Use of Bayesian MUNE to show differing rate of loss of motor units in subgroups of ALS

Objectives To evaluate differences among patients with different clinical features of ALS, we used our Bayesian method of motor unit number estimation (MUNE). Methods We performed serial MUNE studies on 42 subjects who fulfilled the diagnostic criteria for ALS during the course of their illness. Subjects were classified into three subgroups according to whether they had typical ALS (with upper and lower motor neurone signs) or had predominantly upper motor neurone weakness with only minor LMN signs, or predominantly lower motor neurone weakness with only minor UMN signs. In all subjects we calculated the half life of MUs, defined as the expected time for the number of MUs to halve, in one or more of the abductor digiti minimi (ADM), abductor pollicis brevis (APB) and extensor digitorum brevis (EDB) muscles. Results The mean half life of MUs was less in subjects who had typical ALS with both upper and lower motor neurone signs than in those with predominantly upper motor neurone weakness or predominantly lower motor neurone weakness. In 18 subjects we analysed the estimated size of the MUs and demonstrated the appearance of large MUs in subjects with upper or lower motor neurone predominant weakness. We found that the appearance of large MUs was correlated with the half life of MUs. Conclusions Patients with different clinical features of ALS have different rates of loss and different sizes of MUs. Significance: These findings could indicate differences in disease pathogenesis.

Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality

Background & aims: The confounding effect of disease on the outcomes of malnutrition using diagnosis-related groups (DRG) has never been studied in a multidisciplinary setting. This study aims to determine the prevalence of malnutrition in a tertiary hospital in Singapore and its impact on hospitalization outcomes and costs, controlling for DRG. Methods: This prospective cohort study included a matched case control study. Subjective Global Assessment was used to assess the nutritional status on admission of 818 adults. Hospitalization outcomes over 3 years were adjusted for gender, age, ethnicity, and matched for DRG. Results: Malnourished patients (29%) had longer hospital stays (6.9 ± 7.3 days vs. 4.6 ± 5.6 days, p < 0.001) and were more likely to be readmitted within 15 days (adjusted relative risk = 1.9, 95%CI 1.1–3.2, p = 0.025). Within a DRG, the mean difference between actual cost of hospitalization and the average cost for malnourished patients was greater than well-nourished patients (p = 0.014). Mortality was higher in malnourished patients at 1 year (34% vs. 4.1 %), 2 years (42.6% vs. 6.7%) and 3 years (48.5% vs. 9.9%); p < 0.001 for all. Overall, malnutrition was a significant predictor of mortality (adjusted hazard ratio = 4.4, 95% CI 3.3-6.0, p < 0.001). Conclusions: Malnutrition was evident in up to one third of the inpatients and led to poor hospitalization outcomes and survival as well as increased costs of care, even after matching for DRG. Strategies to prevent and treat malnutrition in the hospital and post-discharge are needed.

Do balanced skills help nascent entrepreneurs to make progress in the venture creation process?

We analyze longitudinal data on innovative start-up projects and apply Lazear’s jack-of-all-trades theory to investigate the effect of nascent entrepreneurs’ balanced skills on their progress in the venture creation process. Our results suggest that those nascent entrepreneurs who exhibit a sufficiently broad set of skills undertake more gestation activities towards an operational new venture. This supports the notion that a balanced skill set is an important determinant of entrepreneurial market entry.

Root cause analysis with enriched process logs

In the field of process mining, the use of event logs for the purpose of root cause analysis is increasingly studied. In such an analysis, the availability of attributes/features that may explain the root cause of some phenomena is crucial. Currently, the process of obtaining these attributes from raw event logs is performed more or less on a case-by-case basis: there is still a lack of generalized systematic approach that captures this process. This paper proposes a systematic approach to enrich and transform event logs in order to obtain the required attributes for root cause analysis using classical data mining techniques, the classification techniques. This approach is formalized and its applicability has been validated using both self-generated and publicly-available logs.

Action’s place in the venture creation process

This study examined the effect that venture creation action has on the outcomes of nascent entrepreneurship. A conceptual model was developed which proposes action as a fundamental mechanism in venture creation. Thus, action should rightly be considered as a means which transmits the effects of venture resource endowments on to venture creation outcomes. This conceptual model was empirically supported in a random sample of nascent ventures. Ventures with higher levels of human or social capital were found to be more active in venture creation. In turn, more active venture attempts were more likely to achieve improved venture creation outcomes. Further, human and social capital, on their own, exhibit little direct influence on the venture outcomes achieved. These findings confirm action’s central place in the venture creation process.

