Humans, ‘things’ and space : costing hospital infection control interventions

Background: Previous attempts at costing infection control programmes have tended to focus on accounting costs rather than economic costs. For studies using economic costs, estimates tend to be quite crude and probably underestimate the true cost. One of the largest costs of any intervention is staff time, but this cost is difficult to quantify and has been largely ignored in previous attempts. Aim: To design and evaluate the costs of hospital-based infection control interventions or programmes. This article also discusses several issues to consider when costing interventions, and suggests strategies for overcoming these issues. Methods: Previous literature and techniques in both health economics and psychology are reviewed and synthesized. Findings: This article provides a set of generic, transferable costing guidelines. Key principles such as definition of study scope and focus on large costs, as well as pitfalls (e.g. overconfidence and uncertainty), are discussed. Conclusion: These new guidelines can be used by hospital staff and other researchers to cost their infection control programmes and interventions more accurately.

Improving statistical analysis of matched case-control studies

Matched case–control research designs can be useful because matching can increase power due to reduced variability between subjects. However, inappropriate statistical analysis of matched data could result in a change in the strength of association between the dependent and independent variables or a change in the significance of the findings. We sought to ascertain whether matched case–control studies published in the nursing literature utilized appropriate statistical analyses. Of 41 articles identified that met the inclusion criteria, 31 (76%) used an inappropriate statistical test for comparing data derived from case subjects and their matched controls. In response to this finding, we developed an algorithm to support decision-making regarding statistical tests for matched case–control studies.

Risk factors for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory : a matched case-control study

Background: Side effects of the medications used for procedural sedation and analgesia in the cardiac catheterisation laboratory are known to cause impaired respiratory function. Impaired respiratory function poses considerable risk to patient safety as it can lead to inadequate oxygenation. Having knowledge about the conditions that predict impaired respiratory function prior to the procedure would enable nurses to identify at-risk patients and selectively implement intensive respiratory monitoring. This would reduce the possibility of inadequate oxygenation occurring. Aim: To identify pre-procedure risk factors for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory. Design: Retrospective matched case–control. Methods: 21 cases of impaired respiratory function were identified and matched to 113 controls from a consecutive cohort of patients over 18 years of age. Conditional logistic regression was used to identify risk factors for impaired respiratory function. Results: With each additional indicator of acute illness, case patients were nearly two times more likely than their controls to experience impaired respiratory function (OR 1.78; 95% CI 1.19–2.67; p = 0.005). Indicators of acute illness included emergency admission, being transferred from a critical care unit for the procedure or requiring respiratory or haemodynamic support in the lead up to the procedure. Conclusion: Several factors that predict the likelihood of impaired respiratory function were identified. The results from this study could be used to inform prospective studies investigating the effectiveness of interventions for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory.

Aircraft collision avoidance using spherical visual predictive control and single point features

This paper presents practical vision-based collision avoidance for objects approximating a single point feature. Using a spherical camera model, a visual predictive control scheme guides the aircraft around the object along a conical spiral trajectory. Visibility, state and control constraints are considered explicitly in the controller design by combining image and vehicle dynamics in the process model, and solving the nonlinear optimization problem over the resulting state space. Importantly, range is not required. Instead, the principles of conical spiral motion are used to design an objective function that simultaneously guides the aircraft along the avoidance trajectory, whilst providing an indication of the appropriate point to stop the spiral behaviour. Our approach is aimed at providing a potential solution to the See and Avoid problem for unmanned aircraft and is demonstrated through a series.

Control of dc capacitor voltages in diode-clamped multilevel inverter using bidirectional buck-boost choppers

The dc capacitors voltage unbalancing is the main technical drawback of a diode-clamped multilevel inverter (DCMLI), with more than three levels. A voltage-balancing circuit based on buck–boost chopper connected to the dc link of DCMLI is a reliable and robust solution to this problem. This study presents four different schemes for controlling the chopper circuit to achieve the capacitor voltages equalisation. These can be broadly categorised as single-pulse, multi-pulse and hysteresis band current control schemes. The single-pulse scheme does not involve faster switching actions but need the chopper devices to be rated for higher current. The chopper devices current rating can be kept limited by using the multi-pulse scheme but it involves faster switching actions and slower response. The hysteresis band current control scheme offers faster dynamics, lower current rating of the chopper devices and can nullify the initial voltage imbalance as well. However, it involves much faster switching actions which may not be feasible for some of its applications. Therefore depending on the system requirements and ratings, one of these schemes may be used. The performance and validity of the proposed schemes are confirmed through both simulation and experimental investigations on a prototype five-level diode-clamped inverter.

