Retrospective observational study of patients who present to Australian rural emergency departments with undifferentiated chest pain

Aim To identify the demographic and clinical characteristics of patients who present to Australian rural emergency departments with chest pain. Design Retrospective, observational study Setting Rural emergency departments (ED) in Queensland, Australia Participants 337 consecutive adult patients with undifferentiated chest pain that presented between 1st September 2013 and 30th November 2013. Main outcome measures Service indicators, discharge diagnoses and disposition Results Presentations for undifferentiated chest pain represented 3.5% of all patient presentations during the sampling period. The mean age of patients was 48 years and 54% were male. Overall, 92% of patients left the ED within the 4-hour NEAT target. The majority of presentations were related to cardiac concerns (39%), followed by non-cardiac chest pain (17%), musculoskeletal (15%) and respiratory (10%) conditions. More than half of these patients were discharged at the completion of the ED service (52.8%), 40.6% were admitted, 3.3% left at own risk, 2.4% did not wait and less than 1% of patients required transfer to another hospital directly from the ED. Conclusions This study has provided information on the characteristics and processes of care for patients presenting to Australian rural EDs with undifferentiated chest pain that will inform service planning and further research to evaluate the effectiveness of care for these patients.

Development and characterization of a novel, antimicrobial, sterile hydrogel dressing for burn wounds : single-step production with gamma irradiation creates silver nanoparticles and radical polymerization

Patients with burn wounds are susceptible to wound infection and sepsis. This research introduces a novel burn wound dressing that contains silver nanoparticles (SNPs) to treat infection in a 2-acrylamido-2-methylpropane sulfonic acid sodium salt (AMPS-Na(+) ) hydrogel. Silver nitrate was dissolved in AMPS-Na(+) solution and then exposed to gamma irradiation to form SNP-infused hydrogels. The gamma irradiation results in a cross-linked polymeric network of sterile hydrogel dressing and a reduction of silver ions to form SNPs infused in the hydrogel in a one-step process. About 80% of the total silver was released from the hydrogels after 72 h immersion in simulated body fluid solution; therefore, they could be used on wounds for up to 3 days. All the hydrogels were found to be nontoxic to normal human dermal fibroblast cells. The silver-loaded hydrogels had good inhibitory action against Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus. Results from a pilot study on a porcine burn model showed that the 5-mM silver hydrogel was efficient at preventing bacterial colonization of wounds, and the results were comparable to the commercially available silver dressings (Acticoat(TM) , PolyMem Silver(®) ). These results support its use as a potential burn wound dressing.

