564 resultados para hospital system


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The Lane Change Test (LCT) is one of the growing number of methods developed to quantify driving performance degradation brought about by the use of in-vehicle devices. Beyond its validity and reliability, for such a test to be of practical use, it must also be sensitive to the varied demands of individual tasks. The current study evaluated the ability of several recent LCT lateral control and event detection parameters to discriminate between visual-manual and cognitive surrogate In-Vehicle Information System tasks with different levels of demand. Twenty-seven participants (mean age 24.4 years) completed a PC version of the LCT while performing visual search and math problem solving tasks. A number of the lateral control metrics were found to be sensitive to task differences, but the event detection metrics were less able to discriminate between tasks. The mean deviation and lane excursion measures were able to distinguish between the visual and cognitive tasks, but were less sensitive to the different levels of task demand. The other LCT metrics examined were less sensitive to task differences. A major factor influencing the sensitivity of at least some of the LCT metrics could be the type of lane change instructions given to participants. The provision of clear and explicit lane change instructions and further refinement of its metrics will be essential for increasing the utility of the LCT as an evaluation tool.

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Introduction: The purpose of this study was to assess the capacity of a written intervention, in this case a patient information brochure, to improve patient satisfaction during an Emergency Department (ED) visit. For the purpose of measuring the effect of the intervention the ED journey was conceptualised as a series of distinct areas of service comprising waiting time, service by the triage nurse, care from doctors and nurses and information giving Background of study: Research into patient satisfaction has become a widespread activity endorsed by both governments and hospital administrations. The literature on ED patient satisfaction has consistently indicated three primary areas of patient dissatisfaction: waiting time, nursing care and communication. Recent developments in the literature on patient satisfaction studies however have highlighted the relationship between patients. expectations of a service encounter and their consequent assessment of the experience as dissatisfying or satisfying. Disconfirmation theory posits that the degree to which expectations are confirmed will affect subsequent levels of satisfaction. The conceptual framework utilised in this study is Coye.s (2004) model of disconfirmation. Coye while reiterating satisfaction is a consequence of the degree expectations are either confirmed or disconfirmed also posits that expectations can be modified by interventions. Coye.s work conceptualises these interventions as intra encounter experiences (cues) which function to adjust expectations. Coye suggests some cues are unintended and may have a negative impact which also reinforces the value of planned cues intended to meet or exceed consumer expectations. Consequently the brochure can be characterized as a potentially positive cue, encouraging the patient to understand processes and to orient them in what can be a confronting environment. Only a limited number of studies have examined the effect of written interventions within an ED. No studies could be located which have tested the effect of ED interventions using a conceptual framework which relates the effect of the degree to which expectations are confirmed or disconfirmed in terms of satisfaction with services. Method: Two studies were conducted. Study One used qualitative methods to explore patients. expectations of the ED from the perspective of both patients and health care professionals. Study One was used in part to direct the development of the intervention (brochure) in Study Two. The brochure was an intervention designed to modify patients. expectations thus increasing their satisfaction with the provision of ED service. As there was no existing tools to measure ED patients. expectations and satisfaction a new tool was also developed based on the findings and the literature of Study One. Study Two used a non-randomised, quasi-experimental approach using a non-equivalent post-test only comparison group design used to investigate the effect of the patient education brochure (Stommel and Wills, 2004). The brochure was disseminated to one of two study groups (the intervention group). The effect of the brochure was assessed by comparing the data obtained from both the intervention and control group. These two groups consisted of 150 participants each. It was expected that any differences in the relevant domains selected for examination would indicate the effect of the brochure both on expectation and potentially satisfaction. Results: Study One revealed several areas of common ground between patients and nurses in terms of relevant content for the written intervention, including the need for information on the triage system and waiting times. Areas of difference were also found with patients emphasizing communication issues, whereas focus group members expressed concern that patients were often unable to assimilate verbal information. The findings suggested the potential utility of written material to reinforce verbal communication particularly in terms of the triage process and other ED protocols. This material was synthesized within the final version of the written intervention. Overall the results of Study Two indicated no significant differences between the two groups. The intervention group did indicate a significant number of participants who viewed the brochure of having changed their expectations. The effect of the brochure may have been obscured by a lack of parity between the two groups as the control group presented with statistically significantly higher levels of acuity and experienced significantly shorter waiting times. In terms of disconfirmation theory this would suggest expectations that had been met or exceeded. The results confirmed the correlation of expectations with satisfaction. Several domains also indicated age as a significant predictor with older patients tending to score higher satisfaction results. Other significant predictors of satisfaction established were waiting time and care from nurses, reinforcing the combination of efficient service and positive interpersonal experiences as being valued by patients. Conclusions: Information presented in written form appears to benefit a significant number of ED users in terms of orientation and explaining systems and procedures. The degree to which these effects may interact with other dimensions of satisfaction however is likely to be limited. Waiting time and interpersonal behaviours from staff also provide influential cues in determining satisfaction. Written material is likely to be one element in a series of coordinated strategies to improve patient satisfaction during periods of peak demand.