Smart robust resources control in LV network to deal with voltage rise issue

Often voltage rise along low voltage (LV) networks limits their capacity to accommodate more renewable energy (RE) sources. This paper proposes a robust and effective approach to coordinate customers' resources and control voltage rise in LV networks, where photovoltaics (PVs) are considered as the RE sources. The proposed coordination algorithm includes both localized and distributed control strategies. The localized strategy determines the value of PV inverter active and reactive power, while the distributed strategy coordinates customers' energy storage units (ESUs). To verify the effectiveness of proposed approach, a typical residential LV network is used and simulated in the PSCAD-EMTC platform.

Pregnancy loss and psychiatric disorders in young women : an Australian birth cohort study

Background Recent evidence has linked induced abortion with later adverse psychiatric outcomes in young women. Aims To examine whether abortion or miscarriage are associated with subsequent psychiatric and substance use disorders. Method A sample (n=1223) of women from a cohort born between 1981 and 1984 in Australia were assessed at 21 years for psychiatric and substance use disorders and lifetime pregnancy histories. Results Young women reporting a pregnancy loss had nearly three times the odds of experiencing a lifetime illicit drug disorder (excluding cannabis): abortion odds ratio (OR)=3.6 (95% CI 2.0–6.7) and miscarriage OR=2.6 (95% CI 1.2–5.4). Abortion was associated with alcohol use disorder (OR=2.1, 95% CI 1.3–3.5) and 12-month depression (OR=1.9, 95% CI 1.1–3.1). Conclusions These findings add to the growing body of evidence suggesting that pregnancy loss per se, whether abortion or miscarriage, increases the risk of a range of substance use disorders and affective disorders in young women.

Predicting depressive and anxiety disorders with the YASR internalising scales (empirical and DSM-oriented)

Background The Achenbach problem behaviour scales (CBCL/YSR) are widely used. The DSM-oriented anxiety and depression scales have been created to improve concordance between Achenbach’s internalising scales and DSM-IV depression and anxiety. To date no study has examined the concurrent utility of the young adult (YASR) internalising scales, either the empirical or newly developed DSM-oriented depressive or anxiety scales. Methods A sample of 2,551 young adults, aged 18–23 years, from an Australian cohort study. The association between the empirical and DSM-oriented anxiety and depression scales were individually assessed against DSMIV depression and anxiety diagnoses derived from structured interview. Odds ratios, ROC analyses and diagnostic efficiency tests (sensitivity, specificity, positive and negative predictive values) were used to report findings. Results YASR empirical internalising scale predicted DSM-IV mood disorders (depression OR = 6.9, 95% CI 5.0–9.5; anxiety OR = 5.1, 95% CI 3.8–6.7) in the previous 12 months. DSM-oriented depressive or anxiety scales did not appear to improve the concordance with DSM-IV diagnosed depression or anxiety. The internalising scales were much more effective at identifying those with comorbid depression and anxiety, with Ors between 10.1 and 21.7 depending on the internalising scale used. Conclusion DSM-oriented scales perform no better than the standard internalising in identifying young adults with DSM-IV mood or anxiety disorder.

Screening in early childhood for risk of later mental health problems : a longitudinal study

Depression in childhood or adolescence is associated with increased rates of depression in adulthood. Does this justify efforts to detect (and treat) those with symptoms of depression in early childhood or adolescence? The aim of this study was to determine how well symptoms of anxiety/depression (A-D) in early childhood and adolescence predict adult mental health. The study sample is taken from a population-based prospective birth cohort study. Of the 8556 mothers initially approached to participate 8458 agreed, of whom 7223 mothers gave birth to a live singleton baby. Children were screened using modified Child Behaviour Checklist (CBCL) scales for internalizing and total problems (T-P) at age 5 and the CBCL and Youth Self Report (YSR) A-D subscale and T-P scale at age 14. At age 21, a sub-sample of 2563 young adults in this cohort were administered the CIDI-Auto. Results indicated that screening at age 5 would detect few later cases of significant mental ill-health. Using a cut-point of 20% for internalizing at child age 5 years the CBCL had sensitivities of only 25% and 18% for major depression and anxiety disorders at 21 years, respectively. At age 14, the YSR generally performed a little better than the CBCL as a screening instrument, but neither performed at a satisfactory level. Of the children who were categorised as having YSR A-D at 14 years 30% and 37% met DSM-IV criteria for major depression and anxiety disorders, respectively, at age 21. Our findings challenge an existing movement encouraging the detection and treatment of those with symptoms of mental illness in early childhood.