From product innovation to organizational innovation – and what that has to do with Business Process Management

One of the key trends that we currently witness not only in academic circles but also in industry - all throughout Australia at least – is that “Innovation” is becoming an important driver for business projects, for change agendas – and in turn, for Business Process Management initiatives.

Evaluation of an Augmented Reality Collaborative Process Modelling System

Identifying, modelling and documenting business processes usually requires the collaboration of many stakeholders that may be spread across companies in inter-organizational business settings. While there are many process modelling tools available, the support they provide for remote collaboration is still limited. This paper investigates the application of virtual environment and augmented reality technologies to remote business process modelling, with an aim to assisting common collaboration tasks by providing an increased sense of immersion in a shared workspace. We report on the evaluation of a prototype system with five key informants. The results indicate that this approach to business process modelling is suited to remote collaborative task settings, and stakeholders may indeed benefit from using augmented reality interfaces.

Direct evaluation of IEC 61850-9-2 process bus network performance

This letter presents a technique to assess the overall network performance of sampled value process buses based on IEC 61850-9-2 using measurements from a single location in the network. The method is based upon the use of Ethernet cards with externally synchronized time stamping, and characteristics of the process bus protocol. The application and utility of the method is demonstrated by measuring latency introduced by Ethernet switches. Network latency can be measured from a single set of captures, rather than comparing source and destination captures. Absolute latency measures will greatly assist the design testing, commissioning and maintenance of these critical data networks.

The Cyndi Lauper affect: Bodies, girlhood and popular culture through the collective biography process

Using a collective biography method informed by a Deleuzian theoretical approach (Davies & Gannon, 2009), this paper analyses embodied memories of girlhood becomings through affective engagements with resonating images in media and popular culture.

Computational design of cyclic nitroxides as efficient redox mediators for dye-sensitized solar cells

Cyclic nitroxide radicals represent promising alternatives to the iodine-based redox mediator commonly used in dye-sensitized solar cells (DSSCs). To date DSSCs with nitroxide-based redox mediators have achieved energy conversion efficiencies of just over 5 % but efficiencies of over 15 % might be achievable, given an appropriate mediator. The efficacy of the mediator depends upon two main factors: it must reversibly undergo one-electron oxidation and it must possess an oxidation potential in a range of 0.600-0.850 V (vs. a standard hydrogen electrode (SHE) in acetonitrile at 25 °C). Herein, we have examined the effect that structural modifications have on the value of the oxidation potential of cyclic nitroxides as well as the reversibility of the oxidation process. These included alterations to the N-containing skeleton (pyrrolidine, piperidine, isoindoline, azaphenalene, etc.), as well as the introduction of different substituents (alkyl-, methoxy-, amino-, carboxy-, etc.) to the ring. Standard oxidation potentials were calculated using high-level ab initio methodology that was demonstrated to be very accurate (with a mean absolute deviation from experimental values of only 16 mV). An optimal value of 1.45 for the electrostatic scaling factor for UAKS radii in acetonitrile solution was obtained. Established trends in the values of oxidation potentials were used to guide molecular design of stable nitroxides with desired E° ox and a number of compounds were suggested for potential use as enhanced redox mediators in DSSCs. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Investigating the change in three dimensional deformity for idiopathic scoliosis using axially loaded MRI

Background: Adolescent idiopathic scoliosis is a complex three-dimensional deformity, involving a lateral deformity in the coronal plane and axial rotation of the vertebrae in the transverse plane. Gravitational loading plays an important biomechanical role in governing the coronal deformity, however, less is known about how they influence the axial deformity. This study investigates the change in three-dimensional deformity of a series of scoliosis patients due to compressive axial loading. Methods: Magnetic resonance imaging scans were obtained and coronal deformity (measured using the coronal Cobb angle) and axial rotations measured for a group of 18 scoliosis patients (Mean major Cobb angle was 43.4 o). Each patient was scanned in an unloaded and loaded condition while compressive loads equivalent to 50% body mass were applied using a custom developed compressive device. Findings: The mean increase in major Cobb angle due to compressive loading was 7.4 o (SD 3.5 o). The most axially rotated vertebra was observed at the apex of the structural curve and the largest average intravertebral rotations were observed toward the limits of the coronal deformity. A level-wise comparison showed no significant difference between the average loaded and unloaded vertebral axial rotations (intra-observer error = 2.56 o) or intravertebral rotations at each spinal level. Interpretation: This study suggests that the biomechanical effects of axial loading primarily influence the coronal deformity, with no significant change in vertebral axial rotation or intravertebral rotation observed between the unloaded and loaded condition. However, the magnitude of changes in vertebral rotation with compressive loading may have been too small to detect given the resolution of the current technique.

