Patients perceptions of emergency department services : better specialised staff, convenient and available services

Many factors are identified as contributing to the high demand for emergency department (ED) care. Similarly, there have been many initiatives taken to minimise the impact that is placed on EDs. Many of these, however, do not consider the patient's opinions and motivations. The aim of this cross-sectional study was to understand patients’ perspectives and reasons behind their decision to present to EDs. 911 surveys were collected from patients presenting to eight QLD EDs in 2011. Based on the Principal Component Analysis technique, a six-item scale entitled "Best services at emergency departments" was extracted (α = 0.729) measuring patients' opinions and perspectives. Further, the independent t-tests were conducted between various groups of ED users. The results suggest that multiple users more likely viewed EDs as the best place for their conditions than the first-time users (Median 10.73 v 11.56, p<0.001). Moreover, patients who made the decision to present by themselves had a more favourable perception of the ED services than those for whom the decision was made or others were involved (Median 11.38 v 10.80, p=0.003). Method of arrival did not affect the respondents’ perception of ED (11.13 v 11.00, p=0.65). The results of this research indicate that patients’ perception of ED as the best and most appropriate place for attention to their medical conditions plays an important role in their decision to present and keep returning to ED. Understanding patients’ reasons and decisions enhances the success of planning and implementing alternative services to manage the demand for ED services.

Multiple types of data are required to identify the mechanisms influencing the spatial expansion of melanoma cell colonies

Background The expansion of cell colonies is driven by a delicate balance of several mechanisms including cell motility, cell-to-cell adhesion and cell proliferation. New approaches that can be used to independently identify and quantify the role of each mechanism will help us understand how each mechanism contributes to the expansion process. Standard mathematical modelling approaches to describe such cell colony expansion typically neglect cell-to-cell adhesion, despite the fact that cell-to-cell adhesion is thought to play an important role. Results We use a combined experimental and mathematical modelling approach to determine the cell diffusivity, D, cell-to-cell adhesion strength, q, and cell proliferation rate, ?, in an expanding colony of MM127 melanoma cells. Using a circular barrier assay, we extract several types of experimental data and use a mathematical model to independently estimate D, q and ?. In our first set of experiments, we suppress cell proliferation and analyse three different types of data to estimate D and q. We find that standard types of data, such as the area enclosed by the leading edge of the expanding colony and more detailed cell density profiles throughout the expanding colony, does not provide sufficient information to uniquely identify D and q. We find that additional data relating to the degree of cell-to-cell clustering is required to provide independent estimates of q, and in turn D. In our second set of experiments, where proliferation is not suppressed, we use data describing temporal changes in cell density to determine the cell proliferation rate. In summary, we find that our experiments are best described using the range D = 161 - 243 ?m2 hour-1, q = 0.3 - 0.5 (low to moderate strength) and ? = 0.0305 - 0.0398 hour-1, and with these parameters we can accurately predict the temporal variations in the spatial extent and cell density profile throughout the expanding melanoma cell colony. Conclusions Our systematic approach to identify the cell diffusivity, cell-to-cell adhesion strength and cell proliferation rate highlights the importance of integrating multiple types of data to accurately quantify the factors influencing the spatial expansion of melanoma cell colonies.

Design, implementation and multisite evaluation of a system suitability protocol for the quantitative assessment of instrument performance in liquid chromatography-multiple reaction monitoring-MS (LC-MRM-MS)

