Delirium in the ICU : a review

AIM The aim of this paper was to review the current discourse in relation to intensive care unit (ICU) delirium. In particular, it will discuss the predisposing and contributory factors associated with delirium's development as well as effects of delirium on patients, staff and family members. BACKGROUND Critically ill patients are at greater risk of developing delirium and, with an ageing population and increased patient acuity permitted by medical advances, delirium is a growing problem in the ICU. However, there is a universal consensus that the definition of ICU delirium needs improvement to aid its recognition and to ensure both hypoalert-hypoactive and hyperalert-hyperactive variants are easily and readily identified. RELEVANCE TO CLINICAL PRACTICE The effects of ICU delirium have cost implications to the National Health Service in terms of prolonged ventilation and length of hospital stay. The causes of delirium can be readily classified as either predisposing or precipitating factors, which are organic in nature and commonly reversible. However, contributory factors also exist to exacerbate delirium and having an awareness of all these factors promises to aid prevention and expedite treatment. This will avoid or limit the host of adverse physiological and psychological consequences that delirium can provoke and directly enhance both patient and staff safety. CONCLUSIONS Routine screening of all patients in the ICU for the presence of delirium is crucial to its successful management. Nurses are on the front line to detect, manage and even prevent delirium.

Prevalence of undiagnosed urinary tract infections on admission to a rehabilitation unit

Background Through clinical observation nursing staff of an inpatient rehabilitation unit identified a link between incontinence and undiagnosed urinary tract infections (UTIs). Further, clinical observation and structured continence management led to the realisation that urinary incontinence often improved, or resolved completely, after treatment with antibiotics. In 2009 a small study found that 30% of admitted rehabilitation patients had an undiagnosed UTI, with the majority admitted post-orthopaedic fracture. We suspected that the frequent use of indwelling urinary catheters (IDCs) in the orthopaedic environment may have been a contributing factor. Therefore, a second, more thorough, study was commenced in 2010 and completed in 2011. Aim The aim of this study was to identify what proportion of patients were admitted to one rehabilitation unit with an undiagnosed UTI over a 12-month period. We wanted to identify and highlight the presence of known risk factors associated with UTI and determine whether urinary incontinence was associated with the presence of UTI. Methods Data were collected from every patient that was admitted over a 12-month period (n=140). The majority of patients were over the age of 65 and had an orthopaedic fracture (36.4%) or stroke (27.1%). Mid-stream urine (MSU) samples, routinely collected and sent for culture and sensitivity as part of standard admission procedure, were used by the treating medical officer to detect the presence of UTI. A data collection sheet was developed, reviewed and trialled, before official data collection commenced. Data were collected as part of usual practice and collated by a research assistant. Inferential statistics were used to analyse the data. Results This study found that 25 (17.9%) of the 140 patients admitted to rehabilitation had an undiagnosed UTI, with a statistically significant association between prior presence of an IDC and the diagnosis of UTI. Urinary incontinence improved after the completion of treatment with antibiotics. Results further demonstrated a significant association between the confirmation of a UTI on culture and sensitivity and the absence of symptoms usually associated with UTI, such as burning or stinging on urination. Overall, this study suggests careful monitoring of urinary symptoms in patients admitted to rehabilitation, especially in patients with a prior IDC, is warranted.

A multi-scaling approach to predict hydraulic damage of poromaterials

The purpose of this paper is to introduce the concept of hydraulic damage and its numerical integration. Unlike the common phenomenological continuum damage mechanics approaches, the procedure introduced in this paper relies on mature concepts of homogenization, linear fracture mechanics, and thermodynamics. The model is applied to the problem of fault reactivation within resource reservoirs. The results show that propagation of weaknesses is highly driven by the contrasts of properties in porous media. In particular, it is affected by the fracture toughness of host rocks. Hydraulic damage is diffused when it takes place within extended geological units and localized at interfaces and faults.

