Diabetes mellitus in South Asia : scientific evaluation of the research output

BACKGROUND: Diabetes in South Asia represents a different disease entity in terms of its onset, progression, and complications. In the present study, we systematically analyzed the medical research output on diabetes in South Asia. METHODS: The online SciVerse Scopus database was searched using the search terms "diabetes" and "diabetes mellitus" in the article Title, Abstract or Keywords fields, in conjunction with the names of each regional country in the Author Affiliation field. RESULTS: In total, 8478 research articles were identified. Most were from India (85.1%) and Pakistan (9.6%) and the contribution to the global diabetes research output was 2.1%. Publications from South Asia increased markedly after 2007, with 58.7% of papers published between 2000 and 2010 being published after 2007. Most papers were Research Articles (75.9%) and Reviews (12.9%), with only 90 (1.1%) clinical trials. Publications predominantly appeared in local national journals. Indian authors and institutions had the most number of articles and the highest h-index. There were 136 (1.6%) intraregional collaborative studies. Only 39 articles (0.46%) had >100 citations. CONCLUSIONS: Regional research output on diabetes mellitus is unsatisfactory, with only a minimal contribution to global diabetes research. Publications are not highly cited and only a few randomized controlled trials have been performed. In the coming decades, scientists in the region must collaborate and focus on practical and culturally acceptable interventional studies on diabetes mellitus.

The impact on clinical practice of a postgraduate clinical pharmacy programme, incorporating competency-based performance evaluation

Background A goal of the postgraduate clinical pharmacy programme (PGCPP) at the University of Queensland is to enhance clinical practice. Aims To evaluate student perceptions of the impact of the PGCPP on practice and the inclusion of a competency-based performance evaluation as a formative component of the curriculum. Method In 2010, students completed a questionnaire to evaluate the impact of the PGCPP. In 2011, formative competency-based performance evaluations were conducted as a component of the course and the questionnaire was repeated. Responses, competency ratings and evaluation feedback were collated. Data were analysed using descriptive statistics. Results 51/57 (89%) of students completed the questionnaire in 2010 and 2011. Over 90% of students agreed or strongly agreed that the PGCPP enhanced practice, knowledge, confidence and contribution to patient care. Responses were similarly positive after the inclusion of the performance evaluation. Conclusion This study demonstrated that the PGCPP is achieving the goal of enhancing the practice of pharmacists.

Cross-cultural web user interface design for Indigenous internet users

This project investigated 1) Australian web designers’ cultural perceptions towards Australian Indigenous users and 2) Australian Indigenous cultural features in terms of user interface design. In doing so, it reviews the literature of cross-cultural user interface design by focusing on feasible models and arguments to articulate and integrate Australian Indigenous Internet users’ cultural needs of web user interface. The online survey results collected from 101 Indigenous users and 126 Web designers showed a distinctive difference between them on the integration of Indigenous users' cultural in Web sites. The interview data collected from 14 Indigenous users and 14 web designers suggested practical approaches to the design implications of Indigenous culture.

An evaluation of medication review reports across different settings

Background There is a growing body of evidence which supports that a pharmacist conducted medication review increases the health outcomes for patients. A pharmacist integrated into a primary care medical centre may offer many potential advantages in conducting medication reviews in this setting however research describing this is presently limited. Objective To compare medication review reports conducted by pharmacists practicing externally to a medical centre to those medication review reports conducted by an integrated practice pharmacist. The secondary objective was to compare medication review reports conducted by pharmacists in the patient’s home to those conducted in the medical centre. Setting A primary care medical centre, Brisbane, Australia Method A retrospective analysis of pharmacist conducted medication reviews prior to and after the integration of a pharmacist into a medical centre. Main outcome measures Types of drug related problems identified by the Pharma cists, recommended intervention for drug related problems made by the pharmacist, and the extent of implementation of pharmacist recommendations by the general practitioner. Results The primary drug related problem reported in the practice pharmacist phase was Additional therapy required as compared to Precautions in the external pharmacist phase. The practice pharmacist most frequently recommended to add drug with Additional monitoring recommended most often in the external pharmacists. During the practice pharmacist phase 71 % of recommendations were implemented and was significantly higher than the external pharmacist phase with 53 % of recommendations implemented (p\0.0001). Two of the 23 drug related problem domains differed significantly when comparing medication reviews conducted in the patient’s home to those conducted in the medical centre.