Multiple reaction monitoring (MRM) mass spectrometry coupled with stable isotope dilution (SID) and liquid chromatography (LC) is increasingly used in biological and clinical studies for precise and reproducible quantification of peptides and proteins in complex sample matrices. Robust LC-SID-MRM-MS-based assays that can be replicated across laboratories and ultimately in clinical laboratory settings require standardized protocols to demonstrate that the analysis platforms are performing adequately. We developed a system suitability protocol (SSP), which employs a predigested mixture of six proteins, to facilitate performance evaluation of LC-SID-MRM-MS instrument platforms, configured with nanoflow-LC systems interfaced to triple quadrupole mass spectrometers. The SSP was designed for use with low multiplex analyses as well as high multiplex approaches when software-driven scheduling of data acquisition is required. Performance was assessed by monitoring of a range of chromatographic and mass spectrometric metrics including peak width, chromatographic resolution, peak capacity, and the variability in peak area and analyte retention time (RT) stability. The SSP, which was evaluated in 11 laboratories on a total of 15 different instruments, enabled early diagnoses of LC and MS anomalies that indicated suboptimal LC-MRM-MS performance. The observed range in variation of each of the metrics scrutinized serves to define the criteria for optimized LC-SID-MRM-MS platforms for routine use, with pass/fail criteria for system suitability performance measures defined as peak area coefficient of variation <0.15, peak width coefficient of variation <0.15, standard deviation of RT <0.15 min (9 s), and the RT drift <0.5min (30 s). The deleterious effect of a marginally performing LC-SID-MRM-MS system on the limit of quantification (LOQ) in targeted quantitative assays illustrates the use and need for a SSP to establish robust and reliable system performance. Use of a SSP helps to ensure that analyte quantification measurements can be replicated with good precision within and across multiple laboratories and should facilitate more widespread use of MRM-MS technology by the basic biomedical and clinical laboratory research communities.

The detection of incipient faults in small multi-cylinder diesel engines using multiple acoustic emission sensors

This thesis investigates condition monitoring (CM) of diesel engines using acoustic emission (AE) techniques. The AE signals recorded from a small size diesel engine are mixtures of multiple sources from multiple cylinders. Thus, it is difficult to interpret the information conveyed in the signals for CM purposes. This thesis develops a series of practical signal processing techniques to overcome this problem. Various experimental studies conducted to assess the CM capabilities of AE analysis for diesel engines. A series of modified signal processing techniques were proposed. These techniques showed promising results of capability for CM of multiple cylinders diesel engine using multiple AE sensors.

Bounded rationality and voting decisions over 160 years : voter behavior and increasing complexity in decision-making

Using a quasi-natural voting experiment encompassing a 160-year period (1848–2009) in Switzerland, we investigate whether a higher level of complexity leads to increased reliance on trusted parliamentary representatives. We find that when more referenda are held on the same day, constituents are more likely to refer to parliamentary recommendations when making their decisions. This finding holds true even when we narrow our focus to referenda with a relatively lower voter turnout on days on which more than one referendum is held. We also demonstrate that when constituents face a higher level of complexity, they follow the parliamentary recommendations rather than those of interest groups. "Viewed as a geometric figure, the ant’s path is irregular, complex, hard to describe. But its complexity is really a complexity in the surface of the beach, not a complexity in the ant." ([1] p. 51)

Make-Buy Decisions in the Face of Radical Innovations

Make-buy decisions are an important aspect of the overall strategic plans for most firms, and the introduction of a new and potentially radical technology into an industry should therefore be a cue for managers to review their make-buy policies. Should a company make in-house the components and processes underpinning the technology, or should it buy them from an outside supplier? Earlier attempts to answer this question may have failed to agree on a single verdict because they have overlooked two important market forces: supplier relations and industry clockspeed. Based on an intensive three-year study at the University of Cambridge which analyzed supply chain management practices from a broad range of manufacturers around the world, this book helps to resolve this classic technology outsourcing dilemma and gives managers the tools they will need to determine if they should make or buy the components and processes that go into a potentially radical innovation.

