronic gadgets become increasingly viable today, there is a need to develop materials that suit the fabrication processes involved. Two desirable requirements are solution-processable active materials or precursors and low-temperature processability. In this article, we describe a straightforward method of depositing ZnO films by simple spin coating of an organometallic diethylzinc precursor solution and annealing the resulting film at low temperatures (≤200 °C) without involving any synthetic steps. By controlling the humidity in which annealing is conducted, we are able to adjust the intrinsic doping level and carrier concentration in diethylzinc-derived ZnO. Doped or conducting transport layers are greatly preferable to undoped layers as they enable low-resistance contacts and minimize the potential drops. This ability to controllably realize doped ZnO is a key feature of the fabrication process that we describe in this article. We employ field-effect measurements as a diagnostic tool to measure doping levels and mobilities in ZnO and demonstrate that doped ZnO with high charge carrier concentration is ideal for solar cell applications. Respectable power conversion efficiencies (up to 4.5%) are achieved in inverted solar cells that incorporate diethylzinc-derived ZnO films as the electron transport layer and organic blends as the active material. Extensions of this approach to grow ternary and quaternary films with organometallic precursor chemicals will enable solution based growth of a number of semiconductor films as well as a method to dope them.

A review selection method using product feature taxonomy

As of today, online reviews have become more and more important in decision making process. In recent years, the problem of identifying useful reviews for users has attracted significant attentions. For instance, in order to select reviews that focus on a particular feature, researchers proposed a method which extracts all associated words of this feature as the relevant information to evaluate and find appropriate reviews. However, the extraction of associated words is not that accurate due to the noise in free review text, and this affects the overall performance negatively. In this paper, we propose a method to select reviews according to a given feature by using a review model generated based upon a domain ontology called product feature taxonomy. The proposed review model provides relevant information about the hierarchical relationships of the features in the review which captures the review characteristics accurately. Our experiment results based on real world review dataset show that our approach is able to improve the review selection performance according to the given criteria effectively.

A dual inverter based supercapacitor direct integration scheme for wind energy conversion systems

This paper presents a new direct integration scheme for supercapacitors that are used to mitigate short term power fluctuations in wind power systems. The proposed scheme uses the popular dual inverter topology for grid connection as well as interfacing a supercapacitor bank. The dual inverter system is formed by cascading two 2-level inverters named as the “main inverter” and the “auxiliary inverter”. The main inverter is powered by the rectified output of a wind turbine coupled permanent magnet synchronous generator. The auxiliary inverter is directly connected to a super capacitor bank. This approach eliminates the need for an interfacing dc-dc converter for the supercapacitor bank and thus improves the overall efficiency. A detailed analysis on the effects of non-integer dynamically changing voltage ratio is presented. The concept of integrated boost rectifier is used to carry out the Maximum Power Point Tracking (MPPT) of the wind turbine generator. Another novel feature of this paper is the power reference adjuster which effectively manages capacitor charging and discharging at extreme conditions. Simulation results are presented to verify the efficacy of the proposed system in suppressing short term wind power fluctuations.

Vision-based simultaneous localization and mapping in changing outdoor environments

For robots operating in outdoor environments, a number of factors, including weather, time of day, rough terrain, high speeds, and hardware limitations, make performing vision-based simultaneous localization and mapping with current techniques infeasible due to factors such as image blur and/or underexposure, especially on smaller platforms and low-cost hardware. In this paper, we present novel visual place-recognition and odometry techniques that address the challenges posed by low lighting, perceptual change, and low-cost cameras. Our primary contribution is a novel two-step algorithm that combines fast low-resolution whole image matching with a higher-resolution patch-verification step, as well as image saliency methods that simultaneously improve performance and decrease computing time. The algorithms are demonstrated using consumer cameras mounted on a small vehicle in a mixed urban and vegetated environment and a car traversing highway and suburban streets, at different times of day and night and in various weather conditions. The algorithms achieve reliable mapping over the course of a day, both when incrementally incorporating new visual scenes from different times of day into an existing map, and when using a static map comprising visual scenes captured at only one point in time. Using the two-step place-recognition process, we demonstrate for the first time single-image, error-free place recognition at recall rates above 50% across a day-night dataset without prior training or utilization of image sequences. This place-recognition performance enables topologically correct mapping across day-night cycles.