Evaluation of MegaVoltage Cone Beam CT image quality with an unmodified Elekta Precise Linac and EPID : a feasibility study

In order to increase the accuracy of patient positioning for complex radiotherapy treatments various 3D imaging techniques have been developed. MegaVoltage Cone Beam CT (MVCBCT) can utilise existing hardware to implement a 3D imaging modality to aid patient positioning. MVCBCT has been investigated using an unmodified Elekta Precise linac and 15 iView amorphous silicon electronic portal imaging device (EPID). Two methods of delivery and acquisition have been investigated for imaging an anthropomorphic head phantom and quality assurance phantom. Phantom projections were successfully acquired and CT datasets reconstructed using both acquisition methods. Bone, tissue and air were 20 clearly resolvable in both phantoms even with low dose (22 MU) scans. The feasibility of MegaVoltage Cone beam CT was investigated using a standard linac, amorphous silicon EPID and a combination of a free open source reconstruction toolkit as well as custom in-house software written in Matlab. The resultant image quality has 25 been assessed and presented. Although bone, tissue and air were resolvable 2 in all scans, artifacts are present and scan doses are increased when compared with standard portal imaging. The feasibility of MVCBCT with unmodified Elekta Precise linac and EPID has been considered as well as the identification of possible areas for future development in artifact correction techniques to 30 further improve image quality.

The Implications of Activity Based Funding for Emergency Departments : A Comprehensive Literature Review

Executive Summary Emergency Departments (EDs) locally, nationally and internationally are becoming increasingly busy. Within this context, it can be challenging to deliver a health service that is safe, of high quality and cost-effective. Whilst various models are described within the literature that aim to measure ED ‘work’ or ‘activity’, they are often not linked to a measure of costs to provide such activity. It is important for hospital and ED managers to understand and apply this link so that optimal staffing and financial resourcing can be justifiably sought. This research is timely given that Australia has moved towards a national Activity Based Funding (ABF) model for ED activity. ABF is believed to increase transparency of care and fairness (i.e. equal work receives equal pay). ABF involves a person-, performance- or activity-based payment system, and thus a move away from historical “block payment” models that do not incentivise efficiency and quality. The aim of the Statewide Workforce and Activity-Based Funding Modelling Project in Queensland Emergency Departments (SWAMPED) is to identify and describe best practice Emergency Department (ED) workforce models within the current context of ED funding that operates under an ABF model. The study is comprised of five distinct phases. This monograph (Phase 1) comprises a systematic review of the literature that was completed in June 2013. The remaining phases include a detailed survey of Queensland hospital EDs’ resource levels, activity and operational models of care, development of new resource models, development of a user-friendly modelling interface for ED mangers, and production of a final report that identifies policy implications. The anticipated deliverable outcome of this research is the development of an ABF based Emergency Workforce Modelling Tool that will enable ED managers to profile both their workforce and operational models of care. Additionally, the tool will assist with the ability to more accurately inform adequate staffing numbers required in the future, inform planning of expected expenditures and be used for standardisation and benchmarking across similar EDs. Summary of the Findings Within the remit of this review of the literature, the main findings include: 1. EDs are becoming busier and more congested Rising demand, barriers to ED throughput and transitions of care all contribute to ED congestion. In addition requests by organisational managers and the community require continued broadening of the scope of services required of the ED and further increases in demand. As the population live longer with more lifestyle diseases their propensity to require ED care continues to grow. 2. Various models of care within EDs exist Models often vary to account for site specific characteritics to suit staffing profile, ED geographical location (e.g. metropolitan or rural site), and patient demographic profile (e.g. paediatrics, older persons, ethnicity). Existing and new models implemented within EDs often depend on the target outcome requiring change. Generally this is focussed on addressing issues at the input, throughput or output areas of the ED. Even with models targeting similar demographic or illness, the structure and process elements underpinning the model can vary, which can impact on outcomes and variance to the patient and carer experience between and within EDs. Major models of care to manage throughput inefficiencies include: A. Workforce Models of Care focus on the appropriate level of staffing for a given workload to provide prompt, timely and clinically effective patient care within an emergency care setting. The studies reviewed suggest that the early involvement of senior medical decision maker and/or specialised nursing roles such as Emergency Nurse Practitioners and Clinical Initiatives Nurse, primary contact or extended scope Allied Health Practitioners can facilitate patient flow and improve key indicators such as length of stay and reducing the number of those who did not wait to be seen amongst others. B. Operational Models of Care within EDs focus on mechanisms for streaming (e.g. fast-tracking) or otherwise grouping patient care based on acuity and complexity to assist with minimising any throughput inefficiencies. While studies support the positive impact of these models in general, it appears that they are most effective when they are adequately resourced. 3. Various methods of measuring ED activity exist Measuring ED activity requires careful consideration of models of care and staffing profile. Measuring activity requires the ability to account for factors including: patient census, acuity, LOS, intensity of intervention, department skill-mix plus an adjustment for non-patient care time. 4. Gaps in the literature Continued ED growth calls for new and innovative care delivery models that are safe, clinically effective and cost effective. New roles and stand-alone service delivery models are often evaluated in isolation without considering the global and economic impact on staffing profiles. Whilst various models of accounting for and measuring health care activity exist, costing studies and cost effectiveness studies are lacking for EDs making accurate and reliable assessments of care models difficult. There is a necessity to further understand, refine and account for measures of ED complexity that define a workload upon which resources and appropriate staffing determinations can be made into the future. There is also a need for continued monitoring and comprehensive evaluation of newly implemented workforce modelling tools. This research acknowledges those gaps and aims to: • Undertake a comprehensive and integrated whole of department workforce profiling exercise relative to resources in the context of ABF. • Inform workforce requirements based on traditional quantitative markers (e.g. volume and acuity) combined with qualitative elements of ED models of care; • Develop a comprehensive and validated workforce calculation tool that can be used to better inform or at least guide workforce requirements in a more transparent manner.