Pitfalls in the use of kappa when interpreting agreement between multiple raters in reliability studies

OBJECTIVE To compare different reliability coefficients (exact agreement, and variations of the kappa (generalised, Cohen's and Prevalence Adjusted and Biased Adjusted (PABAK))) for four physiotherapists conducting visual assessments of scapulae. DESIGN Inter-therapist reliability study. SETTING Research laboratory. PARTICIPANTS 30 individuals with no history of neck or shoulder pain were recruited with no obvious significant postural abnormalities. MAIN OUTCOME MEASURES Ratings of scapular posture were recorded in multiple biomechanical planes under four test conditions (at rest, and while under three isometric conditions) by four physiotherapists. RESULTS The magnitude of discrepancy between the two therapist pairs was 0.04 to 0.76 for Cohen's kappa, and 0.00 to 0.86 for PABAK. In comparison, the generalised kappa provided a score between the two paired kappa coefficients. The difference between mean generalised kappa coefficients and mean Cohen's kappa (0.02) and between mean generalised kappa and PABAK (0.02) were negligible, but the magnitude of difference between the generalised kappa and paired kappa within each plane and condition was substantial; 0.02 to 0.57 for Cohen's kappa and 0.02 to 0.63 for PABAK, respectively. CONCLUSIONS Calculating coefficients for therapist pairs alone may result in inconsistent findings. In contrast, the generalised kappa provided a coefficient close to the mean of the paired kappa coefficients. These findings support an assertion that generalised kappa may lead to a better representation of reliability between three or more raters and that reliability studies only calculating agreement between two raters should be interpreted with caution. However, generalised kappa may mask more extreme cases of agreement (or disagreement) that paired comparisons may reveal.

The sound of silence : the absence of voice in determining flexible working arrangements

In the context of a dramatically reconfigured labour market characterized by an individualistic culture and increasingly enmeshed life domains of employees, there is raised awareness of how employees may shape or modify their work arrangements. A small component of broader scholarship addressing issues that affect the social context in which individuals work, has focused on the role of ‘employee voice' in determining flexible-work outcomes (Donnelly et al., 2012). Employee voice is a broad term incorporating a spectrum of different practices designed to give employees a say in organisational issues and decisions (Dundon et al., 2004). This article extends work on voice and workplace flexibility by focusing not simply on ‘voice' but on its antithesis: employee silence. Silence is defined here, (following Van Dyne et al., 2003), as the intentional withholding of ideas, information and opinions. The consequences of employee silence in achieving work-life preferences are likely to be significant for both individuals and organizations, in achieving for example, the goals of business efficiency and facilitating employees' needs to fulfill multiple roles and minimize work-life interference.

Odometry-driven inference to link multiple exemplars of a location

A major challenge for robot localization and mapping systems is maintaining reliable operation in a changing environment. Vision-based systems in particular are susceptible to changes in illumination and weather, and the same location at another time of day may appear radically different to a system using a feature-based visual localization system. One approach for mapping changing environments is to create and maintain maps that contain multiple representations of each physical location in a topological framework or manifold. However, this requires the system to be able to correctly link two or more appearance representations to the same spatial location, even though the representations may appear quite dissimilar. This paper proposes a method of linking visual representations from the same location without requiring a visual match, thereby allowing vision-based localization systems to create multiple appearance representations of physical locations. The most likely position on the robot path is determined using particle filter methods based on dead reckoning data and recent visual loop closures. In order to avoid erroneous loop closures, the odometry-based inferences are only accepted when the inferred path's end point is confirmed as correct by the visual matching system. Algorithm performance is demonstrated using an indoor robot dataset and a large outdoor camera dataset.

Teacher Evidence Matrix : an evaluation using multiple lines of evidence

Welcome to the Teacher evidence matrix. This matrix is designed for highly qualified discipline experts to evaluate their teaching in a systematic manner. The primary purpose of the Teacher evidence matrix is to provide a tool that an academic staff member at university can annually review their teaching. The annual review will result in you being ready for performance, planning and review; promotion; awards; or employment application. This tool is designed for individual use and will lead to an action plan for implementation.

