Excess length of stay due to central line–associated bloodstream infection in intensive care units in Argentina, Brazil, and Mexico

Objective.To estimate the excess length of stay in an intensive care unit (ICU) due to a central line–associated bloodstream infection (CLABSI), using a multistate model that accounts for the timing of infection. Design.A cohort of 3,560 patients followed up for 36,806 days in ICUs. Setting.Eleven ICUs in 3 Latin American countries: Argentina, Brazil, and Mexico. Patients.All patients admitted to the ICU during a defined time period with a central line in place for more than 24 hours. Results.The average excess length of stay due to a CLABSI increased in 10 of 11 ICUs and varied from −1.23 days to 4.69 days. A reduction in length of stay in Mexico was probably caused by an increased risk of death due to CLABSI, leading to shorter times to death. Adjusting for patient age and Average Severity of Illness Score tended to increase the estimated excess length of stays due to CLABSI. Conclusions.CLABSIs are associated with an excess length of ICU stay. The average excess length of stay varies between ICUs, most likely because of the case‐mix of admissions and differences in the ways that hospitals deal with infections.

Minimising transport disadvantage to support knowledge city formation : applying the capability approach to select indicators

Purpose–The aims of this paper are to demonstrate the application of Sen’s theory of well-being, the capability approach; to conceptualise the state of transportation disadvantage; and to underpin a theoretical sounds indicator selection process. Design/methodology/approach–This paper reviews and examines various measurement approaches of transportation disadvantage in order to select indicators and develop an innovative framework of urban transportation disadvantage. Originality/value–The paper provides further understanding of the state of transportation disadvantage from the capability approach perspective. In addition, building from this understanding, a validated and systematic framework is developed to select relevant indicators. Practical implications –The multi-indicator approach has a high tendency to double count for transportation disadvantage, increase the number of TDA population and only accounts each indicator for its individual effects. Instead, indicators that are identified based on a transportation disadvantage scenario will yield more accurate results. Keywords – transport disadvantage, the capability approach, accessibility, measuring urban transportation disadvantage, indicators selection Paper type – Academic Research Paper

Self-narratives of children : using digital journals

This paper takes the position that children are at risk of being marginalised when research methods are not tailored to their requirements. In particular, children who are negotiating early adolescence are presented as an ideal group for involvement with narrative research approaches that attempt to be flexible and creative. With the premise that the need to juggle multiple realities within complex societal structures is challenging and isolating for such children, narrative methods offer a promising mode of access to their individual realities. Children's own self-narratives in the form of email journal entries are proposed as research tools that can help to minimise issues arising from resistance to adults and problems of shared vocabulary that may occur using more traditional methods. Digital journaling, as a means of capturing self-narratives, can provide a convenient space for young people to generate and share their own personal accounts of their lives and their experiences that can also serve to inform others. Guidelines are offered for how to manage a journaling project that is not reliant on children's physical presence within school settings. Digital journals are thus described as multi-function mechanisms that can support personal growth as well as promote shared understandings and social fairness between adults and children.

Toward a cultural economic geography of creative industries and urban development : introduction to the special issue on creative industries and urban development

The connections between the development of creative industries and the growth of cities was noted by several sources over the 2000s, but explanations relating to the nature of the link have thus far provide to be insufficient. The two dominant ‘scripts’ were those of ‘creative clusters’ and ‘creative/cities/creative class’ theories, but both have proved to be insufficient, not least because they privilege amenities-led, supply-drive accounts of urban development that fail to adequately situate cities in wider global circuits of culture and economic production. It is proposed that the emergent field of cultural economic geography provides some insights into redressing these lacunae, particularly in the possibilities for an original synthesis of cultural and economic geography, cultural studies and new strands of economic theory.

Robust multidisciplinary design optimisation using CFD and advanced evolutionary algorithms

Computation Fluid Dynamics (CFD) has become an important tool in optimization and has seen successful in many real world applications. Most important among these is in the optimisation of aerodynamic surfaces which has become Multi-Objective (MO) and Multidisciplinary (MDO) in nature. Most of these have been carried out for a given set of input parameters such as free stream Mach number and angle of attack. One cannot ignore the fact that in aerospace engineering one frequently deals with situations where the design input parameters and flight/flow conditions have some amount of uncertainty attached to them. When the optimisation is carried out for fixed values of design variables and parameters however, one arrives at an optimised solution that results in good performance at design condition but poor drag or lift to drag ratio at slightly off-design conditions. The challenge is still to develop a robust design that accounts for uncertainty in the design in aerospace applications. In this paper this issue is taken up and an attempt is made to prevent the fluctuation of objective performance by using robust design technique or Uncertainty.