Writing embodied practice from the inside : outside the exegesis

The textual turn is a good friend of expert spectating, where it assumes the role of writing-productive apparatus, but no friend at all of expert practices or practitioners (Melrose, 2003). Introduction The challenge of time-based embodied performance when the artefact is unstable As a former full-time professional practitioner with an embodied dance practice as performer, choreographer and artistic director for three decades, I somewhat unexpectedly entered the world of academia in 2000 after completing a practice-based PhD, which was described by its examiners as ‘pioneering’. Like many artists my intention was to deepen and extend my practice through formal research into my work and its context (which was intercultural) and to privilege the artist’s voice in a research world where it was too often silent. Practice as research, practice-based research, and practice-led research were not yet fully named. It was in its infancy and my biggest challenge was to find a serviceable methodology which did not betray my intentions to keep practice at the centre of the research. Over the last 15 years, practice led doctoral research, where examinable creative work is placed alongside an accompanying (exegetical) written component, has come a long way. It has been extensively debated with a range of theories and models proposed (Barrett & Bolt, 2007, Pakes, 2003 & 2004, Piccini, 2005, Philips, Stock & Vincs 2009, Stock, 2009 & 2010, Riley & Hunter 2009, Haseman, 2006, Hecq, 2012). Much of this writing is based around epistemological concerns where the research methodologies proposed normally incorporate a contextualisation of the creative work in its field of practice, and more importantly validation and interrogation of the processes of the practice as the central ‘data gathering’ method. It is now widely accepted, at least in the Australian creative arts context, that knowledge claims in creative practice research arise from the material activities of the practice itself (Carter, 2004). The creative work explicated as the tangible outcome of that practice is sometimes referred to as the ‘artefact’. Although the making of the artefact, according to Colbert (2009, p. 7) is influenced by “personal, experiential and iterative processes”, mapping them through a research pathway is “difficult to predict [for] “the adjustments made to the artefact in the light of emerging knowledge and insights cannot be foreshadowed”. Linking the process and the practice outcome most often occurs through the textual intervention of an exegesis which builds, and/or builds on, theoretical concerns arising in and from the work. This linking produces what Barrett (2007) refers to as “situated knowledge… that operates in relation to established knowledge” (p. 145). But what if those material forms or ‘artefacts’ are not objects or code or digitised forms, but live within the bodies of artist/researchers where the nature of the practice itself is live, ephemeral and constantly transforming, as in dance and physical performance? Even more unsettling is when the ‘artefact’ is literally embedded and embodied in the work and in the maker/researcher; when subject and object are merged. To complicate matters, the performing arts are necessarily collaborative, relying not only on technical mastery and creative/interpretive processes, but on social and artistic relationships which collectively make up the ‘artefact’. This chapter explores issues surrounding live dance and physical performance when placed in a research setting, specifically the complexities of being required to translate embodied dance findings into textual form. Exploring how embodied knowledge can be shared in a research context for those with no experiential knowledge of communicating through and in dance, I draw on theories of “dance enaction” (Warburton, 2011) together with notions of “affective intensities” and “performance mastery” (Melrose, 2003), “intentional activity” (Pakes, 2004) and the place of memory. In seeking ways to capture in another form the knowledge residing in live dance practice, thus making implicit knowledge explicit, I further propose there is a process of triple translation as the performance (the living ‘artefact’) is documented in multi-facetted ways to produce something durable which can be re-visited. This translation becomes more complex if the embodied knowledge resides in culturally specific practices, formed by world views and processes quite different from accepted norms and conventions (even radical ones) of international doctoral research inquiry. But whatever the combination of cultural, virtual and genre-related dance practices being researched, embodiment is central to the process, outcome and findings, and the question remains of how we will use text and what forms that text might take.

“Conversations Before the End of Time” : Refuturing Applications of a New Media Praxis

This chapter examines how the methods, outcomes and transformative potentials of my new media arts praxis have been understood by a range of critical commentators from disciplinary perspectives outside of my own ‘home territory’ of media arts. By drawing upon perspectives from Human Computer Interface Design, Engineering, Sustainability Design, Tertiary Education, Communication Design and Public Librarianship I demonstrate how ideas from my arts disciplines have had tangible ‘external’ significance and application.

Take my brother first : heroic final act saves sibling

"A schoolboy who begged rescuers to save his little brother first is among a dozen people drowned."

New Dawn (Parts I & II)

New Dawn is a cross-media visual art project that comprises a multi–channel video work (Boxcopy ARI, Brisbane) and a series of sculptural works (MetroArts, Brisbane) both of which conflate the online spectacle of real events with virtual gaming. The purpose of this project is to question this new phenomenon and what are the political, social and economic repercussions for these new technological developments on our bodies and subjectivities. By doing this my work asks us to reflect on how we function as a society in response to these new spaces of interaction, how we might respond to the political dimensions of these expanded sites of inhabitation, and how they might also represent a more troubling scenario for the possibility of dissent or opposition in our media saturated culture. The work was shown at multiple venues simultaneously. One of the components of the work won the 2013 Sunshine Coast Art Prize for sculpture.

Incidence trends of keratinocytic skin cancers and melanoma in Israel 2006-2011

BACKGROUND The incidence of skin cancer, both melanoma and keratinocyte cancers (KC) is rising throughout the world, specifically squamous cell carcinomas(SCC) and basal cell carcinoma(BCC), being the most common of all cancers. OBJECTIVE To determine trends in incidence of Melanoma, BCC and SCC among 1.7 million members of Maccabi Healthcare Services from 2006 to 2011. METHODS Data on newly diagnosed Melanoma, SCC and BCC cases was collected from the MHS Cancer Registry and based on histology reports from the centralized pathology lab. Age-specific and overall age-adjusted European standardized rates were computed. Trends were estimated by calculating Average Annual Percentage Change(AAPC). RESULTS During the six year study period, a total of 16,079 subjects were diagnosed with at least one BCC, 4,767 with SCC and 1,264 with invasive melanoma. Age-standardized incidence rates were 188, 58 and 17 per 100,000 person years for BCC, SCC and melanoma, respectively. All lesions were more common among males and primarily affected the elderly. BCC rates were stable throughout the study period(AAPC -0.7%, 95%CI -4.5% to 3.2%) while SCC incidence increased significantly(AAPC 15.5%, 95%CI: 2.6% to 30.0%). In contrast, melanoma rates continuously decreased with a significant AAPC of -3.0%, 95%CI (-4.5 to -0.1). CONCLUSIONS Previously unreported, the incidence of KC in Israel is high. The disparities in incidence trends between SCC, BCC and melanoma allude to their different etiologies. These findings underscore the importance of continuous monitoring, education and prevention programs in a growing high risk population.