Characterising an ECG signal using statistical modelling : a feasibility study

For clinical use, in electrocardiogram (ECG) signal analysis it is important to detect not only the centre of the P wave, the QRS complex and the T wave, but also the time intervals, such as the ST segment. Much research focused entirely on qrs complex detection, via methods such as wavelet transforms, spline fitting and neural networks. However, drawbacks include the false classification of a severe noise spike as a QRS complex, possibly requiring manual editing, or the omission of information contained in other regions of the ECG signal. While some attempts were made to develop algorithms to detect additional signal characteristics, such as P and T waves, the reported success rates are subject to change from person-to-person and beat-to-beat. To address this variability we propose the use of Markov-chain Monte Carlo statistical modelling to extract the key features of an ECG signal and we report on a feasibility study to investigate the utility of the approach. The modelling approach is examined with reference to a realistic computer generated ECG signal, where details such as wave morphology and noise levels are variable.

Unconditionally secure disjointness tests for private datasets

We present two unconditional secure protocols for private set disjointness tests. In order to provide intuition of our protocols, we give a naive example that applies Sylvester matrices. Unfortunately, this simple construction is insecure as it reveals information about the intersection cardinality. More specifically, it discloses its lower bound. By using the Lagrange interpolation, we provide a protocol for the honest-but-curious case without revealing any additional information. Finally, we describe a protocol that is secure against malicious adversaries. In this protocol, a verification test is applied to detect misbehaving participants. Both protocols require O(1) rounds of communication. Our protocols are more efficient than the previous protocols in terms of communication and computation overhead. Unlike previous protocols whose security relies on computational assumptions, our protocols provide information theoretic security. To our knowledge, our protocols are the first ones that have been designed without a generic secure function evaluation. More important, they are the most efficient protocols for private disjointness tests in the malicious adversary case.

Novelty-based visual obstacle detection in agriculture

This paper describes a novel obstacle detection system for autonomous robots in agricultural field environments that uses a novelty detector to inform stereo matching. Stereo vision alone erroneously detects obstacles in environments with ambiguous appearance and ground plane such as in broad-acre crop fields with harvested crop residue. The novelty detector estimates the probability density in image descriptor space and incorporates image-space positional understanding to identify potential regions for obstacle detection using dense stereo matching. The results demonstrate that the system is able to detect obstacles typical to a farm at day and night. This system was successfully used as the sole means of obstacle detection for an autonomous robot performing a long term two hour coverage task travelling 8.5 km.

Tracking-based moving object detection

We present a novel approach for multi-object detection in aerial videos based on tracking. The proposed method mainly involves three steps. Firstly, the spatial-temporal saliency is employed to detect moving objects. Secondly, the detected objects are tracked by mean shift in the subsequent frames. Finally, the saliency results are fused with the weight map generated by tracking to get refined detection results, and in turn the modified detection results are used to update the tracking models. The proposed algorithm is evaluated on VIVID aerial videos, and the results show that our approach can reliably detect moving objects even in challenging situations. Meanwhile, the proposed method can process videos in real time, without the effect of time delay.