Prospective, non-randomized phase 2 clinical trial of carboplatin plus paclitaxel with sequential radical pelvic radiotherapy for uterine papillary serous carcinoma

Objective Uterine Papillary Serous Carcinoma (UPSC) is uncommon and accounts for less than 5% of all uterine cancers. Therefore the majority of evidence about the benefits of adjuvant treatment comes from retrospective case series. We conducted a prospective multi-centre non-randomized phase 2 clinical trial using four cycles of adjuvant paclitaxel plus carboplatin chemotherapy followed by pelvic radiotherapy, in order to evaluate the tolerability and safety of this approach. Methods This trial enrolled patients with newly diagnosed, previously untreated patients with stage 1b-4 (FIGO-1988) UPSC with a papillary serous component of at least 30%. Paclitaxel (175 mg/m2) and carboplatin (AUC 6) were administered on day 1 of each 3-week cycle for 4 cycles. Chemotherapy was followed by external beam radiotherapy to the whole pelvis (50.4 Gy over 5.5 weeks). Completion and toxicity of treatment (Common Toxicity Criteria, CTC) and quality of life measures were the primary outcome indicators. Results Twenty-nine of 31 patients completed treatment as planned. Dose reduction was needed in 9 patients (29%), treatment delay in 7 (23%), and treatment cessation in 2 patients (6.5%). Hematologic toxicity, grade 3 or 4 occurred in 19% (6/31) of patients. Patients' self-reported quality of life remained stable throughout treatment. Thirteen of the 29 patients with stages 1–3 disease (44.8%) recurred (average follow up 28.1 months, range 8–60 months). Conclusion This multimodal treatment is feasible, safe and tolerated reasonably well and would be suitable for use in multi-institutional prospective randomized clinical trials incorporating novel therapies in patients with UPSC.

Media Economics

A concise introduction to the key ideas and issues in the study of media economics, drawing on a broad range of case studies - from Amazon and Twitter, to Apple and Netflix - to illustrate how economic paradigms are not just theories, but provide important practical insights into how the media operates today. Understanding the economic paradigms at work in media industries and markets is vitally important for the analysis of the media system as a whole. The changing dynamics of media production, distribution and consumption are stretching the capacity of established economic paradigms. In addition to succinct accounts of neo-classical and critical political economics, the text offers fresh perspectives for understanding media drawn from two 'heterodox' approaches: institutional economics and evolutionary economics. Applying these paradigms to vital topics and case studies, Media Economics stresses the value – and limits – of contending economic approaches in understanding how the media operates today. It is essential reading for all students of Media and Communication Studies, and also those from Economics, Policy Studies, Business Studies and Marketing backgrounds who are studying the media. Table of Contents: 1. Media Economics: The Mainstream Approach 2. Critical Political Economy of the Media 3. Institutional Economics 4. Evolutionary Economics 5. Case Studies and Conclusions

Time-dependent analysis of length of stay and mortality due urinary tract infections in ten developing countries : INICC findings

Catheter associated urinary tract infections (CAUTI) are a worldwide problem that may lead to increased patient morbidity, cost and mortality.1e3 The literature is divided on whether there are real effects from CAUTI on length of stay or mortality. Platt4 found the costs and mortality risks to be largeyetGraves et al found the opposite.5 A reviewof the published estimates of the extra length of stay showed results between zero and 30 days.6 The differences in estimates may have been caused by the different epidemiological methods applied. Accurately estimating the effects of CAUTI is difficult because it is a time-dependent exposure. This means that standard statistical techniques, such asmatched case-control studies, tend to overestimate the increased hospital stay and mortality risk due to infection. The aim of the study was to estimate excess length of stay andmortality in an intensive care unit (ICU) due to a CAUTI, using a statistical model that accounts for the timing of infection. Data collected from ICU units in lower and middle income countries were used for this analysis.7,8 There has been little research for these settings, hence the need for this paper.

The critical meets the cultural : International students’ responses to critical, dialogic postgraduate education in a Western university

What happens when international students encounter critical, dialogic approaches to postgraduate education in a Western university? This chapter works with the narrative accounts of two students from Asian countries about their varied experiences of and responses to critically-oriented, interactive, English-medium study in a Master of Education course in Australia. Beginning from researcher standpoint, it tables the students’ stories of cultural, academic, linguistic and personal border crossings, and their ‘readings’ of course demands prioritising critical analysis, dialogic exchange and problem-solving. Their responses raise ongoing, unresolved epistemological and experiential issues about the cross-cultural and transnational relevance and value of Western/Eurocentric ‘critical’ education.

