Response shift, recall bias and their effect on measuring change in health-related quality of life amongst older hospital patients

Background: Assessments of change in subjective patient reported outcomes such as health-related quality of life (HRQoL) are a key component of many clinical and research evaluations. However, conventional longitudinal evaluation of change may not agree with patient perceived change if patients' understanding of the subjective construct under evaluation changes over time (response shift) or if patients' have inaccurate recollection (recall bias). This study examined whether older adults' perception of change is in agreement with conventional longitudinal evaluation of change in their HRQoL over the duration of their hospital stay. It also investigated this level of agreement after adjusting patient perceived change for recall bias that patients may have experienced. Methods: A prospective longitudinal cohort design nested within a larger randomised controlled trial was implemented. 103 hospitalised older adults participated in this investigation at a tertiary hospital facility. The EQ-5D utility and Visual Analogue Scale (VAS) scores were used to evaluate HRQoL. Participants completed EQ-5D reports as soon as they were medically stable (within three days of admission) then again immediately prior to discharge. Three methods of change score calculation were used (conventional change, patient perceived change and patient perceived change adjusted for recall bias). Agreement was primarily investigated using intraclass correlation coefficients (ICC) and limits of agreement. Results: Overall 101 (98%) participants completed both admission and discharge assessments. The mean (SD) age was 73.3 (11.2). The median (IQR) length of stay was 38 (20-60) days. For agreement between conventional longitudinal change and patient perceived change: ICCs were 0.34 and 0.40 for EQ-5D utility and VAS respectively. For agreement between conventional longitudinal change and patient perceived change adjusted for recall bias: ICCs were 0.98 and 0.90 respectively. Discrepancy between conventional longitudinal change and patient perceived change was considered clinically meaningful for 84 (83.2%) of participants, after adjusting for recall bias this reduced to 8 (7.9%). Conclusions: Agreement between conventional change and patient perceived change was not strong. A large proportion of this disagreement could be attributed to recall bias. To overcome the invalidating effect of response shift (on conventional change) and recall bias (on patient perceived change) a method of adjusting patient perceived change for recall bias has been described.

A synthesizable hardware evolutionary algorithm design for unmanned aerial system real-time path planning

The main objective of this paper is to detail the development of a feasible hardware design based on Evolutionary Algorithms (EAs) to determine flight path planning for Unmanned Aerial Vehicles (UAVs) navigating terrain with obstacle boundaries. The design architecture includes the hardware implementation of Light Detection And Ranging (LiDAR) terrain and EA population memories within the hardware, as well as the EA search and evaluation algorithms used in the optimizing stage of path planning. A synthesisable Very-high-speed integrated circuit Hardware Description Language (VHDL) implementation of the design was developed, for realisation on a Field Programmable Gate Array (FPGA) platform. Simulation results show significant speedup compared with an equivalent software implementation written in C++, suggesting that the present approach is well suited for UAV real-time path planning applications.

Randomised controlled trial of an automated, interactive telephone intervention to improve type 2 diabetes self-management (Telephone-Linked Care Diabetes Project) : study protocol

Background: An estimated 285 million people worldwide have diabetes and its prevalence is predicted to increase to 439 million by 2030. For the year 2010, it is estimated that 3.96 million excess deaths in the age group 20-79 years are attributable to diabetes around the world. Self-management is recognised as an integral part of diabetes care. This paper describes the protocol of a randomised controlled trial of an automated interactive telephone system aiming to improve the uptake and maintenance of essential diabetes self-management behaviours. ---------- Methods/Design: A total of 340 individuals with type 2 diabetes will be randomised, either to the routine care arm, or to the intervention arm in which participants receive the Telephone-Linked Care (TLC) Diabetes program in addition to their routine care. The intervention requires the participants to telephone the TLC Diabetes phone system weekly for 6 months. They receive the study handbook and a glucose meter linked to a data uploading device. The TLC system consists of a computer with software designed to provide monitoring, tailored feedback and education on key aspects of diabetes self-management, based on answers voiced or entered during the current or previous conversations. Data collection is conducted at baseline (Time 1), 6-month follow-up (Time 2), and 12-month follow-up (Time 3). The primary outcomes are glycaemic control (HbA1c) and quality of life (Short Form-36 Health Survey version 2). Secondary outcomes include anthropometric measures, blood pressure, blood lipid profile, psychosocial measures as well as measures of diet, physical activity, blood glucose monitoring, foot care and medication taking. Information on utilisation of healthcare services including hospital admissions, medication use and costs is collected. An economic evaluation is also planned.---------- Discussion: Outcomes will provide evidence concerning the efficacy of a telephone-linked care intervention for self-management of diabetes. Furthermore, the study will provide insight into the potential for more widespread uptake of automated telehealth interventions, globally.

Physical function and health-related quality of life of older adults undergoing hospital rehabilitation : how strong is the association?

