Predicting the likelihood of QA failure using treatment plan accuracy metrics

This study used automated data processing techniques to calculate a set of novel treatment plan accuracy metrics, and investigate their usefulness as predictors of quality assurance (QA) success and failure. 151 beams from 23 prostate and cranial IMRT treatment plans were used in this study. These plans had been evaluated before treatment using measurements with a diode array system. The TADA software suite was adapted to allow automatic batch calculation of several proposed plan accuracy metrics, including mean field area, small-aperture, off-axis and closed-leaf factors. All of these results were compared the gamma pass rates from the QA measurements and correlations were investigated. The mean field area factor provided a threshold field size (5 cm2, equivalent to a 2.2 x 2.2 cm2 square field), below which all beams failed the QA tests. The small aperture score provided a useful predictor of plan failure, when averaged over all beams, despite being weakly correlated with gamma pass rates for individual beams. By contrast, the closed leaf and off-axis factors provided information about the geometric arrangement of the beam segments but were not useful for distinguishing between plans that passed and failed QA. This study has provided some simple tests for plan accuracy, which may help minimise time spent on QA assessments of treatments that are unlikely to pass.

Sub-modelling for the ratchetting failure of insulated rail joints

Insulated rail joints are critical for train safety as they control electrical signalling systems; unfortunately they exhibit excessive ratchetting of the railhead near the endpost insulators. This paper reports a three-dimensional global model of these joints under wheel–rail contact pressure loading and a sub-model examining the ratchetting failures of the railhead. The sub-model employs a non-linear isotropic–kinematic elastic–plastic material model and predicts stress/strain levels in the localised railhead zone adjacent to the endpost which is placed in the air gap between the two rail ends at the insulated rail joint. The equivalent plastic strain plot is utilised to capture the progressive railhead damage adequately. Associated field and laboratory testing results of damage to the railhead material suggest that the simulation results are reasonable.

Unintended consequences : satellite policy and Indigenous television

This article examines two instances of media policy involving satellite transmission and Indigenous television: the introduction of the Viewer Access Satellite Television (VAST) platform in 2010 and the introduction of AUSSAT in the mid-1980s. The government’s failure to provide community and Indigenous broadcasters with an access regime at the time of AUSSAT resulted in Australia’s first and only Indigenous commercial television licensee, Imparja. Over a quarter of a century later, Imparja now forms part of the joint-venture company that runs VAST, a key component of Australia’s digital switchover planning. During the passage of the legislative amendments required to establish VAST, the issue of access resurfaced – this time in relation to Australia’s national and community Indigenous television channels. The article recounts the events leading up to the 2010 Bill, and examines the intended and unintended consequences of satellite policy in relation to Indigenous media, including equalisation and transparency of government funding programs.

State-of-the-art : track degradation at bridge transitions

Transition zones between bridge decks and rail tracks suffer early failure due to poor interaction between rail vehicles and sudden changes of stiffness. This has been an ongoing problem to rail industry and yet still no systematic studies appear to have been taken to maintain a gradually smoothening transmission of forces between the bridge and its approach. Differential settlement between the bridge deck and rail track in the transition zone is the fundamental issue, which negatively impacts the rail industry by causing passenger discomfort, early damage to infrastructure and vehicle components, speed reduction, and frequent maintenance cycles. Identification of mechanism of the track degradation and factors affecting is imperative to design any mitigation method for reducing track degradation rate at the bridge transition zone. Unfortunately this issue is still not well understood, after conducting a numbers of reviews to evaluate the key causes, and introducing a wide range of mitigation techniques. In this study, a comprehensive analysis of the available literature has been carried out to develop either a novel design framework or a mitigation technique for the bridge transition zone. This paper addresses three critical questions in relation to the track degradation at transition zone: (1) what are the causes of bridge transition track degradation?; (2) what are the available mitigation techniques in reducing the track degradation rate?; (3) what are the factors affecting on poor performance of the existing mitigation techniques?. It is found that the absence of soil-water response, dynamic loading response, and behaviour of geotechnical characteristics under long-term conditions in existing track transition design frameworks critically influence on the failures of existing mitigation techniques. This paper also evaluates some of the existing design frameworks to identify how each design framework addresses the track degradation at the bridge transition zone.

Leptospirosis and Leptospires - The silent assassins

Leptospirosis is one of the most common yet under reported zoonoses. Leptospires, the etiological agents of leptospirosis are ubiquitous pathogens, with a world-wide distribution, causing a spectrum of disease ranging from a mild influenza-like illness to Weil’s disease, which manifests itself in multi-organ failure. The following chapter reports on the epidemiology and transmission of the disease in humans and animals. The chapter will also delineate the symptoms observed in humans and animals and in concluding outline unresolved and evolving issues for microbiologists, epidemiologists and public health officials.