Mining specific features for acquiring user information needs

Term-based approaches can extract many features in text documents, but most include noise. Many popular text-mining strategies have been adapted to reduce noisy information from extracted features; however, text-mining techniques suffer from low frequency. The key issue is how to discover relevance features in text documents to fulfil user information needs. To address this issue, we propose a new method to extract specific features from user relevance feedback. The proposed approach includes two stages. The first stage extracts topics (or patterns) from text documents to focus on interesting topics. In the second stage, topics are deployed to lower level terms to address the low-frequency problem and find specific terms. The specific terms are determined based on their appearances in relevance feedback and their distribution in topics or high-level patterns. We test our proposed method with extensive experiments in the Reuters Corpus Volume 1 dataset and TREC topics. Results show that our proposed approach significantly outperforms the state-of-the-art models.

Experimental evaluation of an autonomous surface vehicle for water quality and greenhouse gas emission monitoring

This paper describes the experimental evaluation of a novel Autonomous Surface Vehicle capable of navigating complex inland water reservoirs and measuring a range of water quality properties and greenhouse gas emissions. The 16 ft long solar powered catamaran is capable of collecting water column profiles whilst in motion. It is also directly integrated with a reservoir scale floating sensor network to allow remote mission uploads, data download and adaptive sampling strategies. This paper describes the onboard vehicle navigation and control algorithms as well as obstacle avoidance strategies. Experimental results are shown demonstrating its ability to maintain track and avoid obstacles on a variety of large-scale missions and under differing weather conditions, as well as its ability to continuously collect various water quality parameters complimenting traditional manual monitoring campaigns.

Statutory right of user - its impact in practice?

Scenario 1 A buys a two storey commercial building built along the only street frontage to the property. Vehicles cannot reach the rear of the property as the building extends across the entire width of the land. A bought the building with full knowledge that vehicular access to the rest of the property had been compromised by a desire to obtain maximum street frontage for the building which was occupied by a commercial tenant. On street parking is scarce in the surrounding area. A (to the knowledge of the adjoining owner B) constructs a carpark at the rear of the building. The employees of A’s tenant have been using the carpark obtaining access via a driveway on B’s land. To formalise this arrangement, A seeks a right of way for vehicles to travel down B’s driveway to access the carpark...

Retrospective evaluation of dosimetric quality for prostate carcinomas treated with 3D conformal, intensity-modulated and volumetric-modulated arc radiotherapy

Introduction This study examines and compares the dosimetric quality of radiotherapy treatment plans for prostate carcinoma across a cohort of 163 patients treated across 5 centres: 83 treated with three-dimensional conformal radiotherapy (3DCRT), 33 treated with intensity-modulated radiotherapy (IMRT) and 47 treated with volumetric-modulated arc therapy (VMAT). Methods Treatment plan quality was evaluated in terms of target dose homogeneity and organ-at-risk sparing, through the use of a set of dose metrics. These included the mean, maximum and minimum doses; the homogeneity and conformity indices for the target volumes; and a selection of dose coverage values that were relevant to each organ-at-risk. Statistical significance was evaluated using two-tailed Welch’s T-tests. The Monte Carlo DICOM ToolKit software was adapted to permit the evaluation of dose metrics from DICOM data exported from a commercial radiotherapy treatment planning system. Results The 3DCRT treatment plans offered greater planning target volume dose homogeneity than the other two treatment modalities. The IMRT and VMAT plans offered greater dose reduction in the organs-at-risk: with increased compliance with recommended organ-at-risk dose constraints, compared to conventional 3DCRT treatments. When compared to each other, IMRT and VMAT did not provide significantly different treatment plan quality for like-sized tumour volumes. Conclusions This study indicates that IMRT and VMAT have provided similar dosimetric quality, which is superior to the dosimetric quality achieved with 3DCRT.