The purpose of this research is to report preliminary empirical evidence regarding the association between common physical performance measures and health-related quality of life (HRQoL) of hospitalized older adults recovering from illness and injury. Frequently, these patients do not return to premorbid levels of independence and physical ability. Rehabilitation for this population often focuses on improving physical functioning and mobility with the intention of maximizing their HRQoL for discharge and thereafter. For this reason, longitudinal use of physical performance measures as an indicator of improvement in physical functioning (and thus HRQoL) is common. Although this is a logical approach, there have been mixed results from previous investigations into the association between common measures of physical function and HRQoL amongst other adult patient populations.1,2 There has been no previous investigation reporting the association between HRQoL and a variety of common physical performance measures in hospitalized older adults.

Performance analysis of hybrid liquid desiccant solar cooling system

This thesis investigates the coefficient of performance (COP) of a hybrid liquid desiccant solar cooling system. This hybrid cooling system includes three sections: 1) conventional air-conditioning section; 2) liquid desiccant dehumidification section and 3) air mixture section. The air handling unit (AHU) with mixture variable air volume design is included in the hybrid cooling system to control humidity. In the combined system, the air is first dehumidified in the dehumidifier and then mixed with ambient air by AHU before entering the evaporator. Experiments using lithium chloride as the liquid desiccant have been carried out for the performance evaluation of the dehumidifier and regenerator. Based on the air mixture (AHU) design, the electrical coefficient of performance (ECOP), thermal coefficient of performance (TCOP) and whole system coefficient of performance (COPsys) models used in the hybrid liquid desiccant solar cooing system were developed to evaluate this system performance. These mathematical models can be used to describe the coefficient of performance trend under different ambient conditions, while also providing a convenient comparison with conventional air conditioning systems. These models provide good explanations about the relationship between the performance predictions of models and ambient air parameters. The simulation results have revealed the coefficient of performance in hybrid liquid desiccant solar cooling systems substantially depends on ambient air and dehumidifier parameters. Also, the liquid desiccant experiments prove that the latent component of the total cooling load requirements can be easily fulfilled by using the liquid desiccant dehumidifier. While cooling requirements can be met, the liquid desiccant system is however still subject to the hysteresis problems.

QUT Speaker Identity Verification system for EVALITA 2009

This document outlines the system submitted by the Speech and Audio Research Laboratory at the Queensland University of Technology (QUT) for the Speaker Identity Verification: Application task of EVALITA 2009. This competitive submission consisted of a score-level fusion of three component systems; a joint-factor analysis GMM system and two SVM systems using GLDS and GMM supervector kernels. Development evaluation and post-submission results are presented in this study, demonstrating the effectiveness of this fused system approach. This study highlights the challenges associated with system calibration from limited development data and that mismatch between training and testing conditions continues to be a major source of error in speaker verification technology.

A social matching system for an online dating network : a preliminary study

Due to the change in attitudes and lifestyles, people expect to find new partners and friends via various ways now-a-days. Online dating networks create a network for people to meet each other and allow making contact with different objectives of developing a personal, romantic or sexual relationship. Due to the higher expectation of users, online matching companies are trying to adopt recommender systems. However, the existing recommendation techniques such as content-based, collaborative filtering or hybrid techniques focus on users explicit contact behaviors but ignore the implicit relationship among users in the network. This paper proposes a social matching system that uses past relations and user similarities in finding potential matches. The proposed system is evaluated on the dataset collected from an online dating network. Empirical analysis shows that the recommendation success rate has increased to 31% as compared to the baseline success rate of 19%.

Stage 1 of the Yueyang Urban Water System Project: Landscape planning and design of Wangjia River

Chinese landscape architects are largely focused on objective practical solutions to environmental problems. In the West, theoretical landscape knowledge is largely conceptual and abstract. This research debated how Australian ecological concepts could or should be transposed to Chinese landscapes. This project responded to severe water and soil pollution issues in the estuarine and riparian zones of rivers flowing into Dongting Lake, in Yueyang City, Hunan Province. This work proposed a range of waterfront design innovations that challenged the notion of corridor as habitat, filter, barrier and conduit in a Chinese riparian context.

A generative nervous system for the planet

Generative systems are now being proposed for addressing major ecological problems. The Complex Urban Systems Project (CUSP) founded in 2008 at the Queensland University of Technology, emphasises the ecological significance of the generative global networking of urban environments. It argues that the natural planetary systems for balancing global ecology are no longer able to respond sufficiently rapidly to the ecological damage caused by humankind and by dense urban conurbations in particular as evidenced by impacts such as climate change. The proposal of this research project is to provide a high speed generative nervous system for the planet by connecting major cities globally to interact directly with natural ecosystems to engender rapid ecological response. This would be achieved by active interactions of the global urban network with the natural ecosystem in the ecological principle of entropy. The key goal is to achieve ecologically positive cities by activating self-organising cities capable of full integration into natural eco-systems and to netowork the cities globally to provide the planet with a nervous system.