A distributed computing framework for all-to-all comparison problems

Distributed computation and storage have been widely used for processing of big data sets. For many big data problems, with the size of data growing rapidly, the distribution of computing tasks and related data can affect the performance of the computing system greatly. In this paper, a distributed computing framework is presented for high performance computing of All-to-All Comparison Problems. A data distribution strategy is embedded in the framework for reduced storage space and balanced computing load. Experiments are conducted to demonstrate the effectiveness of the developed approach. They have shown that about 88% of the ideal performance capacity have be achieved in multiple machines through using the approach presented in this paper.

High performance all-carbon thin film supercapacitors

We fabricated high performance supercapacitors by using all carbon electrodes, with volume energy in the order of 10−3 Whcm−3, comparable to Li-ion batteries, and power densities in the range of 10 Wcm−3, better than laser-scribed-graphene supercapacitors. All-carbon supercapacitor electrodes are made by solution processing and filtering electrochemically-exfoliated graphene sheets mixed with clusters of spontaneously entangled multiwall carbon nanotubes. We maximize the capacitance by using a 1:1 weight ratio of graphene to multi-wall carbon nanotubes and by controlling their packing in the electrode film so as to maximize accessible surface and further enhance the charge collection. This electrode is transferred onto a plastic-paper-supported double-wall carbon nanotube film used as current collector. These all-carbon thin films are combined with plastic paper and gelled electrolyte to produce solid-state bendable thin film supercapacitors. We assembled supercapacitor cells in series in a planar configuration to increase the operating voltage and find that the shape of our supercapacitor film strongly affects its capacitance. An in-line superposition of rectangular sheets is superior to a cross superposition in maintaining high capacitance when subject to fast charge/discharge cycles. The effect is explained by addressing the mechanism of ion diffusion into stacked graphene sheets.

Sexual selection in true fruit flies (Diptera: Tephritidae) : transcriptome and experimental evidences for phytochemicals increasing male competitive ability

In male tephritid fruit flies of the genus Bactrocera, feeding on secondary plant compounds (sensu lato male lures = methyl eugenol, raspberry ketone and zingerone) increases male mating success. Ingested male lures alter the male pheromonal blend, normally making it more attractive to females and this is considered the primary mechanism for the enhanced mating success. However, the male lures raspberry ketone and zingerone are known, across a diverse range of other organisms, to be involved in increasing energy metabolism. If this also occurs in Bactrocera, then this may represent an additional benefit to males as courtship is metabolically expensive and lure feeding may increase a fly's short-term energy. We tested this hypothesis by performing comparative RNA-seq analysis between zingerone-fed and unfed males of Bactrocera tryoni. We also carried out behavioural assays with zingerone- and cuelure-fed males to test whether they became more active. RNA-seq analysis revealed, in zingerone-fed flies, up-regulation of 3183 genes with homologues transcripts to those known to regulate intermale aggression, pheromone synthesis, mating and accessory gland proteins, along with significant enrichment of several energy metabolic pathways and gene ontology terms. Behavioural assays show significant increases in locomotor activity, weight reduction and successful mating after mounting; all direct/indirect measures of increased activity. These results suggest that feeding on lures leads to complex physiological changes, which result in more competitive males. These results do not negate the pheromone effect, but do strongly suggest that the phytochemical-induced sexual selection is governed by both female preference and male competitive mechanisms.

