'Online' geriatric assessment procedure for older adults referred for geriatric assessment during an acute care episode for consideration of reliability of triage decisions

Background Comprehensive geriatric assessment has been shown to improve patient outcomes, but the geriatricians who deliver it are in short-supply. A web-based method of comprehensive geriatric assessment has been developed with the potential to improve access to specialist geriatric expertise. The current study aims to test the reliability and safety of comprehensive geriatric assessment performed “online” in making geriatric triage decisions. It will also explore the accuracy of the procedure in identifying common geriatric syndromes, and its cost relative to conventional “live” consultations. Methods/Design The study population will consist of 270 acutely hospitalized patients referred for geriatric consultation at three sites. Paired assessments (live and online) will be conducted by independent, blinded geriatricians and the level of agreement examined. This will be compared with the level of agreement between two independent, blinded geriatricians each consulting with the patient in person (i.e. “live”). Agreement between the triage decision from live-live assessments and between the triage decision from live-online assessments will be calculated using kappa statistics. Agreement between the online and live detection of common geriatric syndromes will also be assessed using kappa statistics. Resource use data will be collected for online and live-live assessments to allow comparison between the two procedures. Discussion If the online approach is found to be less precise than live assessment, further analysis will seek to identify patient subgroups where disagreement is more likely. This may enable a protocol to be developed that avoids unsafe clinical decisions at a distance. Trial registration Trial registration number: ACTRN12611000936921

Sequential Fusion Using Correlated Decisions for Controlled Verification Errors

Fusion techniques have received considerable attention for achieving lower error rates with biometrics. A fused classifier architecture based on sequential integration of multi-instance and multi-sample fusion schemes allows controlled trade-off between false alarms and false rejects. Expressions for each type of error for the fused system have previously been derived for the case of statistically independent classifier decisions. It is shown in this paper that the performance of this architecture can be improved by modelling the correlation between classifier decisions. Correlation modelling also enables better tuning of fusion model parameters, ‘N’, the number of classifiers and ‘M’, the number of attempts/samples, and facilitates the determination of error bounds for false rejects and false accepts for each specific user. Error trade-off performance of the architecture is evaluated using HMM based speaker verification on utterances of individual digits. Results show that performance is improved for the case of favourable correlated decisions. The architecture investigated here is directly applicable to speaker verification from spoken digit strings such as credit card numbers in telephone or voice over internet protocol based applications. It is also applicable to other biometric modalities such as finger prints and handwriting samples.

“They’re lunatics on the road” : Exploring the normative influences of parents, friends, and police on young novices’ risky driving decisions

Purpose: Young novice drivers experience significantly greater risk of being injured or killed in car crashes than older more experienced drivers. This research utilised a qualitative approach guided by the framework of Akers’ social learning theory. It explored young novice drivers’ perspectives on risky driving including rewards and punishments expected from and administered by parents, friends, and police, imitation of parents’ and friends’ driving, and advantages and disadvantages of risky driving. Methods: Twenty-one young drivers (12 females, 9 males) aged 16–25 years (M = 17.71 years, SD = 2.15) with a Learner (n = 11) or Provisional (n = 10) driver licence participated in individual or small group interviews. Findings and conclusions: Content analysis supported four themes: (1) rewards and (2) punishments for risky driving, and the influence of (3) parents and (4) friends. The young novice drivers differed in their vulnerability to the negative influences of friends and parents, with some novices advising they were able to resist risky normative influences whilst others felt they could not. The authority of the police as enforcers of road rules was either accepted and respected or seen as being used to persecute young novices. These findings suggest that road safety interventions should consider the normative influence of parents and friends on the risky and safe behaviour of young novices. Police were also seen as influential upon behaviour. Future research should explore the complicated relationship between parents, friends, the police, young novices, and their risky driving behaviour.

