What can we do to improve the coordination of care for cancer patients?

The delivery of cancer services has become increasingly complex as we move to more personalized diagnostic and treatment approaches and cancer is recognized as a chronic disease. Cancer patients today typically come into contact with multiple health services over long periods. Healthcare reforms in many countries also mean that the various services involved in cancer care are funded by a confusing mix of personal, private insurer, and government sources. It is not surprising then that many patients today tell us their cancer experience is disjointed. Importantly, this lack of coordination of cancer care results in poor outcomes that can range from minor inconvenience at best to potentially life-threatening safety incidents at worst.

Multi-rotor with suspended load: System dynamics and control toolbox

There is an increasing demand for Unmanned Aerial Systems (UAS) to carry suspended loads as this can provide significant benefits to several applications in agriculture, law enforcement and construction. The load impact on the underlying system dynamics should not be neglected as significant feedback forces may be induced on the vehicle during certain flight manoeuvres. The constant variation in operating point induced by the slung load also causes conventional controllers to demand increased control effort. Much research has focused on standard multi-rotor position and attitude control with and without a slung load. However, predictive control schemes, such as Nonlinear Model Predictive Control (NMPC), have not yet been fully explored. To this end, we present a novel controller for safe and precise operation of multi-rotors with heavy slung load in three dimensions. The paper describes a System Dynamics and Control Simulation Toolbox for use with MATLAB/SIMULINK which includes a detailed simulation of the multi-rotor and slung load as well as a predictive controller to manage the nonlinear dynamics whilst accounting for system constraints. It is demonstrated that the controller simultaneously tracks specified waypoints and actively damps large slung load oscillations. A linear-quadratic regulator (LQR) is derived and control performance is compared. Results show the improved performance of the predictive controller for a larger flight envelope, including aggressive manoeuvres and large slung load displacements. The computational cost remains relatively small, amenable to practical implementations.

Adoption dynamics of increasing-return technologies in systemic contexts

Many systemic, complex technologies have been suggested to exhibit increasing returns to adoption, whereby the initial increase in adoption leads to increasing experience with the technology, which drives technological improvements and use, subsequently leading to further adoption. In addition, in the systemic context, mimetic behavior may lend support to increasing returns as technology adoption is witnessed among other agents in the systemic context. Finally, inter-dependencies in the systemic context also sensitize the adoption behavior to fundamental changes in technology provisioning, and this may lend support for the increasing returns type of dynamics in adoption. Our empirical study examines the dynamics of organizational technology adoption when technology is provisioned by organizations in another sub-system in a systemic context. We hypothesize that innovation, imitation, and technological change effects are present in creating increasing returns in the systemic context. Our empirical setting considers 24 technologies represented by 2282 data points in the computer industry. Our results provide support for our prediction that imitation effects are present in creating increasing returns to adoption. We further discuss the managerial and research implications of our results.

Determining reverse salient types and evolutionary dynamics of technology systems with performance disparities

Technological system evolution is marked by the uneven evolution of constituent sub-systems. Subsequently, system evolution is hampered by the resulting state of unevenness, or reverse salience, which results from the presence of the sub-system that delivers the lowest level of performance with respect to other sub-systems, namely, the reverse salient. In this paper, we develop absolute and proportional performance gap measures of reverse salience and, in turn, derive a typology of reverse salients that distinguishes alternative dynamics of change in the evolving system. We subsequently demonstrate the applicability of the measures and the typology through an illustrative empirical study of the PC (personal computer) technological system that functions as a gaming platform. Our empirical analysis demonstrates that patterns of temporal dynamics can be distinguished with the measurement of reverse salience, and that distinct paths of technological system evolution can be identified as different types of reverse salients emerge over time.

Dynamics of reverse salience as technological performance gap: An empirical study of the personal computer technology system

The evolution of technological systems is hindered by systemic components, referred to as reverse salients, which fail to deliver the necessary level of technological performance thereby inhibiting the performance delivery of the system as a whole. This paper develops a performance gap measure of reverse salience and applies this measurement in the study of the PC (personal computer) technological system, focusing on the evolutions of firstly the CPU (central processing unit) and PC game sub-systems, and secondly the GPU (graphics processing unit) and PC game sub-systems. The measurement of the temporal behavior of reverse salience indicates that the PC game sub-system is the reverse salient, continuously trailing behind the technological performance of the CPU and GPU sub-systems from 1996 through 2006. The technological performance of the PC game sub-system as a reverse salient trails that of the CPU sub-system by up to 2300 MHz with a gradually decreasing performance disparity in recent years. In contrast, the dynamics of the PC game sub-system as a reverse salient trails the GPU sub-system with an ever increasing performance gap throughout the timeframe of analysis. In addition, we further discuss the research and managerial implications of our findings.