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The treatment of challenging fractures and large osseous defects presents a formidable problem for orthopaedic surgeons. Tissue engineering/regenerative medicine approaches seek to solve this problem by delivering osteogenic signals within scaffolding biomaterials. In this study, we introduce a hybrid growth factor delivery system that consists of an electrospun nanofiber mesh tube for guiding bone regeneration combined with peptide-modified alginate hydrogel injected inside the tube for sustained growth factor release. We tested the ability of this system to deliver recombinant bone morphogenetic protein-2 (rhBMP-2) for the repair of critically-sized segmental bone defects in a rat model. Longitudinal [mu]-CT analysis and torsional testing provided quantitative assessment of bone regeneration. Our results indicate that the hybrid delivery system resulted in consistent bony bridging of the challenging bone defects. However, in the absence of rhBMP-2, the use of nanofiber mesh tube and alginate did not result in substantial bone formation. Perforations in the nanofiber mesh accelerated the rhBMP-2 mediated bone repair, and resulted in functional restoration of the regenerated bone. [mu]-CT based angiography indicated that perforations did not significantly affect the revascularization of defects, suggesting that some other interaction with the tissue surrounding the defect such as improved infiltration of osteoprogenitor cells contributed to the observed differences in repair. Overall, our results indicate that the hybrid alginate/nanofiber mesh system is a promising growth factor delivery strategy for the repair of challenging bone injuries.

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Power system stabilizers (PSS) work well at the particular network configuration and steady state conditions for which they were designed. Once conditions change, their performance degrades. This can be overcome by an intelligent nonlinear PSS based on fuzzy logic. Such a fuzzy logic power system stabilizer (FLPSS) is developed, using speed and power deviation as inputs, and provides an auxiliary signal for the excitation system of a synchronous motor in a multimachine power system environment. The FLPSS's effect on the system damping is then compared with a conventional power system stabilizer's (CPSS) effect on the system. The results demonstrate an improved system performance with the FLPSS and also that the FLPSS is robust

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An algorithm based on the concept of combining Kalman filter and Least Error Square (LES) techniques is proposed in this paper. The algorithm is intended to estimate signal attributes like amplitude, frequency and phase angle in the online mode. This technique can be used in protection relays, digital AVRs, DGs, DSTATCOMs, FACTS and other power electronics applications. The Kalman filter is modified to operate on a fictitious input signal and provides precise estimation results insensitive to noise and other disturbances. At the same time, the LES system has been arranged to operate in critical transient cases to compensate the delay and inaccuracy identified because of the response of the standard Kalman filter. Practical considerations such as the effect of noise, higher order harmonics, and computational issues of the algorithm are considered and tested in the paper. Several computer simulations and a laboratory test are presented to highlight the usefulness of the proposed method. Simulation results show that the proposed technique can simultaneously estimate the signal attributes, even if it is highly distorted due to the presence of non-linear loads and noise.

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Prostate cancer metastasis is reliant on the reciprocal interactions between cancer cells and the bone niche/micro-environment. The production of suitable matrices to study metastasis, carcinogenesis and in particular prostate cancer/bone micro-environment interaction has been limited to specific protein matrices or matrix secreted by immortalised cell lines that may have undergone transformation processes altering signaling pathways and modifying gene or receptor expression. We hypothesize that matrices produced by primary human osteoblasts are a suitable means to develop an in vitro model system for bone metastasis research mimicking in vivo conditions. We have used a decellularized matrix secreted from primary human osteoblasts as a model for prostate cancer function in the bone micro-environment. We show that this collagen I rich matrix is of fibrillar appearance, highly mineralized, and contains proteins, such as osteocalcin, osteonectin and osteopontin, and growth factors characteristic of bone extracellular matrix (ECM). LNCaP and PC3 cells grown on this matrix, adhere strongly, proliferate, and express markers consistent with a loss of epithelial phenotype. Moreover, growth of these cells on the matrix is accompanied by the induction of genes associated with attachment, migration, increased invasive potential, Ca2+ signaling and osteolysis. In summary, we show that growth of prostate cancer cells on matrices produced by primary human osteoblasts mimics key features of prostate cancer bone metastases and thus is a suitable model system to study the tumor/bone micro-environment interaction in this disease.