Sequential fusion of decisions from adaptive and random samples for controlled verification of errors

Fusion techniques have received considerable attention for achieving performance improvement with biometrics. While a multi-sample fusion architecture reduces false rejects, it also increases false accepts. This impact on performance also depends on the nature of subsequent attempts, i.e., random or adaptive. Expressions for error rates are presented and experimentally evaluated in this work by considering the multi-sample fusion architecture for text-dependent speaker verification using HMM based digit dependent speaker models. Analysis incorporating correlation modeling demonstrates that the use of adaptive samples improves overall fusion performance compared to randomly repeated samples. For a text dependent speaker verification system using digit strings, sequential decision fusion of seven instances with three random samples is shown to reduce the overall error of the verification system by 26% which can be further reduced by 6% for adaptive samples. This analysis novel in its treatment of random and adaptive multiple presentations within a sequential fused decision architecture, is also applicable to other biometric modalities such as finger prints and handwriting samples.

Sequential fusion of decisions with favorable dependence for controlled verification errors

Statistical dependence between classifier decisions is often shown to improve performance over statistically independent decisions. Though the solution for favourable dependence between two classifier decisions has been derived, the theoretical analysis for the general case of 'n' client and impostor decision fusion has not been presented before. This paper presents the expressions developed for favourable dependence of multi-instance and multi-sample fusion schemes that employ 'AND' and 'OR' rules. The expressions are experimentally evaluated by considering the proposed architecture for text-dependent speaker verification using HMM based digit dependent speaker models. The improvement in fusion performance is found to be higher when digit combinations with favourable client and impostor decisions are used for speaker verification. The total error rate of 20% for fusion of independent decisions is reduced to 2.1% for fusion of decisions that are favourable for both client and impostors. The expressions developed here are also applicable to other biometric modalities, such as finger prints and handwriting samples, for reliable identity verification.

Modeling collision avoidance decisions in navigation

Due to grave potential human, environmental and economical consequences of collisions at sea, collision avoidance has become an important safety concern in navigation. To reduce the risk of collisions at sea, appropriate collision avoidance actions need to be taken in accordance with the regulations, i.e., International Regulations for Preventing Collisions at Sea. However, the regulations only provide qualitative rules and guidelines, and therefore it requires navigators to decide on collision avoidance actions quantitatively by using their judgments which often leads to making errors in navigation. To better help navigators in collision avoidance, this paper develops a comprehensive collision avoidance decision making model for providing whether a collision avoidance action is required, when to take action and what action to be taken. The model is developed based on three types of collision avoidance actions, such as course change only, speed change only, and a combination of both. The model has potential to reduce the chance of making human error in navigation by assisting navigators in decision making on collision avoidance actions.

Vertical vegetation design decisions and their impact on energy consumption in subtropical cities

Vertical vegetation is vegetation growing on, or adjacent to, the unused sunlit exterior surfaces of buildings in cities. Vertical vegetation can improve the energy efficiency of the building on which it is installed mainly by insulating, shading and transpiring moisture from foliage and substrate. Several design parameters may affect the extent of the vertical vegetation's improvement of energy performance. Examples are choice of vegetation, growing medium geometry, north/south aspect and others. The purpose of this study is to quantitatively map out the contribution of several parameters to energy savings in a subtropical setting. The method is thermal simulation based on EnergyPlus configured to reflect the special characteristics of vertical vegetation. Thermal simulation results show that yearly cooling energy savings can reach 25% with realistic design choices in subtropical environments. Heating energy savings are negligible. The most important parameter is the aspect of walls covered by vegetation. Vertical vegetation covering walls facing north (south for the northern hemisphere) will result in the highest energy savings. In making plant selections, the most significant parameter is Leaf Area Index (LAI). Plants with larger LAI, preferably LAI>4, contribute to greater savings whereas vertical vegetation with LAI<2 can actually consume energy. The choice of growing media and its thickness influence both heating and cooling energy consumption. Change of growing medium thickness from 6cm to 8cm causes dramatic increase in energy savings from 2% to 18%. For cooling, it is best to use a growing material with high water retention, due to the importance of evapotranspiration for cooling. Similarly, for increased savings in cooling energy, sufficient irrigation is required. Insufficient irrigation results in the vertical vegetation requiring more energy to cool the building. To conclude, the choice of design parameters for vertical vegetation is crucial in making sure that it contributes to energy savings rather than energy consumption. Optimal design decisions can create a dramatic sustainability enhancement for the built environment in subtropical climates.