Dynamics of gray matter loss in Alzheimer's disease

We detected and mapped a dynamically spreading wave of gray matter loss in the brains of patients with Alzheimer's disease (AD). The loss pattern was visualized in four dimensions as it spread over time from temporal and limbic cortices into frontal and occipital brain regions, sparing sensorimotor cortices. The shifting deficits were asymmetric (left hemisphere > right hemisphere) and correlated with progressively declining cognitive status (p < 0.0006). Novel brain mapping methods allowed us to visualize dynamic patterns of atrophy in 52 high-resolution magnetic resonance image scans of 12 patients with AD (age 68.4 ± 1.9 years) and 14 elderly matched controls (age 71.4 ± 0.9 years) scanned longitudinally (two scans; interscan interval 2.1 ± 0.4 years). A cortical pattern matching technique encoded changes in brain shape and tissue distribution across subjects and time. Cortical atrophy occurred in a well defined sequence as the disease progressed, mirroring the sequence of neurofibrillary tangle accumulation observed in cross sections at autopsy. Advancing deficits were visualized as dynamic maps that change over time. Frontal regions, spared early in the disease, showed pervasive deficits later (< 15% loss). The maps distinguished different phases of AD and differentiated AD from normal aging. Local gray matter loss rates (5.3 ± 2.3% per year in AD v 0.9 ± 0.9% per year in controls) were faster in the left hemisphere (p < 0.029) than the right. Transient barriers to disease progression appeared at limbic/frontal boundaries. This degenerative sequence, observed in vivo as it developed, provides the first quantitative, dynamic visualization of cortical atrophic rates in normal elderly populations and in those with dementia.

Utilising big transit data for transfer coordination

In public transport, seamless coordinated transfer strengthens the quality of service and attracts ridership. The problem of transfer coordination is sophisticated due to (1) the stochasticity of travel time variability, (2) unavailability of passenger transfer plan. However, the proliferation of Big Data technologies provides a tremendous opportunity to solve these problems. This dissertation enhances passenger transfer quality by offline and online transfer coordination. While offline transfer coordination exploits the knowledge of travel time variability to coordinate transfers, online transfer coordination provides simultaneous vehicle arrivals at stops to facilitate transfers by employing the knowledge of passenger behaviours.

The dynamics of global visual effects and games development industries: lessons for Australia’s creative industries development policy

The paper critiques the focus of creative industries policy on capability development of small and medium sized firms and the provision of regional incentives. It analyses factors affecting the competitiveness and sustainability of the games development industry and visual effects suppliers to feature films. Interviews with participants in these industries highlight the need for policy instruments to take into consideration the structure and organization of global markets and the power of lead multinational corporations. We show that although forms of economic governance in these industries may allow sustainable value capture, they are interrupted by bottlenecks in which ferocious competition among suppliers is confronted by comparatively little competition among the lead firms. We argue that current approaches to creative industries policy aimed at building self-sustaining creative industries are unlikely to be sufficient because of the globalized nature of the industries. Rather, we argue that a more profitable approach is likely to require supporting diversification of the industries as ‘feeders’ into other areas of the economy.

Boundary crossing: A theoretical framework to understand the operation dynamics of industry-school partnerships

Industry-school partnerships (ISPs) are increasingly being recognised as a new way of providing vocational education opportunities. However, there is limited research investigating their impact on systemic (organisational and structural) and human resource (teachers and education managers) capacity to support school to work transitions. This paper reports on a government led ISP, established by the Queensland state government. ISPs across three industry sectors: minerals and energy; building and construction; and aviation are included in this study. This research adopted a qualitative case study methodology and draws upon boundary crossing theory to understand the dynamics of how each industry sector responded to systemic and human resource issues that emerged in each ISP. The main finding being that the systematic application of boundary crossing mechanisms by all partners pro-duced mutually beneficial outcomes. ISPs from the three sectors adopted different models, leveraged different boundary crossing objects but all maintained the joint vision and mutually agreed outcomes. All three ISPs genuinely crossed boundaries, albeit in different ways, and assisted teachers to co-pro-duce industry-based curriculums, share sector specific knowledge and skills that help enhance the school to work transition for school graduates.