Liability in negligence and the failure to disclose multiple risks in surgery : I would have been willing to run the risk

It has been 21 years since the decision in Rogers v Whitaker and the legal principles concerning informed consent and liability for negligence are still strongly grounded in this landmark High Court decision. This paper considers more recent developments in the law concerning the failure to disclose inherent risks in medical procedures, focusing on the decision in Wallace v Kam [2013] HCA 19. In this case, the appellant underwent a surgical procedure that carried a number of risks. The surgery itself was not performed in a sub-standard way, but the surgeon failed to disclose two risks to the patient, a failure that constituted a breach of the surgeon’s duty of care in negligence. One of the undisclosed risks was considered to be less serious than the other, and this lesser risk eventuated causing injury to the appellant. The more serious risk did not eventuate, but the appellant argued that if the more serious risk had been disclosed, he would have avoided his injuries completely because he would have refused to undergo the procedure. Liability was disputed by the surgeon, with particular reference to causation principles. The High Court of Australia held that the appellant should not be compensated for harm that resulted from a risk he would have been willing to run. We examine the policy reasons underpinning the law of negligence in this specific context and consider some of the issues raised by this unusual case. We question whether some of the judicial reasoning adopted in this case, represents a significant shift in traditional causation principles.

Assessing the property market impact of stigma removal : high voltage overhead transmission lines removal in Wellington, NZ

This thesis advances the understanding of the impact of stigma on property values. A case study in Wellington, New Zealand, enabled hedonic modelling and an empirical analysis to determine the impact of the stigma from the high voltage transmission line structure and how long the stigma remained after removal. The results reveal a substantial difference between the discount applied to individual properties while the structure is in place, as compared to the overall increase in neighbourhood value once the structure, which created the stigma, is removed.

Unidentified vehicle in multi-vehicle accident - failure to notify Nominal Defendant no bar to proceedings against it

In Kumar v Suncorp Metway Insurance Limited [2004] QSC 381 Douglas J examined s37 of the Motor Accident Insurance Act 1994 (Qld) in the context of an accident involving multiple insurers when a notice of accident had not been given to the Nominal Defendant

Failure of discontinuous railhead edges due to plastic strain accumulation

Railhead is perhaps the highest stressed civil infrastructure due to the passage of heavily loaded wheels through a very small contact patch. The stresses at the contact patch cause yielding of the railhead material and wear. Many theories exist for the prediction of these mechanisms of continuous rails; this process in the discontinuous rails is relatively sparingly researched. Discontinuous railhead edges fail due to accumulating excessive plastic strains. Significant safety concern is widely reported as these edges form part of Insulated Rail Joints (IRJs) in the signalling track circuitry. Since Hertzian contact is not valid at a discontinuous edge, 3D finite element (3DFE) models of wheel contact at a railhead edge have been used in this research. Elastic–plastic material properties of the head hardened rail steel have been experimentally determined through uniaxial monotonic tension tests and incorporated into a FE model of a cylindrical specimen subject to cyclic tension load- ing. The parameters required for the Chaboche kinematic hardening model have been determined from the stabilised hysteresis loops of the cyclic load simulation and imple- mented into the 3DFE model. The 3DFE predictions of the plastic strain accumulation in the vicinity of the wheel contact at discontinuous railhead edges are shown to be affected by the contact due to passage of wheels rather than the magnitude of the loads the wheels carry. Therefore to eliminate this failure mechanism, modification to the contact patch is essential; reduction in wheel load cannot solve this problem.

Performance evaluation of three-level Z-source inverters under semiconductor-failure conditions

This paper evaluates and proposes various compensation methods for three-level Z-source inverters under semiconductor-failure conditions. Unlike the fault-tolerant techniques used in traditional three-level inverters, where either an extra phase-leg or collective switching states are used, the proposed methods for three-level Z-source inverters simply reconfigure their relevant gating signals so as to ride-through the failed semiconductor conditions smoothly without any significant decrease in their ac-output quality and amplitude. These features are partly attributed to the inherent boost characteristics of a Z-source inverter, in addition to its usual voltage-buck operation. By focusing on specific types of three-level Z-source inverters, it can also be shown that, for the dual Z-source inverters, a unique feature accompanying it is its extra ability to force common-mode voltage to zero even under semiconductor-failure conditions. For verifying these described performance features, PLECS simulation and experimental testing were performed with some results captured and shown in a later section for visual confirmation.

A typology of technological enablers of website service failure prevention

An increasing range of services are now offered via online applications and e-commerce websites. However, problems with online services still occur at times, even for the best service providers due to the technical failures, informational failures, or lack of required website functionalities. Also, the widespread and increasing implementation of web services means that service failures are both more likely to occur, and more likely to have serious consequences. In this paper we first develop a digital service value chain framework based on existing service delivery models adapted for digital services. We then review current literature on service failure prevention, and provide a typology of technolo- gies and approaches that can be used to prevent failures of different types (functional, informational, system), that can occur at different stages in the web service delivery. This makes a contribution to theory by relating specific technologies and technological approaches to the point in the value chain framework where they will have the maximum impact. Our typology can also be used to guide the planning, justification and design of robust, reliable web services.