Visual support for work assignment in process-aware information systems : framework formalisation and implementation

Process-aware information systems, ranging from generic workflow systems to dedicated enterprise information systems, use work-lists to offer so-called work items to users. In real scenarios, users can be confronted with a very large number of work items that stem from multiple cases of different processes. In this jungle of work items, users may find it hard to choose the right item to work on next. The system cannot autonomously decide which is the right work item, since the decision is also dependent on conditions that are somehow outside the system. For instance, what is “best” for an organisation should be mediated with what is “best” for its employees. Current work-list handlers show work items as a simple sorted list and therefore do not provide much decision support for choosing the right work item. Since the work-list handler is the dominant interface between the system and its users, it is worthwhile to provide an intuitive graphical interface that uses contextual information about work items and users to provide suggestions about prioritisation of work items. This paper uses the so-called map metaphor to visualise work items and resources (e.g., users) in a sophisticated manner. Moreover, based on distance notions, the work-list handler can suggest the next work item by considering different perspectives. For example, urgent work items of a type that suits the user may be highlighted. The underlying map and distance notions may be of a geographical nature (e.g., a map of a city or office building), but may also be based on process designs, organisational structures, social networks, due dates, calendars, etc. The framework proposed in this paper is generic and can be applied to any process-aware information system. Moreover, in order to show its practical feasibility, the paper discusses a full-fledged implementation developed in the context of the open-source workflow environment YAWL, together with two real examples stemming from two very different scenarios. The results of an initial usability evaluation of the implementation are also presented, which provide a first indication of the validity of the approach.

An innovative approach to the assessment of nutrient intake in adults with type 2 diabetes : the development, trial and evaluation of a mobile phone photo/voice dietary record