Adaptive subcarrier allocation in multiuser OFDM system using forced cost based decisions

Subcarrier allocation scheme for Orthogonal Frequency Division Multiplexing(OFDM) based multiuser system is proposed. Most previous algorithms use greedy approach as a subcarrier allocation scheme until a conflict occurs or as an initial first round allocation with improvement steps carried out in next rounds. Our algorithm uses information obtained by the forced costs of a system that incur by a current allocation to make assignment decisions. This algorithm does not rely on greedy approach and therefore can also be considered as a substitute for first layer Greedy algorithms. Simulation results show that for two user case this algorithm gives better or equal allocation 80-90 percent of the time when compared with the greedy allocation.

Investigating mothers' decisions about their child's sun-protective behaviour using the Theory of Planned Behaviour

This study tested the utility of the Theory of Planned Behaviour (TPB) to predict mothers’ decisions to ensure their child engages in sun-protective behaviours. Mothers (N = 162) of children aged four or five years completed standard TPB items (attitude, subjective norm, perceived behavioural control, intention) and additional variables of role construction, mothers’ own sun safe behaviour, planning and past behaviour. One week later, participants (N = 116) reported their behaviour. Results found support for the TPB constructs, role construction, past behaviour and the mediating role of planning. These findings can inform strategies to prevent skin cancer.

Resource allocation in multiuser cooperative OFDM system using forced cost based decisions

A sub optimal resource allocation algorithm for Orthogonal Frequency Division Multiplexing (OFDM) based cooperative scheme is proposed. The system consists of multiple relays. Subcarrier space is divided into blocks and relays participating in cooperation are allocated specific blocks to be used with a user. To ensure unique subcarrier assignment system is constrained such that same block cannot be used by more than one user. Users are given fair block assignments while no restriction for maximum number of blocks a relay can employ is given. Forced cost based decisions [1] are used for block allocation. Simulation results show that this scheme outperforms a non cooperating scheme with sequential allocation with respect to power usage.

Daylighting performance of subtropical multi-residential towers : simulations tools for design decisions

During an intensive design-led workshop multidisciplinary design teams examined options for a sustainable multi-residential tower on an inner urban site in Brisbane (Australia). The main aim was to demonstrate the key principles of daylight to every habitable room and cross-ventilation to every apartment in the subtropical climate while responding to acceptable yield and price points. The four conceptual design proposals demonstrated a wide range of outcomes, with buildings ranging from 15 to 30 storeys. Daylight Factor (DF), view to the outside, and the avoidance of direct sunlight were the only quantitative and qualitative performance metrics used to implement daylighting to the proposed buildings during the charrette. This paper further assesses the daylighting performance of the four conceptual designs by utilizing Climate-based daylight modeling (CBDM), specifically Daylight Autonomy (DA) and Useful Daylight Illuminance (UDI). Results show that UDI 100-2000lux calculations provide more useful information on the daylighting design than DF. The percentage of the space with a UDI <100-2000lux larger than 50% ranged from 77% to 86% of the time for active occupant behaviour (occupancy from 6am to 6pm). The paper also highlights the architectural features that mostly affect daylighting design in subtropical climates.