Crystal structures of the potassium and rubidium salts of (3,5-dichlorophenoxy)acetic acid: Two isotypic coordination polymers

The two-dimensional coordination polymeric structures of the hydrated potassium and rubidium salts of (3,5-dichlorophenoxy)acetic acid, (3,5-D) namely, poly[mu-aqua-bis[mu3-2-(3,5-dichlorophenoxy)acetato]potassium, [K2(C8H5Cl2O3)2 (H2O)]n (I) and poly[mu-aqua-bis[mu3-2-(3,5-dichlorophenoxy)acetato]dirubidium] [Rb2(C8H5Cl2O3)2 (H2O)]n (II), respectively have been determined and are described. The two compounds are isotypic and the polymer is based on centrosymmetric dinuclear bridged complex units. The irregular six-coordination about the metal centres comprises a bridging water molecule lying on a twofold rotation axis, the phenoxy O-atom donor and and a triple bridging carboxylate O-atom of the oxoacetate side chain of the 3,5-D ligand in a bidentate chelate mode, the second carboxy O-donor, also bridging. The K-O and Rb-O bond-length ranges are 2.7238(15)--2.9459(14) and 2.832(2)--3.050(2) \%A respectively and the K...K and Rb...Rb separations in the dinuclear unit are 4.0214(7) and 4.1289(6) \%A, respectively. Within the two-dimensional layers which lie parallel to (100), the coordinated water molecule forms an O---H...O hydrogen bond to the single bridging carboxylate O atom.

Infection and cellular defense dynamics in a novel 17beta-estradiol murine model of chronic human group B streptococcus genital tract colonization reveal a role for hemolysin in persistence and neutrophil accumulation

Genital tract carriage of group B streptococcus (GBS) is prevalent among adult women; however, the dynamics of chronic GBS genital tract carriage, including how GBS persists in this immunologically active host niche long term, are not well defined. To our knowledge, in this study, we report the first animal model of chronic GBS genital tract colonization using female mice synchronized into estrus by delivery of 17β-estradiol prior to intravaginal challenge with wild-type GBS 874391. Cervicovaginal swabs, which were used to measure bacterial persistence, showed that GBS colonized the vaginal mucosa of mice at high numbers (106–107 CFU/swab) for at least 90 d. Cellular and histological analyses showed that chronic GBS colonization of the murine genital tract caused significant lymphocyte and PMN cell infiltrates, which were localized to the vaginal mucosal surface. Long-term colonization was independent of regular hormone cycling. Immunological analyses of 23 soluble proteins related to chemotaxis and inflammation showed that the host response to GBS in the genital tract comprised markers of innate immune activation including cytokines such as GM-CSF and TNF-α. A nonhemolytic isogenic mutant of GBS 874391, Δcyle9, was impaired for colonization and was associated with amplified local PMN responses. Induction of DNA neutrophil extracellular traps, which was observed in GBS-infected human PMNs in vitro in a hemolysin-dependent manner, appeared to be part of this response. Overall, this study defines key infection dynamics in a novel murine model of chronic GBS genital tract colonization and establishes previously unknown cellular and soluble defense responses to GBS in the female genital tract.

Spatiotemporal transmission dynamics of hemorrhagic fever with renal syndrome in China, 2005-2012

Background Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne disease caused by many serotypes of hantaviruses. In China, HFRS has been recognized as a severe public health problem with 90% of the total reported cases in the world. This study describes the spatiotemporal dynamics of HFRS cases in China and identifies the regions, time, and populations at highest risk, which could help the planning and implementation of key preventative measures. Methods Data on all reported HFRS cases at the county level from January 2005 to December 2012 were collected from Chinese Center for Disease Control and Prevention. Geographic Information System-based spatiotemporal analyses including Local Indicators of Spatial Association and Kulldorff's space-time scan statistic were performed to detect local high-risk space-time clusters of HFRS in China. In addition, cases from high-risk and low-risk counties were compared to identify significant demographic differences. Results A total of 100,868 cases were reported during 2005–2012 in mainland China. There were significant variations in the spatiotemporal dynamics of HFRS. HFRS cases occurred most frequently in June, November, and December. There was a significant positive spatial autocorrelation of HFRS incidence during the study periods, with Moran's I values ranging from 0.46 to 0.56 (P<0.05). Several distinct HFRS cluster areas were identified, mainly concentrated in northeastern, central, and eastern of China. Compared with cases from low-risk areas, a higher proportion of cases were younger, non-farmer, and floating residents in high-risk counties. Conclusions This study identified significant space-time clusters of HFRS in China during 2005–2012 indicating that preventative strategies for HFRS should be particularly focused on the northeastern, central, and eastern of China to achieve the most cost-effective outcomes.