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Design teams are confronted with the quandary of choosing apposite building control systems to suit the needs of particular intelligent building projects, due to the availability of innumerable ‘intelligent’ building products and a dearth of inclusive evaluation tools. This paper is organised to develop a model for facilitating the selection evaluation for intelligent HVAC control systems for commercial intelligent buildings. To achieve these objectives, systematic research activities have been conducted to first develop, test and refine the general conceptual model using consecutive surveys; then, to convert the developed conceptual framework into a practical model; and, finally, to evaluate the effectiveness of the model by means of expert validation. The results of the surveys are that ‘total energy use’ is perceived as the top selection criterion, followed by the‘system reliability and stability’, ‘operating and maintenance costs’, and ‘control of indoor humidity and temperature’. This research not only presents a systematic and structured approach to evaluate candidate intelligent HVAC control system against the critical selection criteria (CSC), but it also suggests a benchmark for the selection of one control system candidate against another.

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Open access reforms to railway regulations allow multiple train operators to provide rail services on a common infrastructure. As railway operations are now independently managed by different stakeholders, conflicts in operations may arise, and there have been attempts to derive an effective access charge regime so that these conflicts may be resolved. One approach is by direct negotiation between the infrastructure manager and the train service providers. Despite the substantial literature on the topic, few consider the benefits of employing computer simulation as an evaluation tool for railway operational activities such as access pricing. This article proposes a multi-agent system (MAS) framework for the railway open market and demonstrates its feasibility by modelling the negotiation between an infrastructure provider and a train service operator. Empirical results show that the model is capable of resolving operational conflicts according to market demand.

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The concept of moving block signallings (MBS) has been adopted in a few mass transit railway systems. When a dense queue of trains begins to move from a complete stop, the trains can re-start in very close succession under MBS. The feeding substations nearby are likely to be overloaded and the service will inevitably be disturbed unless substations of higher power rating are used. By introducing starting time delays among the trains or limiting the trains’ acceleration rate to a certain extent, the peak energy demand can be contained. However, delay is introduced and quality of service is degraded. An expert system approach is presented to provide a supervisory tool for the operators. As the knowledge base is vital for the quality of decisions to be made, the study focuses on its formulation with a balance between delay and peak power demand.

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Emergency departments (EDs) are often the first point of contact with an abused child. Despite legal mandate, the reporting of definite or suspected abusive injury to child safety authorities by ED clinicians varies due to a number of factors including training, access to child safety professionals, departmental culture and a fear of ‘getting it wrong’. This study examined the quality of documentation and coding of child abuse captured by ED based injury surveillance data and ED medical records in the state of Queensland and the concordance of these data with child welfare records. A retrospective medical record review was used to examine the clinical documentation of almost 1000 injured children included in the Queensland Injury Surveillance Unit database (QISU) from 10 hospitals in urban and rural centres. Independent experts re-coded the records based on their review of the notes. A data linkage methodology was then used to link these records with records in the state government’s child welfare database. Cases were sampled from three sub-groups according to the surveillance intent codes: Maltreatment by parent, Undetermined and Unintentional injury. Only 0.1% of cases coded as unintentional injury were recoded to maltreatment by parent, while 1.2% of cases coded as maltreatment by parent were reclassified as unintentional and 5% of cases where the intent was undetermined by the triage nurse were recoded as maltreatment by parent. Quality of documentation varied across type of hospital (tertiary referral centre, children’s, urban, regional and remote). Concordance of health data with child welfare data varied across patient subgroups. Outcomes from this research will guide initiatives to improve the quality of intentional child injury surveillance systems.

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Railway signaling facilitates two main functions, namely, train detection and train control, in order to maintain safe separations among the trains. Track circuits are the most commonly used train detection means with the simple open/close circuit principles; and subsequent adoption of axle counters further allows the detection of trains under adverse track conditions. However, with electrification and power electronics traction drive systems, aggravated by the electromagnetic interference in the vicinity of the signaling system, railway engineers often find unstable or even faulty operations of track circuits and axle counting systems, which inevitably jeopardizes the safe operation of trains. A new means of train detection, which is completely free from electromagnetic interference, is therefore required for the modern railway signaling system. This paper presents a novel optical fiber sensor signaling system. The sensor operation, field setup, axle detection solution set, and test results of an installation in a trial system on a busy suburban railway line are given.