FP01-5 Pregnancy loss and psychiatric disorders in young men and women : results from Australian longitudinal cohort study

Recent evidence has linked induced abortion with later adverse psychiatric outcomes in young women. Little is known about later adverse psychiatric outcomes in young men whose partners have fallen pregnant and either go on to have a child, have an abortion or miscarry. 1223 women and 1159 men, from an Austrailan cohort born between 1981 and 1984, were assessed at 21 years for psychiatric and substance misuse and lifetime pregnancy histories. Young women reporting a pregnancy loss (either miscarriage or abortion) had nearly three times the odds of experiencing a illicit drug disorder (excluding cannabis), and nearly twice the odds of an alcohol misuse compared to never pregnant women. Young men whose partner had an abortion, but not a miscarriage, had nearly twice the odds of cannabis disorder, illicit drug disorder, and mood disorder compared to men that had never fathered a pregnancy. Young women who have lost a pregnancy have an increased risk of developing alcohol or substance abuse in later life. Young men whose partner aborted a pregnancy only had an increased of substance abuse and mood disorder in later life. These findings add to the growing body of evidence suggesting that pregnancy loss per se increases the risk of a range of substance use disorders in young women. The findings for young men are novel and raise the possibility that the associations measured may be due to common unmeasured factors associated with early pregnancy in young people rather than pregnancy loss.

Factors associated with common mental disorders during the transition to adulthood : do emerging adults and ‘early starters’ differ? Findings from an Australian birth cohort study