Towards bio-inspired place recognition over multiple spatial scales

This paper presents a new multi-scale place recognition system inspired by the recent discovery of overlapping, multi-scale spatial maps stored in the rodent brain. By training a set of Support Vector Machines to recognize places at varying levels of spatial specificity, we are able to validate spatially specific place recognition hypotheses against broader place recognition hypotheses without sacrificing localization accuracy. We evaluate the system in a range of experiments using cameras mounted on a motorbike and a human in two different environments. At 100% precision, the multiscale approach results in a 56% average improvement in recall rate across both datasets. We analyse the results and then discuss future work that may lead to improvements in both robotic mapping and our understanding of sensory processing and encoding in the mammalian brain.

A recommendation approach dealing with multiple market segments

A new community and communication type of social networks - online dating - are gaining momentum. With many people joining in the dating network, users become overwhelmed by choices for an ideal partner. A solution to this problem is providing users with partners recommendation based on their interests and activities. Traditional recommendation methods ignore the users’ needs and provide recommendations equally to all users. In this paper, we propose a recommendation approach that employs different recommendation strategies to different groups of members. A segmentation method using the Gaussian Mixture Model (GMM) is proposed to customize users’ needs. Then a targeted recommendation strategy is applied to each identified segment. Empirical results show that the proposed approach outperforms several existing recommendation methods.

Birth control : to what extent do women report being informed and involved in decisions about pregnancy and birth procedures?

Background: Health policy, guidelines, and standards advocate giving patients comprehensive information and facilitating their involvement in health-related decision-making. Routine assessment of patient reports of these processes is needed. Our objective was to examine decision-making processes, specifically information provision and consumer involvement in decision-making, for nine pregnancy, labour, and birth procedures, as reported by maternity care consumers in Queensland, Australia. Methods: Participants were women who had a live birth in Queensland in a specified time period and were not found to have had a baby that died since birth, who completed the extended Having a Baby in Queensland Survey, 2010 about their maternity care experiences, and who reported at least one of the nine procedures of interest. For each procedure, women answered two questions that measured perceived (i) receipt of information about the benefits and risks of the procedure and (ii) role in decision-making about the procedure. Results: In all, 3,542 eligible women (34.2%) completed the survey. Between 4% (for pre-labour caesarean section) and 60% (for vaginal examination) of women reported not being informed of the benefits and risks of the procedure they experienced. Between 2% (epidural) and 34% (episiotomy) of women reported being unconsulted in decision-making. Over one quarter (26%) of the women who experienced episiotomy reported being neither informed nor consulted. Conclusions: There is an urgent need for interventions that facilitate information provision and consumer involvement in decision-making about several perinatal procedures, especially those performed within the time-limited intrapartum care episode.

Greener workplace : understanding senior management's adoption decisions through the Theory of Planned Behaviour

Human Resources (HR) policies and practices have changed due to global environmental instability. These policies and practices are key factors for successful environmental management. Using the Theory of Planned Behaviour, this article aims to understand the critical factors which influence senior management’s decision to adopt ‘green’ HR practices. Data were collected from 210 organisations in Australia using two separate surveys. Survey one, which was addressed directly to HR managers and directors, contained questions relating to HR policies (the dependent variables), while survey two, which was addressed directly to CEOs and senior managers, contained questions about environmental-related attitudes, subjective norms and perceived control (the independent variables). Results indicated that senior management’s environmental-related attitudes, subjective norms from stakeholders and perceived green resource readiness influenced their decision to adopt green HR initiatives. However, attitudes and green resource readiness in particular had greater impacts than subjective norms. Limitations, implications and future research are also outlined.

Volcanic architecture and chemostratigraphy within the Kalkarindji Continental Flood Basalt Province, Northern Territory : implications for eruption style from multiple fissure eruptions

This thesis was the first to define individual lava flow chemical variation and a detailed definition of the Kalkarindji Continental Flood Basalt Province, a lesser known province of the Phanerozoic eon. This thesis conducted an intensive field study that yielded numerous samples for petrography and chemical analyses as well as the generation of a detailed map of a portion of the Kalkarindji province.