Clinical perceptions of radiation therapy undergraduate competency standards

Introduction The multifactorial nature of clinical skills development makes assessment of undergraduate radiation therapist competence level by clinical mentors challenging. A recent overhaul of the clinical assessment strategy at Queensland University of Technology has moved away from the high-stakes Observed Structured Clinical Examination (OSCE) to encompass a more continuous measure of competence. This quantitative study aimed to gather stakeholder evidence to inform development of standards by which to measure student competence for a range of levels of progression. Methods A simple anonymous questionnaire was distributed to all Queensland radiation therapists. The tool asked respondents to assign different levels of competency with a range of clinical tasks to different levels of student. All data were anonymous and was combined for analysis using Microsoft Excel. Results Feedback indicated good agreement with tasks that specified amount of direction required and this has been incorporated into the new clinical achievements record that the students need to have signed off. Additional puzzling findings suggested higher expectations with planning tasks than with treatment-based tasks. Conclusion The findings suggest that the amount of direction required by students is a valid indicator of their level and has been adopted into the clinical assessment scheme. Further work will build on this to further define standards of competency for undergraduates.

The varied presentation of metastatic melanoma in fine needle aspiration cytology of the breast

Objective To identify cytomorphological patterns of metastatic melanoma (MM) in breast fine needle aspiration (FNA) specimens and highlight the differential diagnoses and features most useful in identifying MM. Methods The clinical, radiological and FNA findings of 16 cases were reviewed. Cytological features evaluated related to cell arrangement, size and shape of cells, nuclear and cytoplasmic features, and the presence or absence of necrosis. Results The series consisted of 14 females and two males, ranging in age from 24 to 83 years (mean = 50 years). A previous history of melanoma was available in 12/16 (75%) cases at the time of FNA reporting; however the clinical/radiological impression in 4/16 cases was of a breast cyst. The cases were classified into six morphological variants: classical (8/16), pseudopapillary (3/16), spindle-cell (1/16), melanin-rich (1/16), pleomorphic (2/16) and lymphoma-like (1/16). The varying patterns raised a wide range of differential diagnoses; however, discohesion, binucleation and granular cytoplasm were the major features seen in 94% of all cases. In 14/16 cases (88%), plasmacytoid cells, prominent nucleoli and cytoplasmic vacuolation were identified. Melanin and multinucleation were detected in 44% of cases and intranuclear cytoplasmic invaginations in 63%. Necrosis was present in more than half of the cases (56%). Conclusion MM should be considered in the differential diagnosis of breast FNA specimens when atypical cells are seen that present as plasmacytoid cells in a dispersed or pseudopapillary pattern, or as spindle, pleomorphic or pigmented cells. These features, combined with clinical history and immunocytochemistry, may assist in correctly identifying MM and directing optimal treatment.

It wasn't my fault : does crash culpability improve predictive outcomes in a self-report study?

Introduction: Research that has focused on the ability of self-report assessment tools to predict crash outcomes has proven to be mixed. As a result, researchers are now beginning to explore whether examining culpability of crash involvement can subsequently improve this predictive efficacy. This study reports on the application of the Manchester Driver Behaviour Questionnaire (DBQ) to predict crash involvement among a sample of general Queensland motorists, and in particular, whether including a crash culpability variable improves predictive outcomes. Surveys were completed by 249 general motorists on-line or via a pen-and-paper format. Results: Consistent with previous research, a factor analysis revealed a three factor solution for the DBQ accounting for 40.5% of the overall variance. However, multivariate analysis using the DBQ revealed little predictive ability of the tool to predict crash involvement. Rather, exposure to the road was found to be predictive of crashes. An analysis into culpability revealed 88 participants reported being “at fault” for their most recent crash. Corresponding between and multi-variate analyses that included the culpability variable did not result in an improvement in identifying those involved in crashes. Conclusions: While preliminary, the results suggest that including crash culpability may not necessarily improve predictive outcomes in self-report methodologies, although it is noted the current small sample size may also have had a deleterious effect on this endeavour. This paper also outlines the need for future research (which also includes official crash and offence outcomes) to better understand the actual contribution of self-report assessment tools, and culpability variables, to understanding and improving road safety.

Facial identity and facial expression matching in 5 - 12-year-old children and adults

Facial identity and facial expression matching tasks were completed by 5–12-year-old children and adults using stimuli extracted from the same set of normalized faces. Configural and feature processing were examined using speed and accuracy of responding and facial feature selection, respectively. Facial identity matching was slower than face expression matching for all age groups. Large age effects were found on both speed and accuracy of responding and feature use in both identity and expression matching tasks. Eye region preference was found on the facial identity task and mouth region preference on the facial expression task. Use of mouth region information for facial expression matching increased with age, whereas use of eye region information for facial identity matching peaked early. The feature use information suggests that the specific use of primary facial features to arrive at identity and emotion matching judgments matures across middle childhood.