Nutrition interventions in the form of both self-management education and individualised diet therapy are considered essential for the long-term management of type 2 diabetes mellitus (T2DM). The measurement of diet is essential to inform, support and evaluate nutrition interventions in the management of T2DM. Barriers inherent within health care settings and systems limit ongoing access to personnel and resources, while traditional prospective methods of assessing diet are burdensome for the individual and often result in changes in typical intake to facilitate recording. This thesis investigated the inclusion of information and communication technologies (ICT) to overcome limitations to current approaches in the nutritional management of T2DM, in particular the development, trial and evaluation of the Nutricam dietary assessment method (NuDAM) consisting of a mobile phone photo/voice application to assess nutrient intake in a free-living environment with older adults with T2DM. Study 1: Effectiveness of an automated telephone system in promoting change in dietary intake among adults with T2DM The effectiveness of an automated telephone system, Telephone-Linked Care (TLC) Diabetes, designed to deliver self-management education was evaluated in terms of promoting dietary change in adults with T2DM and sub-optimal glycaemic control. In this secondary data analysis independent of the larger randomised controlled trial, complete data was available for 95 adults (59 male; mean age(±SD)=56.8±8.1 years; mean(±SD)BMI=34.2±7.0kg/m2). The treatment effect showed a reduction in total fat of 1.4% and saturated fat of 0.9% energy intake, body weight of 0.7 kg and waist circumference of 2.0 cm. In addition, a significant increase in the nutrition self-efficacy score of 1.3 (p<0.05) was observed in the TLC group compared to the control group. The modest trends observed in this study indicate that the TLC Diabetes system does support the adoption of positive nutrition behaviours as a result of diabetes self-management education, however caution must be applied in the interpretation of results due to the inherent limitations of the dietary assessment method used. The decision to use a close-list FFQ with known bias may have influenced the accuracy of reporting dietary intake in this instance. This study provided an example of the methodological challenges experienced with measuring changes in absolute diet using a FFQ, and reaffirmed the need for novel prospective assessment methods capable of capturing natural variance in usual intakes. Study 2: The development and trial of NuDAM recording protocol The feasibility of the Nutricam mobile phone photo/voice dietary record was evaluated in 10 adults with T2DM (6 Male; age=64.7±3.8 years; BMI=33.9±7.0 kg/m2). Intake was recorded over a 3-day period using both Nutricam and a written estimated food record (EFR). Compared to the EFR, the Nutricam device was found to be acceptable among subjects, however, energy intake was under-recorded using Nutricam (-0.6±0.8 MJ/day; p<0.05). Beverages and snacks were the items most frequently not recorded using Nutricam; however forgotten meals contributed to the greatest difference in energy intake between records. In addition, the quality of dietary data recorded using Nutricam was unacceptable for just under one-third of entries. It was concluded that an additional mechanism was necessary to complement dietary information collected via Nutricam. Modifications to the method were made to allow for clarification of Nutricam entries and probing forgotten foods during a brief phone call to the subject the following morning. The revised recording protocol was evaluated in Study 4. Study 3: The development and trial of the NuDAM analysis protocol Part A explored the effect of the type of portion size estimation aid (PSEA) on the error associated with quantifying four portions of 15 single foods items contained in photographs. Seventeen dietetic students (1 male; age=24.7±9.1 years; BMI=21.1±1.9 kg/m2) estimated all food portions on two occasions: without aids and with aids (food models or reference food photographs). Overall, the use of a PSEA significantly reduced mean (±SD) group error between estimates compared to no aid (-2.5±11.5% vs. 19.0±28.8%; p<0.05). The type of PSEA (i.e. food models vs. reference food photograph) did not have a notable effect on the group estimation error (-6.7±14.9% vs. 1.4±5.9%, respectively; p=0.321). This exploratory study provided evidence that the use of aids in general, rather than the type, was more effective in reducing estimation error. Findings guided the development of the Dietary Estimation and Assessment Tool (DEAT) for use in the analysis of the Nutricam dietary record. Part B evaluated the effect of the DEAT on the error associated with the quantification of two 3-day Nutricam dietary records in a sample of 29 dietetic students (2 males; age=23.3±5.1 years; BMI=20.6±1.9 kg/m2). Subjects were randomised into two groups: Group A and Group B. For Record 1, the use of the DEAT (Group A) resulted in a smaller error compared to estimations made without the tool (Group B) (17.7±15.8%/day vs. 34.0±22.6%/day, p=0.331; respectively). In comparison, all subjects used the DEAT to estimate Record 2, with resultant error similar between Group A and B (21.2±19.2%/day vs. 25.8±13.6%/day; p=0.377 respectively). In general, the moderate estimation error associated with quantifying food items did not translate into clinically significant differences in the nutrient profile of the Nutricam dietary records, only amorphous foods were notably over-estimated in energy content without the use of the DEAT (57kJ/day vs. 274kJ/day; p<0.001). A large proportion (89.6%) of the group found the DEAT helpful when quantifying food items contained in the Nutricam dietary records. The use of the DEAT reduced quantification error, minimising any potential effect on the estimation of energy and macronutrient intake. Study 4: Evaluation of the NuDAM The accuracy and inter-rater reliability of the NuDAM to assess energy and macronutrient intake was evaluated in a sample of 10 adults (6 males; age=61.2±6.9 years; BMI=31.0±4.5 kg/m2). Intake recorded using both the NuDAM and a weighed food record (WFR) was coded by three dietitians and compared with an objective measure of total energy expenditure (TEE) obtained using the doubly labelled water technique. At the group level, energy intake (EI) was under-reported to a similar extent using both methods, with the ratio of EI:TEE was 0.76±0.20 for the NuDAM and 0.76±0.17 for the WFR. At the individual level, four subjects reported implausible levels of energy intake using the WFR method, compared to three using the NuDAM. Overall, moderate to high correlation coefficients (r=0.57-0.85) were found across energy and macronutrients except fat (r=0.24) between the two dietary measures. High agreement was observed between dietitians for estimates of energy and macronutrient derived for both the NuDAM (ICC=0.77-0.99; p<0.001) and WFR (ICC=0.82-0.99; p<0.001). All subjects preferred using the NuDAM over the WFR to record intake and were willing to use the novel method again over longer recording periods. This research program explored two novel approaches which utilised distinct technologies to aid in the nutritional management of adults with T2DM. In particular, this thesis makes a significant contribution to the evidence base surrounding the use of PhRs through the development, trial and evaluation of a novel mobile phone photo/voice dietary record. The NuDAM is an extremely promising advancement in the nutritional management of individuals with diabetes and other chronic conditions. Future applications lie in integrating the NuDAM with other technologies to facilitate practice across the remaining stages of the nutrition care process.

Managing open incremental process innovation : absorptive capacity and distributed learning

In this conceptual article, we extend earlier work on Open Innovation and Absorptive Capacity. We suggest that the literature on Absorptive Capacity does not place sufficient emphasis on distributed knowledge and learning or on the application of innovative knowledge. To accomplish physical transformations, organisations need specific Innovative Capacities that extend beyond knowledge management. Accessive Capacity is the ability to collect, sort and analyse knowledge from both internal and external sources. Adaptive Capacity is needed to ensure that new pieces of equipment are suitable for the organisation's own purposes even though they may have been originally developed for other uses. Integrative Capacity makes it possible for a new or modified piece of equipment to be fitted into an existing production process with a minimum of inessential and expensive adjustment elsewhere in the process. These Innovative Capacities are controlled and coordinated by Innovative Management Capacity, a higher-order dynamic capability.