Background: Despite increasing diversity in pathways to adulthood, choices available to young people are influenced by environmental, familial and individual factors, namely access to socioeconomic resources, family support and mental and physical health status. Young people from families with higher socioeconomic position (SEP) are more likely to pursue tertiary education and delay entry to adulthood, whereas those from low socioeconomic backgrounds are less likely to attain higher education or training, and more likely to partner and become parents early. The first group are commonly termed ‘emerging adults’ and the latter group ‘early starters’. Mental health disorders during this transition can seriously disrupt psychological, social and academic development as well as employment prospects. Depression, anxiety and most substance use disorders have early onset during adolescence and early adulthood with approximately three quarters of lifetime psychiatric disorders having emerged by 24 years of age. Aims: This thesis aimed to explore the relationships between mental health, sociodemographic factors and family functioning during the transition to adulthood. Four areas were investigated: 1) The key differences between emerging adults and ‘early starters’, were examined and focused on a series of social, economic, and demographic factors as well as DSM-IV diagnoses; 2) Methodological issues associated with the measurement of depression and anxiety in young adults were explored by comparing a quantitative measure of symptoms of anxiety and depression (Achenbach’s YSR and YASR internalising scales) with DSM-IV diagnosed depression and anxiety. 3) The association between family SEP and DSM-IV depression and anxiety was examined in relation to the different pathways to adulthood. 4) Finally, the association between pregnancy loss, abortion and miscarriage, and DSM-IV diagnoses of common psychiatric disorders was assessed in young women who reported early parenting, experiencing a pregnancy loss, or who had never been pregnant. Methods: Data were taken from the Mater University Study of Pregnancy (MUSP), a large birth cohort started in 1981 in Brisbane, Australia. 7223 mothers and their children were assessed five times, at 6 months, 5, 14 and 21 years after birth. Over 3700 young adults, aged 18 to 23 years, were interviewed at the 21-year phase. Respondents completed an extensive series of self-reported questionnaires and a computerised structured psychiatric interview. Three outcomes were assessed at the 21-year phase. Mental health disorders diagnosed by a computerised structured psychiatric interview (CIDI-Auto), the prevalence of DSM-IV depression, anxiety and substance use disorders within the previous 12-month, during the transition (between ages of 18 and 23 years) or lifetime were examined. The primary outcome “current stage in the transition to adulthood” was developed using a measure conceptually constructed from the literature. The measure was based on important demographic markers, and these defined four independent groups: emerging adults (single with no children and living with parents), and three categories of ‘early starter’, singles (with no children or partner, living independently), those with a partner (married or cohabitating but without children) and parents. Early pregnancy loss was assessed using a measure that also defined four independent groups and was based on pregnancy outcomes in the young women This categorised the young women into those who were never pregnant, women who gave birth to a live child, and women who reported some form of pregnancy loss, either an abortion or a spontaneous miscarriage. A series of analyses were undertaken to test the study aims. Potential confounding and mediating factors were prospectively measured between the child’s birth and the 21-year phase. Binomial and multinomial logistic regression was used to estimate the risk of relevant outcomes, and the associations were reported as odds ratios (OR) and 95% confidence intervals (95%CI). Key findings: The thesis makes a number of important contributions to our understanding of the transition to adulthood, particularly in relation to the mental health consequences associated with different pathways. Firstly, findings from the thesis clearly showed that young people who parented or partnered early fared worse across most of the economic and social factors as well as the common mental disorders when compared to emerging adults. That is, young people who became early parents were also more likely to experience recent anxiety (OR=2.0, 95%CI 1.5-2.8) and depression (OR=1.7, 95%CI 1.1-2.7) than were emerging adults after taking into account a range of confounding factors. Singles and those partnering early also had higher rates of lifetime anxiety and depression than emerging adults. Young people who partnered early, but were without children, had decreased odds of recent depression; this may be due to the protective effect of early marriage against depression. It was also found that young people who form families early had an increased risk of cigarette smoking (parents OR=3.7, 95%CI 2.9-4.8) compared to emerging adults, but not heavy alcohol (parents OR=0.4, 95%CI 0.3-0.6) or recent illicit drug use. The high rates of cigarette smoking and tobacco use disorders in ‘early starters’ were explained by common risk factors related to early adversity and lower SEP. Having a child and early marriage may well function as a ‘turning point’ for some young people, it is not clear whether this is due to a conscious decision to disengage from a previous ‘substance using’ lifestyle or simply that they no longer have the time to devote to such activities because of child caring. In relation to the methodological issues associated with assessing common mental disorders in young adults, it was found that although the Achenbach empirical internalising scales successfully predicted both later DSM-IV depression (YSR OR=2.3, 95%CI 1.7-3.1) and concurrently diagnosed depression (YASR OR=6.9, 95%CI 5.0- 9.5) and anxiety (YASR OR=5.1, 95%CI 3.8- 6.7), the scales discriminated poorly between young people with or without DSM-IV diagnosed mood disorder. Sensitivity values (the proportion of true positives) for the internalising scales were surprisingly low. Only a third of young people with current DSM-IV depression (range for each of the scales was between 34% to 42%) were correctly identified as cases by the YASR internalising scales, and only a quarter with current anxiety disorder (range of 23% to 31%) were correctly identified. Also, use of the DSM-oriented scales increased sensitivity only marginally (for depression between 2-8%, and anxiety between 2-6%) above the standard Achenbach scales. This is despite the fact that the DSM-oriented scales were originally developed to overcome the poor prediction of DSM-IV diagnoses by the Achenbach scales. The internalising scales, both standard and DSM-oriented, were much more effective at identifying young people with comorbid depression and anxiety, with OR’s 10.1 to 21.7 depending on the internalising scale used. SEP is an important predictor of both an early transition to adulthood and the experience of anxiety during that time Family income during adolescence was a strong predictor of early parenting and partnering before age 24 but not early independent living. Compared to families in the upper quintile, young people from families with low income were nearly twice as likely to live with a partner and four times more likely to become parents (OR ranged from 2.6 to 4.0). This association remained after adjusting for current employment and education level. Children raised in low income families were 30% more likely to have an anxiety disorder (OR=1.3, 95%CI 0.9-1.9), but not depression, as young adults when compared to children from wealthier families. Emerging adults and ‘early starters’ from low income families did not differ in their likelihood of having a later anxiety disorder. Young women reporting a pregnancy loss had nearly three times the odds of experiencing a lifetime illicit drug disorder (excluding cannabis) [abortion OR=3.6, 95%CI 2.0-6.7 and miscarriage OR=2.6, 95%CI 1.2-5.4]. Abortion was associated with alcohol use disorder (OR=2.1, 95%CI 1.3- 3.5) and 12-month depression (OR=1.9, 95%CI 1.1- 3.1). These finding suggest that the association identified by Fergusson et al between abortion and later psychiatric disorders in young women may be due to pregnancy loss and not to abortion, per se. Conclusion: Findings from this thesis support the view that young people who parent or partner early have a greater burden of depression and anxiety when compared to emerging adults. As well, young women experiencing pregnancy loss, from either abortion or miscarriage, are more likely to experience depression and anxiety than are those who give birth to a live infant or who have never been pregnant. Depression, anxiety and substance use disorders often go unrecognised and untreated in young people; this is especially true in young people from lower SEP. Early identification of these common mental health disorders is important, as depression and anxiety experienced during the transition to adulthood have been found to seriously disrupt an individual’s social, educational and economic prospects in later life.