HPAKE : Password authentication secure against cross-site user impersonation

We propose a new kind of asymmetric mutual authentication from passwords with stronger privacy against malicious servers, lest they be tempted to engage in “cross-site user impersonation” to each other. It enables a person to authenticate (with) arbitrarily many independent servers, over adversarial channels, using a memorable and reusable single short password. Beside the usual PAKE security guarantees, our framework goes to lengths to secure the password against brute-force cracking from privileged server information.

Constructing the Architext : Georges Perec's life a user's manual

Mitchell critiques Georges Perec's Life a User's Manual, which articulates compellingly the confluence of literature and architecture studies that emerged in the late twentieth century. He argues the Perec's novel diverges from this tradition, for, rather than being a search for origins and true expression, Life a User's Manual denies the very possibility of originality. He adds that Perec's architext is de-constructive and ironic.

Document ranking with quantum probabilities

In this thesis we investigate the use of quantum probability theory for ranking documents. Quantum probability theory is used to estimate the probability of relevance of a document given a user's query. We posit that quantum probability theory can lead to a better estimation of the probability of a document being relevant to a user's query than the common approach, i. e. the Probability Ranking Principle (PRP), which is based upon Kolmogorovian probability theory. Following our hypothesis, we formulate an analogy between the document retrieval scenario and a physical scenario, that of the double slit experiment. Through the analogy, we propose a novel ranking approach, the quantum probability ranking principle (qPRP). Key to our proposal is the presence of quantum interference. Mathematically, this is the statistical deviation between empirical observations and expected values predicted by the Kolmogorovian rule of additivity of probabilities of disjoint events in configurations such that of the double slit experiment. We propose an interpretation of quantum interference in the document ranking scenario, and examine how quantum interference can be effectively estimated for document retrieval. To validate our proposal and to gain more insights about approaches for document ranking, we (1) analyse PRP, qPRP and other ranking approaches, exposing the assumptions underlying their ranking criteria and formulating the conditions for the optimality of the two ranking principles, (2) empirically compare three ranking principles (i. e. PRP, interactive PRP, and qPRP) and two state-of-the-art ranking strategies in two retrieval scenarios, those of ad-hoc retrieval and diversity retrieval, (3) analytically contrast the ranking criteria of the examined approaches, exposing similarities and differences, (4) study the ranking behaviours of approaches alternative to PRP in terms of the kinematics they impose on relevant documents, i. e. by considering the extent and direction of the movements of relevant documents across the ranking recorded when comparing PRP against its alternatives. Our findings show that the effectiveness of the examined ranking approaches strongly depends upon the evaluation context. In the traditional evaluation context of ad-hoc retrieval, PRP is empirically shown to be better or comparable to alternative ranking approaches. However, when we turn to examine evaluation contexts that account for interdependent document relevance (i. e. when the relevance of a document is assessed also with respect to other retrieved documents, as it is the case in the diversity retrieval scenario) then the use of quantum probability theory and thus of qPRP is shown to improve retrieval and ranking effectiveness over the traditional PRP and alternative ranking strategies, such as Maximal Marginal Relevance, Portfolio theory, and Interactive PRP. This work represents a significant step forward regarding the use of quantum theory in information retrieval. It demonstrates in fact that the application of quantum theory to problems within information retrieval can lead to improvements both in modelling power and retrieval effectiveness, allowing the constructions of models that capture the complexity of information retrieval situations. Furthermore, the thesis opens up a number of lines for future research. These include: (1) investigating estimations and approximations of quantum interference in qPRP; (2) exploiting complex numbers for the representation of documents and queries, and; (3) applying the concepts underlying qPRP to tasks other than document ranking.

Creation of a new evaluation benchmark for information retrieval targeting patient information needs

Searching for health advice on the web is becoming increasingly common. Because of the great importance of this activity for patients and clinicians and the effect that incorrect information may have on health outcomes, it is critical to present relevant and valuable information to a searcher. Previous evaluation campaigns on health information retrieval (IR) have provided benchmarks that have been widely used to improve health IR and record these improvements. However, in general these benchmarks have targeted the specialised information needs of physicians and other healthcare workers. In this paper, we describe the development of a new collection for evaluation of effectiveness in IR seeking to satisfy the health information needs of patients. Our methodology features a novel way to create statements of patients’ information needs using realistic short queries associated with patient discharge summaries, which provide details of patient disorders. We adopt a scenario where the patient then creates a query to seek information relating to these disorders. Thus, discharge summaries provide us with a means to create contextually driven search statements, since they may include details on the stage of the disease, family history etc. The collection will be used for the first time as part of the ShARe/-CLEF 2013 eHealth Evaluation Lab, which focuses on natural language processing and IR for clinical care.