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The field of collaborative health planning faces significant challenges due to the lack of effective information, systems and the absence of a framework to make informed decisions. These challenges have been magnified by the rise of the healthy cities movement, consequently, there have been more frequent calls for localised, collaborative and evidence-driven decision-making. Some studies in the past have reported that the use of decision support systems (DSS) for planning healthy cities may lead to: increase collaboration between stakeholders and the general public, improve the accuracy and quality of the decision-making processes and improve the availability of data and information for health decision-makers. These links have not yet been fully tested and only a handful of studies have evaluated the impact of DSS on stakeholders, policy-makers and health planners. This study suggests a framework for developing healthy cities and introduces an online Geographic Information Systems (GIS)-based DSS for improving the collaborative health planning. It also presents preliminary findings of an ongoing case study conducted in the Logan-Beaudesert region of Queensland, Australia. These findings highlight the perceptions of decision-making prior to the implementation of the DSS intervention. Further, the findings help us to understand the potential role of the DSS to improve collaborative health planning practice.

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Many infrastructure and necessity systems such as electricity and telecommunication in Europe and the Northern America were used to be operated as monopolies, if not state-owned. However, they have now been disintegrated into a group of smaller companies managed by different stakeholders. Railways are no exceptions. Since the early 1980s, there have been reforms in the shape of restructuring of the national railways in different parts of the world. Continuous refinements are still conducted to allow better utilisation of railway resources and quality of service. There has been a growing interest for the industry to understand the impacts of these reforms on the operation efficiency and constraints. A number of post-evaluations have been conducted by analysing the performance of the stakeholders on their profits (Crompton and Jupe 2003), quality of train service (Shaw 2001) and engineering operations (Watson 2001). Results from these studies are valuable for future improvement in the system, followed by a new cycle of post-evaluations. However, direct implementation of these changes is often costly and the consequences take a long period of time (e.g. years) to surface. With the advance of fast computing technologies, computer simulation is a cost-effective means to evaluate a hypothetical change in a system prior to actual implementation. For example, simulation suites have been developed to study a variety of traffic control strategies according to sophisticated models of train dynamics, traction and power systems (Goodman, Siu and Ho 1998, Ho and Yeung 2001). Unfortunately, under the restructured railway environment, it is by no means easy to model the complex behaviour of the stakeholders and the interactions between them. Multi-agent system (MAS) is a recently developed modelling technique which may be useful in assisting the railway industry to conduct simulations on the restructured railway system. In MAS, a real-world entity is modelled as a software agent that is autonomous, reactive to changes, able to initiate proactive actions and social communicative acts. It has been applied in the areas of supply-chain management processes (García-Flores, Wang and Goltz 2000, Jennings et al. 2000a, b) and e-commerce activities (Au, Ngai and Parameswaran 2003, Liu and You 2003), in which the objectives and behaviour of the buyers and sellers are captured by software agents. It is therefore beneficial to investigate the suitability or feasibility of applying agent modelling in railways and the extent to which it might help in developing better resource management strategies. This paper sets out to examine the benefits of using MAS to model the resource management process in railways. Section 2 first describes the business environment after the railway 2 Modelling issues on the railway resource management process using MAS reforms. Then the problems emerge from the restructuring process are identified in section 3. Section 4 describes the realisation of a MAS for railway resource management under the restructured scheme and the feasible studies expected from the model.

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To maximise the capacity of the rail lineand provide a reliable service for pas-sengers throughout the day, regulation of train service to maintain steady service headway is es-sential. In most current metro systems, train usually starts coasting at a fixed distance from the departed station to achieve service regulation. However, this approach is only effective with re-spect to a nominal operational condition of train schedule but not necessarily the current service demand. Moreover, it is not simply to identify the necessary starting point for coasting under the run time constraints of current service conditions since train movement is attributed by a large number of factors, most of which are non-linear and inter-dependent. This paper presents an ap-plication of classical measures to search for the appropriate coasting point to meet a specified inter-station run time and they can be integrated in the on-board Automatic Train Operation (ATO) system and have the potential for on-line implementation in making a set of coasting command decisions.

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The design of high-rise building is more often dictated by its serviceability rather than strength. Structural Engineers are always striving to overcome challenges of controlling lateral deflection and storey drifts as well as self weight of structure imposed on foundation. One of the most effective techniques is the use of outrigger and belt truss system in Composite structures that can astutely solve the above two issues in High-rise constructions. This paper investigates deflection control by effective utilisation of belt truss and outrigger system on a 60-storey composite building subjected to wind loads. A three dimensional Finite Element Analysis is performed with one, two and three outrigger levels. The reductions in deflection are 34 percent, 42 percent and 51 percent respectively as compared to a model without any outrigger system. There is an appreciable decline in the storey drifts with the introduction of these stiffer arrangements.