Effects of different instructional constraints on task performance and emergence of coordination in children

The objectives of this study were to determine the impact of different instructional constraints on standing board jump (sbj) performance in children and understand the underlying changes in emergent movement patterns. Two groups of novice participants were provided with either externally or internally focused attentional instructions during an intervention phase. Pre- and post-test sessions were undertaken to determine changes to performance and movement patterns. Thirty-six primary fourth-grade male students were recruited for this study and randomly assigned to either an external, internal focus or control group. Different instructional constraints with either an external focus (image of the achievement) or an internal focus (image of the act) were provided to the participants. Performance scores (jump distances), and data from key kinematic (joint range of motion, ROM) and kinetic variables (jump impulses) were collected. Instructional constraints with an emphasis on an external focus of attention were generally more effective in assisting learners to improve jump distances. Intra-individual analyses highlighted how enhanced jump distances for successful participants may be concomitant with specific changes to kinematic and kinetic variables. Larger joint ROM and adjustment to a comparatively larger horizontal impulse to a vertical impulse were observed for more successful participants at post-test performance. From a constraints-led perspective, the inclusion of instructional constraints encouraging self-adjustments in the control of movements (i.e., image of achievement) had a beneficial effect on individuals performing the standing broad jump task. However, the advantage of using an external focus of attentional instructions could be task- and individual-specific.

Flow evaluation and hemolysis analysis of BVAD centrifugal blood pump by computational fluids dynamics

Computational fluid dynamics (CFD) and particle image velocimetry (PIV) are commonly used techniques to evaluate the flow characteristics in the development stage of blood pumps. CFD technique allows rapid change to pump parameters to optimize the pump performance without having to construct a costly prototype model. These techniques are used in the construction of a bi-ventricular assist device (BVAD) which combines the functions of LVAD and RVAD in a compact unit. The BVAD construction consists of two separate chambers with similar impellers, volutes, inlet and output sections. To achieve the required flow characteristics of an average flow rate of 5 l/min and different pressure heads (left – 100mmHg and right – 20mmHg), the impellers were set at different rotating speeds. From the CFD results, a six-blade impeller design was adopted for the development of the BVAD. It was also observed that the fluid can flow smoothly through the pump with minimum shear stress and area of stagnation which are related to haemolysis and thrombosis. Based on the compatible Reynolds number the flow through the model was calculated for the left and the right pumps. As it was not possible to have both the left and right chambers in the experimental model, the left and right pumps were tested separately.

Stochastic dynamics of interacting haematopoietic stem cell niche lineages

Since we still know very little about stem cells in their natural environment, it is useful to explore their dynamics through modelling and simulation, as well as experimentally. Most models of stem cell systems are based on deterministic differential equations that ignore the natural heterogeneity of stem cell populations. This is not appropriate at the level of individual cells and niches, when randomness is more likely to affect dynamics. In this paper, we introduce a fast stochastic method for simulating a metapopulation of stem cell niche lineages, that is, many sub-populations that together form a heterogeneous metapopulation, over time. By selecting the common limiting timestep, our method ensures that the entire metapopulation is simulated synchronously. This is important, as it allows us to introduce interactions between separate niche lineages, which would otherwise be impossible. We expand our method to enable the coupling of many lineages into niche groups, where differentiated cells are pooled within each niche group. Using this method, we explore the dynamics of the haematopoietic system from a demand control system perspective. We find that coupling together niche lineages allows the organism to regulate blood cell numbers as closely as possible to the homeostatic optimum. Furthermore, coupled lineages respond better than uncoupled ones to random perturbations, here the loss of some myeloid cells. This could imply that it is advantageous for an organism to connect together its niche lineages into groups. Our results suggest that a potential fruitful empirical direction will be to understand how stem cell descendants communicate with the niche and how cancer may arise as a result of a failure of such communication.