Crossing boundaries to explore sustainable architecture by open system design

This paper argues a model of open system design for sustainable architecture, based on a thermodynamics framework of entropy as an evolutionary paradigm. The framework can be simplified to stating that an open system evolves in a non-linear pattern from a far-from-equilibrium state towards a non-equilibrium state of entropy balance, which is a highly ordered organization of the system when order comes out of chaos. This paper is work in progress on a PhD research project which aims to propose building information modelling for optimization and adaptation of buildings environmental performance as an alternative sustainable design program in architecture. It will be used for efficient distribution and consumption of energy and material resource in life-cycle buildings, with the active involvement of the end-users and the physical constraints of the natural environment.

Multivariate Markov Process Models for the transmission of methicillin-resistant Staphylococcus Aureus in a hospital ward

Methicillin-resistant Staphylococcus Aureus (MRSA) is a pathogen that continues to be of major concern in hospitals. We develop models and computational schemes based on observed weekly incidence data to estimate MRSA transmission parameters. We extend the deterministic model of McBryde, Pettitt, and McElwain (2007, Journal of Theoretical Biology 245, 470–481) involving an underlying population of MRSA colonized patients and health-care workers that describes, among other processes, transmission between uncolonized patients and colonized health-care workers and vice versa. We develop new bivariate and trivariate Markov models to include incidence so that estimated transmission rates can be based directly on new colonizations rather than indirectly on prevalence. Imperfect sensitivity of pathogen detection is modeled using a hidden Markov process. The advantages of our approach include (i) a discrete valued assumption for the number of colonized health-care workers, (ii) two transmission parameters can be incorporated into the likelihood, (iii) the likelihood depends on the number of new cases to improve precision of inference, (iv) individual patient records are not required, and (v) the possibility of imperfect detection of colonization is incorporated. We compare our approach with that used by McBryde et al. (2007) based on an approximation that eliminates the health-care workers from the model, uses Markov chain Monte Carlo and individual patient data. We apply these models to MRSA colonization data collected in a small intensive care unit at the Princess Alexandra Hospital, Brisbane, Australia.

Flight testing of an augmented separation management system providing separation protection during failure of the central communication network

Future air traffic management concepts often involve the proposal of automated separation management algorithms that replaces human air traffic controllers. This paper proposes a new type of automated separation management algorithm (based on the satisficing approach) that utilizes inter-aircraft communication and a track file manager (or bank of Kalman filters) that is capable of resolving conflicts during periods of communication failure. The proposed separation management algorithm is tested in a range of flight scenarios involving during periods of communication failure, in both simulation and flight test (flight tests were conducted as part of the Smart Skies project). The intention of the conducted flight tests was to investigate the benefits of using inter-aircraft communication to provide an extra layer of safety protection in support air traffic management during periods of failure of the communication network. These benefits were confirmed.

Common mode voltage in a motor drive system with PFC

Common mode voltage generated by a power converter in combination with parasitic capacitive couplings is a potential source of shaft voltage in an AC motor drive system. In this paper, a three-phase motor drive system supplied with a single-phase AC-DC diode rectifier is investigated in order to reduce shaft voltage in a three-phase AC motor drive system. In this topology, the common mode voltage generated by the inverter is influenced by the AC-DC diode rectifier because the placement of the neutral point is changing in different rectifier circuit states. A pulse width modulation technique is presented by a proper placement of the zero vectors to reduce the common mode voltage level, which leads to a cost effective shaft voltage reduction technique without load current distortion, while keeping the switching frequency constant. Analysis and simulations have been presented to investigate the proposed method.

Pedagogy and participation : literacy education for low-literate refugee students of African origin in a western school system

For ESL teachers working with low-literate adolescents the challenge is to provide instruction in basic literacy capabilities while also realising the benefits of interactive and dialogic pedagogies advocated for the students. In this article we look at literacy pedagogy for refugees of African origin in Australian classrooms. We report on an interview study conducted in an intensive English language school for new arrival adolescents and in three regular secondary schools. Brian Street’s ideological model is used. From this perspective, literacy entails not only technical skills, but also social and cultural ways of making meaning that are embedded within relations of power. The findings showed that teachers were strengthening control of instruction to enable mastery of technical capabilities in basic literacy and genre analysis. We suggest that this approach should be supplemented by a critical approach transforming relations of linguistic power that exclude, marginalise and humiliate the study students in the classroom.

Designing a workflow system using coloured petri nets

Traditional workflow systems focus on providing support for the control-flow perspective of a business process, with other aspects such as data management and work distribution receiving markedly less attention. A guide to desirable workflow characteristics is provided by the well-known workflow patterns which are derived from a comprehensive survey of contemporary tools and modelling formalisms. In this paper we describe the approach taken to designing the newYAWL workflow system, an offering that aims to provide comprehensive support for the control-flow, data and resource perspectives based on the workflow patterns. The semantics of the newYAWL workflow language are based on Coloured Petri Nets thus facilitating the direct enactment and analysis of processes described in terms of newYAWL language constructs. As part of this discussion, we explain how the operational semantics for each of the language elements are embodied in the newYAWL system and indicate the facilities required to support them in an operational environment. We also review the experiences associated with developing a complete operational design for an offering of this scale using formal techniques.