An integrated approach to supporting land-use decisions in site redevelopment for urban renewal in Hong Kong

Urban renewal is a significant issue in developed urban areas, with a particular problem for urban planners being redevelopment of land to meet demand whilst ensuring compatibility with existing land use. This paper presents a geographic information systems (GIS)-based decision support tool (called LUDS) to quantitatively assess land-use suitability for site redevelopment in urban renewal areas. This consists of a model for the suitability analysis and an affiliated land-information database for residential, commercial, industrial, G/I/C (government/institution/community) and open space land uses. Development has occurred with support from interviews with industry experts, focus group meetings and an experimental trial, combined with several advanced techniques and tools, including GIS data processing and spatial analysis, multi-criterion analysis, as well as the AHP method for constructing the model and database. As demonstrated in the trial, LUDS assists planners in making land-use decisions and supports the planning process in assessing urban land-use suitability for site redevelopment. Moreover, it facilitates public consultation (participatory planning) by providing stakeholders with an explicit understanding of planners' views.

Heart beats and economic decisions : Observing mental stress in the ultimatum bargaining game

One aim of experimental economics is to try to better understand human economic decision making. Early research of the ultimatum bargaining game (Gueth et al., 1982) revealed that other motives than pure monetary reward play a role. Neuroeconomic research has introduced the recording of physiological observations as signals of emotional responses. In this study, we apply heart rate variability (HRV) measuring technology to explore the behaviour and physiological reactions of proposers and responders in the ultimatum bargaining game. Since this technology is small and non-intrusive, we are able to run the experiment in a standard experimental economic setup. We show that low o�ers by a proposer cause signs of mental stress in both the proposer and the responder, as both exhibit high ratios of low to high frequency activity in the HRV spectrum.

Supporting risk-informed decisions during business process execution

This paper proposes a technique that supports process participants in making risk-informed decisions, with the aim to reduce the process risks. Risk reduction involves decreasing the likelihood and severity of a process fault from occurring. Given a process exposed to risks, e.g. a financial process exposed to a risk of reputation loss, we enact this process and whenever a process participant needs to provide input to the process, e.g. by selecting the next task to execute or by filling out a form, we prompt the participant with the expected risk that a given fault will occur given the particular input. These risks are predicted by traversing decision trees generated from the logs of past process executions and considering process data, involved resources, task durations and contextual information like task frequencies. The approach has been implemented in the YAWL system and its effectiveness evaluated. The results show that the process instances executed in the tests complete with substantially fewer faults and with lower fault severities, when taking into account the recommendations provided by our technique.

Exo1 plays a major role in DNA end resection in humans and influences double-strand break repair and damage signaling decisions

The resection of DNA double-strand breaks (DSBs) to generate ssDNA tails is a pivotal event in the cellular response to these breaks. In the two-step model of resection, primarily elucidated in yeast, initial resection by Mre11-CtIP is followed by extensive resection by two distinct pathways involving Exo1 or BLM/WRN-Dna2. However, resection pathways and their exact contributions in humans in vivo are not as clearly worked out as in yeast. Here, we examined the contribution of Exo1 to DNA end resection in humans in vivo in response to ionizing radiation (IR) and its relationship with other resection pathways (Mre11-CtIP or BLM/WRN). We find that Exo1 plays a predominant role in resection in human cells along with an alternate pathway dependent on WRN. While Mre11 and CtIP stimulate resection in human cells, they are not absolutely required for this process and Exo1 can function in resection even in the absence of Mre11-CtIP. Interestingly, the recruitment of Exo1 to DNA breaks appears to be inhibited by the NHEJ protein Ku80, and the higher level of resection that occurs upon siRNA-mediated depletion of Ku80 is dependent on Exo1. In addition, Exo1 may be regulated by 53BP1 and Brca1, and the restoration of resection in BRCA1-deficient cells upon depletion of 53BP1 is dependent on Exo1. Finally, we find that Exo1-mediated resection facilitates a transition from ATM- to ATR-mediated cell cycle checkpoint signaling. Our results identify Exo1 as a key mediator of DNA end resection and DSB repair and damage signaling decisions in human cells.