Multiscale coupling and multiphysics approaches in earth sciences : applications

Geoscientists are confronted with the challenge of assessing nonlinear phenomena that result from multiphysics coupling across multiple scales from the quantum level to the scale of the earth and from femtoseconds to the 4.5 Ga of history of our planet. We neglect in this review electromagnetic modelling of the processes in the Earth’s core, and focus on four types of couplings that underpin fundamental instabilities in the Earth. These are thermal (T), hydraulic (H), mechanical (M) and chemical (C) processes which are driven and controlled by the transfer of heat to the Earth’s surface. Instabilities appear as faults, folds, compaction bands, shear/fault zones, plate boundaries and convective patterns. Convective patterns emerge from buoyancy overcoming viscous drag at a critical Rayleigh number. All other processes emerge from non-conservative thermodynamic forces with a critical critical dissipative source term, which can be characterised by the modified Gruntfest number Gr. These dissipative processes reach a quasi-steady state when, at maximum dissipation, THMC diffusion (Fourier, Darcy, Biot, Fick) balance the source term. The emerging steady state dissipative patterns are defined by the respective diffusion length scales. These length scales provide a fundamental thermodynamic yardstick for measuring instabilities in the Earth. The implementation of a fully coupled THMC multiscale theoretical framework into an applied workflow is still in its early stages. This is largely owing to the four fundamentally different lengths of the THMC diffusion yardsticks spanning micro-metre to tens of kilometres compounded by the additional necessity to consider microstructure information in the formulation of enriched continua for THMC feedback simulations (i.e., micro-structure enriched continuum formulation). Another challenge is to consider the important factor time which implies that the geomaterial often is very far away from initial yield and flowing on a time scale that cannot be accessed in the laboratory. This leads to the requirement of adopting a thermodynamic framework in conjunction with flow theories of plasticity. This framework allows, unlike consistency plasticity, the description of both solid mechanical and fluid dynamic instabilities. In the applications we show the similarity of THMC feedback patterns across scales such as brittle and ductile folds and faults. A particular interesting case is discussed in detail, where out of the fluid dynamic solution, ductile compaction bands appear which are akin and can be confused with their brittle siblings. The main difference is that they require the factor time and also a much lower driving forces to emerge. These low stress solutions cannot be obtained on short laboratory time scales and they are therefore much more likely to appear in nature than in the laboratory. We finish with a multiscale description of a seminal structure in the Swiss Alps, the Glarus thrust, which puzzled geologists for more than 100 years. Along the Glarus thrust, a km-scale package of rocks (nappe) has been pushed 40 km over its footwall as a solid rock body. The thrust itself is a m-wide ductile shear zone, while in turn the centre of the thrust shows a mm-cm wide central slip zone experiencing periodic extreme deformation akin to a stick-slip event. The m-wide creeping zone is consistent with the THM feedback length scale of solid mechanics, while the ultralocalised central slip zones is most likely a fluid dynamic instability.

Online self-supervised multi-instance segmentation of dynamic objects

This paper presents a method for the continuous segmentation of dynamic objects using only a vehicle mounted monocular camera without any prior knowledge of the object’s appearance. Prior work in online static/dynamic segmentation is extended to identify multiple instances of dynamic objects by introducing an unsupervised motion clustering step. These clusters are then used to update a multi-class classifier within a self-supervised framework. In contrast to many tracking-by-detection based methods, our system is able to detect dynamic objects without any prior knowledge of their visual appearance shape or location. Furthermore, the classifier is used to propagate labels of the same object in previous frames, which facilitates the continuous tracking of individual objects based on motion. The proposed system is evaluated using recall and false alarm metrics in addition to a new multi-instance labelled dataset to evaluate the performance of segmenting multiple instances of objects.

Winning the phishing war : a strategy for Australia

Phishing, a form of on-line identity theft, is a major problem worldwide, accounting for more than $7.5 Billion in losses in the US alone between 2005 and 2008. Australia was the first country to be targeted by Internet bank phishing in 2003 and continues to have a significant problem in this area. The major cyber crime groups responsible for phishing are based in Eastern Europe. They operate with a large degree of freedom due to the inherent difficulties in cross border law enforcement and the current situation in Eastern Europe, particularly in Russia and the Ukraine. They employ highly sophisticated and efficient technical tools to compromise victims and subvert bank authentication systems. However because it is difficult for them to repatriate the fraudulently obtained funds directly they employ Internet money mules in Australia to transfer the money via Western Union or Money gram. It is proposed a strategy, which firstly places more focus by Australian law enforcement upon transactions via Western Union and Money gram to detect this money laundering, would significantly impact the success of the Phishing attack model. This combined with a technical monitoring of Trojan technology and education of potential Internet money mules to avoid being duped would provide a winning strategy for the war on phishing for Australia.