Mathematical modelling of chronic wound healing

Chronicwounds fail to proceed through an orderly process to produce anatomic and functional integrity and are a significant socioeconomic problem. There is much debate about the best way to treat these wounds. In this thesis we review earlier mathematical models of angiogenesis and wound healing. Many of these models assume a chemotactic response of endothelial cells, the primary cell type involved in angiogenesis. Modelling this chemotactic response leads to a system of advection-dominated partial differential equations and we review numerical methods to solve these equations and argue that the finite volume method with flux limiting is best-suited to these problems. One treatment of chronic wounds that is shrouded with controversy is hyperbaric oxygen therapy (HBOT). There is currently no conclusive data showing that HBOT can assist chronic wound healing, but there has been some clinical success. In this thesis we use several mathematical models of wound healing to investigate the use of hyperbaric oxygen therapy to assist the healing process - a novel threespecies model and a more complex six-species model. The second model accounts formore of the biological phenomena but does not lend itself tomathematical analysis. Bothmodels are then used tomake predictions about the efficacy of hyperbaric oxygen therapy and the optimal treatment protocol. Based on our modelling, we are able to make several predictions including that intermittent HBOT will assist chronic wound healing while normobaric oxygen is ineffective in treating such wounds, treatment should continue until healing is complete and finding the right protocol for an individual patient is crucial if HBOT is to be effective. Analysis of the models allows us to derive constraints for the range of HBOT protocols that will stimulate healing, which enables us to predict which patients are more likely to have a positive response to HBOT and thus has the potential to assist in improving both the success rate and thus the cost-effectiveness of this therapy.

Even Penelope had a plan : imagining a metaphysics of wandering in the contemporary travel blogs of Australian Women Abroad

Despite the continued popularity of travel blogs and virtual travel communities, there is currently a lack of contemporary criticism surrounding the coded structures and connotations of online travel writings, especially those arising out of the Australian context. While there have been few significant studies of Australian women’s travel to date, there have been even less about female wandering. Reimagining the archetype of Penelope, this paper considers liminal accounts of wandering in contemporary travel blogs of Australian women abroad. When women travel as wanderers, they undermine normative accounts of travel and trace out alternative movements fused with gendered meaning.

A Bayesian approach for place recognition

This paper presents a robust place recognition algorithm for mobile robots. The framework proposed combines nonlinear dimensionality reduction, nonlinear regression under noise, and variational Bayesian learning to create consistent probabilistic representations of places from images. These generative models are learnt from a few images and used for multi-class place recognition where classification is computed from a set of feature-vectors. Recognition can be performed in near real-time and accounts for complexity such as changes in illumination, occlusions and blurring. The algorithm was tested with a mobile robot in indoor and outdoor environments with sequences of 1579 and 3820 images respectively. This framework has several potential applications such as map building, autonomous navigation, search-rescue tasks and context recognition.

Ethical fashion : the human stories driving a fashion movement

This paper examines and compares two stories, the novel Helen Fleetwood (Elizabeth, 1841) and the film China Blue (Teddy Bear Films, 2005), in relation to the Ethical Fashion movement. In 2005, more than 50 designers from around the world took part in The Ethical Fashion Show in Paris. This movement dictates that designers ensure that their garments are produced in an ethical manner, rather than support the ‘sweatshop’ environments of some industrialists determined to make a profit at the expense of workers rights. The momentum of the Ethical Fashion movement suggests that it is possible for fashion to be ethical, desirable and profitable in the 21st century. In 1841, after extensive research, Charlotte Elizabeth Tonna (using the pseudonym Charlotte Elizabeth) began to write about the atrocities of the factory system in industrialised England. Her novel, Helen Fleetwood, is one of the earliest examples of this kind of work, providing the reader with an extensive insight into the life of English factory workers in the mid-19th century. The story is about the Widow Green and her orphan dependents who are led, through circumstance, to leave their rural home and take up employment in the cotton mills of Manchester, with the hope of having an independent existence. Instead they discover the realities of factory life – extremely long hours, unsafe conditions, poor wages and a steady decline into extreme poverty. In his film China Blue (Teddy Bear Films, 2005), director Micha X. Peled tells an alarmingly similar tale set in 21st century China. This ‘docu-drama’ (a recreation from actual interviews and diary entries) tells the story of ‘Little Jasmine’ who leaves her family’s farm to pursue an independent life in Southern China’s manufacturing district. It is not long before the realities of modern factory life are revealed to the teenage ‘heroine’ – crowded dormitories, long working hours, arbitrary fines and wages that do not compare with those of workers in the Western world. While much of the human story remains unchanged, there have been significant improvements in technology and safety in the last 165 years that result in the reality that not all clothing manufacture is performed in ‘sweatshop’ conditions. After a recent visit to a manufacturing plant in China, consultation with peers in the industry and having worked in the Australian fashion industry for many years, the author compares these stories with her own experiences.