Failure of amino acid homeostasis causes cell death following proteasome inhibition

The ubiquitin-proteasome system targets many cellular proteins for degradation and thereby controls most cellular processes. Although it is well established that proteasome inhibition is lethal, the underlying mechanism is unknown. Here, we show that proteasome inhibition results in a lethal amino acid shortage. In yeast, mammalian cells, and flies, the deleterious consequences of proteasome inhibition are rescued by amino acid supplementation. In all three systems, this rescuing effect occurs without noticeable changes in the levels of proteasome substrates. In mammalian cells, the amino acid scarcity resulting from proteasome inhibition is the signal that causes induction of both the integrated stress response and autophagy, in an unsuccessful attempt to replenish the pool of intracellular amino acids. These results reveal that cells can tolerate protein waste, but not the amino acid scarcity resulting from proteasome inhibition.

Changes in healthcare-associated Staphylococcus aureus bloodstream infections after the introduction of a national hand hygiene initiative

Background. Interventions that prevent healthcare-associated infection should lead to fewer deaths and shorter hospital stays. Cleaning hands (with soap or alcohol) is an effective way to prevent the transmission of organisms, but rates of compliance with hand hygiene are sometimes disappointingly low. The National Hand Hygiene Initiative in Australia aimed to improve hand hygiene compliance among healthcare workers, with the goal of reducing rates of healthcare-associated infection. Methods. We examined whether the introduction of the National Hand Hygiene Initiative was associated with a change in infection rates. Monthly infection rates for healthcare-associated Staphylococcus aureus bloodstream infections were examined in 38 Australian hospitals across 6 states. We used Poisson regression and examined 12 possible patterns of change, with the best fitting pattern chosen using the Akaike information criterion. Monthly bed-days were included to control for increased hospital use over time. Results. The National Hand Hygiene Initiative was associated with a reduction in infection rates in 4 of the 6 states studied. Two states showed an immediate reduction in rates of 17% and 28%, 2 states showed a linear decrease in rates of 8% and 11% per year, and 2 showed no change in infection rates. Conclusions. The intervention was associated with reduced infection rates in most states. The failure in 2 states may have been because those states already had effective initiatives before the national initiative’s introduction or because infection rates were already low and could not be further reduced.

Artemisinin-induced parasite dormancy : a plausible mechanism for treatment failure

Background Artemisinin-combination therapy is a highly effective treatment for uncomplicated falciparum malaria but parasite recrudescence has been commonly reported following artemisinin (ART) monotherapy. The dormancy recovery hypothesis has been proposed to explain this phenomenon, which is different from the slower parasite clearance times reported as the first evidence of the development of ART resistance. Methods In this study, an existing P. falciparum infection model is modified to incorporate the hypothesis of dormancy. Published in vitro data describing the characteristics of dormant parasites is used to explore whether dormancy alone could be responsible for the high recrudescence rates observed in field studies using monotherapy. Several treatment regimens and dormancy rates were simulated to investigate the rate of clinical and parasitological failure following treatment. Results The model output indicates that following a single treatment with ART parasitological and clinical failures occur in up to 77% and 67% of simulations, respectively. These rates rapidly decline with repeated treatment and are sensitive to the assumed dormancy rate. The simulated parasitological and clinical treatment failure rates after 3 and 7 days of treatment are comparable to those reported from several field trials. Conclusions Although further studies are required to confirm dormancy in vivo, this theoretical study adds support for the hypothesis, highlighting the potential role of this parasite sub-population in treatment failure following monotherapy and reinforcing the importance of using ART in combination with other anti-malarials.

Artemisinin induced dormancy in Plasmodium falciparum : duration, recovery rates and implications in treatment failure

Background Despite the remarkable activity of artemisinin and its derivatives, monotherapy with these agents has been associated with high rates of recrudescence. The temporary arrest of the growth of ring-stage parasites (dormancy) after exposure to artemisinin drugs provides a plausible explanation for this phenomenon. Methods Ring-stage parasites of several Plasmodium falciparum lines were exposed to different doses of dihydroartemisinin (DHA) alone or in combination with mefloquine. For each regime, the proportion of recovering parasites was determined daily for 20 days. Results Parasite development was abruptly arrested after a single exposure to DHA, with some parasites being dormant for up to 20 days. Approximately 50% of dormant parasites recovered to resume growth within the first 9 days. The overall proportion of parasites recovering was dose dependent, with recovery rates ranging from 0.044% to 1.313%. Repeated treatment with DHA or with DHA in combination with mefloquine led to a delay in recovery and an ∼10-fold reduction in total recovery. Strains with different genetic backgrounds appeared to vary in their capacity to recover. Conclusions These results imply that artemisinin-induced arrest of growth occurs readily in laboratory-treated parasites and may be a key factor in P. falciparum malaria treatment failure.