Locating delamination in composite laminated beams using the A0 Lamb mode

In this study, experimental and numerical investigations have been conducted to explore the possibility of using A0 mode in Lamb waves to detect the position of delamination in carbon fiber reinforced plastic (CFRP) laminated beams. An experimental technique for exciting and sensing the pure A0 mode has been developed. By measuring the propagation speed of A0 mode and traveling time of a signal reflected from the delamination, its location can be identified experimentally and numerically. Moreover, the numerical analysis has been extended to gain a better understanding of the complex interaction between A0 mode and a long delamination case.

Blind steganalysis : a countermeasure for binary image steganography

In this paper, we propose a new blind steganalytic method to detect the presence of secret messages embedded in black and white images using the steganographic techniques. We start by extracting several sets of matrix, such as run length matrix, gap length matrix and pixel difference. We also apply characteristic function on these matrices to enhance their discriminative capabilities. Then we calculate the statistics which include mean, variance, kurtosis and skewness to form our feature sets. The presented empirical works demonstrate our proposed method can effectively detect three different types of steganography. This proves the universality of our proposed method as a blind steganalysis. In addition, the experimental results show our proposed method is capable of detecting small amount of the embedded message.

Estimating hidden message length in binary image embedded by using boundary pixels steganography

In this paper, we propose a new steganalytic method to detect the message hidden in a black and white image using the steganographic technique developed by Liang, Wang and Zhang. Our detection method estimates the length of hidden message embedded in a binary image. Although the hidden message embedded is visually imperceptible, it changes some image statistic (such as inter-pixels correlation). Based on this observation, we first derive the 512 patterns histogram from the boundary pixels as the distinguishing statistic, then we compute the histogram difference to determine the changes of the 512 patterns histogram induced by the embedding operation. Finally we propose histogram quotient to estimate the length of the embedded message. Experimental results confirm that the proposed method can effectively and reliably detect the length of the embedded message.

Health monitoring of short-and medium-spen bridges using an improved modal strain energy method

Increasing the importance and use of infrastructures such as bridges, demands more effective structural health monitoring (SHM) systems. SHM has well addressed the damage detection issues through several methods such as modal strain energy (MSE). Many of the available MSE methods either have been validated for limited type of structures such as beams or their performance is not satisfactory. Therefore, it requires a further improvement and validation of them for different types of structures. In this study, an MSE method was mathematically improved to precisely quantify the structural damage at an early stage of formation. Initially, the MSE equation was accurately formulated considering the damaged stiffness and then it was used for derivation of a more accurate sensitivity matrix. Verification of the improved method was done through two plane structures: a steel truss bridge and a concrete frame bridge models that demonstrate the framework of a short- and medium-span of bridge samples. Two damage scenarios including single- and multiple-damage were considered to occur in each structure. Then, for each structure, both intact and damaged, modal analysis was performed using STRAND7. Effects of up to 5 per cent noise were also comprised. The simulated mode shapes and natural frequencies derived were then imported to a MATLAB code. The results indicate that the improved method converges fast and performs well in agreement with numerical assumptions with few computational cycles. In presence of some noise level, it performs quite well too. The findings of this study can be numerically extended to 2D infrastructures particularly short- and medium-span bridges to detect the damage and quantify it more accurately. The method is capable of providing a proper SHM that facilitates timely maintenance of bridges to minimise the possible loss of lives and properties.

Reversible and blind database watermarking using difference expansion

Database watermarking has received significant research attention in the current decade. Although, almost all watermarking models have been either irreversible (the original relation cannot be restored from the watermarked relation) and/or non-blind (requiring original relation to detect the watermark in watermarked relation). This model has several disadvantages over reversible and blind watermarking (requiring only watermarked relation and secret key from which the watermark is detected and original relation is restored) including inability to identify rightful owner in case of successful secondary watermarking, inability to revert the relation to original data set (required in high precision industries) and requirement to store unmarked relation at a secure secondary storage. To overcome these problems, we propose a watermarking scheme that is reversible as well as blind. We utilize difference expansion on integers to achieve reversibility. The major advantages provided by our scheme are reversibility to high quality original data set, rightful owner identification, resistance against secondary watermarking attacks, and no need to store original database at a secure secondary storage.