Universal active and reactive power control of electronically interfaced distributed generation sources in virtual power plants operating in gridconnected and islanding modes

The control paradigms of the distributed generation (DG) sources in the smart grid are realised by either utilising virtual power plant (VPP) or by employing MicroGrid structures. Both VPP and MicroGrid are presented with the problem of control of power flow between their comprising DG sources. This study depicts this issue for VPP and proposes a novel and improved universal active and reactive power flow controllers for three-phase pulse width modulated voltage source inverters (PWM-VSI) operating in the VPP environment. The proposed controller takes into account all cases of R-X relationship, thus allowing it to function in systems operating at high, medium (MV) and low-voltage (LV) levels. Also proposed control scheme for the first time in an inverter control takes into account the capacitance of the transmission line which is an important factor to accurately represent medium length transmission lines. This allows the proposed control scheme to be applied in VPP structures, where DG sources can operate at MV LV levels over a short/medium length transmission line. The authors also conducted small signal stability analysis of the proposed controller and compared it against the small signal study of the existing controllers.

Mediating conflict and control : practice challenges for nurses working in palliative care

A work-based professional development program was offered to a group of registered nurses working in palliative care. The goal of the program was to improve skills in psychosocial care (Yates et al., 1996). Participants were encouraged to reflect critically on their practice experience within a group setting. The focus of the group discussion and reflection were shared practice incidents. Each participant was given the opportunity to identify and describe an incident from their professional practice that presented a challenging issue within palliative nursing. This paper explores the themes of conflict and control, evident within the collection of fifteen practice incidents and discusses the nurses role as mediator. The concepts of patient advocacy and professional autonomy are challenged through the nurses experience of providing care within a hierarchical and bureaucratic health service. The outcome of reflection for the organization is most effective when shared experience and collective action (rather than individual practice) are the focus.

A multi-objective optimization approach for coordinating available transfer capability with risk control

In the electricity market environment, coordination of system reliability and economics of a power system is of great significance in determining the available transfer capability (ATC). In addition, the risks associated with uncertainties should be properly addressed in the ATC determination process for risk-benefit maximization. Against this background, it is necessary that the ATC be optimally allocated and utilized within relative security constraints. First of all, the non-sequential Monte Carlo stimulation is employed to derive the probability density distribution of ATC of designated areas incorporating uncertainty factors. Second, on the basis of that, a multi-objective optimization model is formulated to determine the multi-area ATC so as to maximize the risk-benefits. Then, the solution to the developed model is achieved by the fast non-dominated sorting (NSGA-II) algorithm, which could decrease the risk caused by uncertainties while coordinating the ATCs of different areas. Finally, the IEEE 118-bus test system is served for demonstrating the essential features of the developed model and employed algorithm.

A bondgraph approach to formation control using relative state measurements

In this paper we apply port-Hamiltonian theory with the bondgraph modelling approach to the problem of formation control using partial measurements of relative positions. We present a control design that drives a group of vehicles to a desired formation without requiring inter-vehicle communications or global position and velocity measurements to be available. Our generic approach is applicable to any form of relative measurement between vehicles, but we specifically consider the important cases of relative bearings and relative distances. In the case of bearings, our theory closely relates to the field of image-based visual servo (IBVS) control. We present simulation results to support the developed theory.