'The black hole of our history' : a conversation with Louis Nowra

This is an edited version of an interview recorded for Canadian Theatre Review in 1992. By that time Nowra had established a reputation as one of Australia's foremost playwrights. Part of the generation which succeeded the New Wave of the late 1960s and early 1970s, Nowra became known for a stylistic inventiveness which placed him outside the tradition of realist playwriting in Australia. The international outlook in his early plays, and the fact that he was not exclusively preoccupied with Australian settings and subject matter, was often a focal point in critical accounts of his work. In this interview Nowra discusses his 'internationalism', and a range of topics including the playwriting process; the presence of landscape in his plays; and the autobiographical elements in his work.

Listening in to others : in between noise and silence

Since the launch of the ‘Clean Delhi, Green Delhi’ campaign in 2003, slums have become a significant social and political issue in India’s capital city. Through this campaign, the state, in collaboration with Delhi’s middle class through the ‘Bhagidari system’ (literally translated as ‘participatory system’), aims to transform Delhi into a ‘world-class city’ that offers a sanitised, aesthetically appealing urban experience to its citizens and Western visitors. In 2007, Delhi won the bid to host the 2010 Commonwealth Games; since then, this agenda has acquired an urgent, almost violent, impetus to transform Delhi into an environmentally friendly, aesthetically appealing and ‘truly international city’. Slums and slum-dwellers, with their ‘filth, dirt, and noise’, have no place in this imagined city. The violence inflicted upon slum-dwellers, including the denial of their judicial rights, is justified on these accounts. In addition, the juridical discourse since 2000 has ‘re-problematised slums as ‘nuisance’. The rising antagonism of the middle-classes against the poor, supported by the state’s ambition to have a ‘world-class city’, has allowed a new rhetoric to situate the slums in the city. These representations articulate slums as homogenised spaces of experience and identity. The ‘illegal’ status of slum-dwellers, as encroachers upon public space, is stretched to involve ‘social, cultural, and moral’ decadence and depravity. This thesis is an ethnographic exploration of everyday life in a prominent slum settlement in Delhi. It sensually examines the social, cultural and political materiality of slums, and the relationship of slums with the middle class. In doing so, it highlights the politics of sensorial ordering of slums as ‘filthy, dirty, and noisy’ by the middle classes to calcify their position as ‘others’ in order to further segregate, exclude and discriminate the slums. The ethnographic experience in the slums, however, highlights a complex sensorial ordering and politics of its own. Not only are the interactions between diverse communities in slums highly restricted and sensually ordained, but the middle class is identified as a sensual ‘other’, and its sensual practices prohibited. This is significant in two ways. First, it highlights the multiplicity of social, cultural experience and engagement in the slums, thereby challenging its homogenised representation. Second, the ethnographic exploration allowed me to frame a distinct sense of self amongst the slums, which is denied in mainstream discourses, and allowed me to identify the slums’ own ’others’, middle class being one of them. This thesis highlights sound – its production, performances and articulations – as an act with social, cultural, and political implications and manifestations. ‘Noise’ can be understood as a political construct to identify ‘others’ – and both slum-dwellers and the middle classes identify different sonic practices as noise to situate the ‘other’ sonically. It is within this context that this thesis frames the position of Listener and Hearer, which corresponds to their social-political positions. These positions can be, and are, resisted and circumvented through sonic practices. For instance, amplification tactics in the Karimnagar slums, which are understood as ‘uncultured, callous activities to just create more noise’ by the slums’ middle-class neighbours, also serve definite purposes in shaping and navigating the space through the slums’ soundscapes, asserting a presence that is otherwise denied. Such tactics allow the residents to define their sonic territories and scope of sonic performances; they are significant in terms of exerting one’s position, territory and identity, and they are very important in subverting hierarchies. The residents of the Karimnagar slums have to negotiate many social, cultural, moral and political prejudices in their everyday lives. Their identity is constantly under scrutiny and threat. However, the sonic cultures and practices in the Karimnagar slums allow their residents to exert a definite sonic presence – which the middle class has to hear. The articulation of noise and silence is an act manifesting, referencing and resisting social, cultural, and political power and hierarchies.