A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study

Background: Patients with chest pain contribute substantially to emergency department attendances, lengthy hospital stay, and inpatient admissions. A reliable, reproducible, and fast process to identify patients presenting with chest pain who have a low short-term risk of a major adverse cardiac event is needed to facilitate early discharge. We aimed to prospectively validate the safety of a predefined 2-h accelerated diagnostic protocol (ADP) to assess patients presenting to the emergency department with chest pain symptoms suggestive of acute coronary syndrome. Methods: This observational study was undertaken in 14 emergency departments in nine countries in the Asia-Pacific region, in patients aged 18 years and older with at least 5 min of chest pain. The ADP included use of a structured pre-test probability scoring method (Thrombolysis in Myocardial Infarction [TIMI] score), electrocardiograph, and point-of-care biomarker panel of troponin, creatine kinase MB, and myoglobin. The primary endpoint was major adverse cardiac events within 30 days after initial presentation (including initial hospital attendance). This trial is registered with the Australia-New Zealand Clinical Trials Registry, number ACTRN12609000283279. Findings: 3582 consecutive patients were recruited and completed 30-day follow-up. 421 (11•8%) patients had a major adverse cardiac event. The ADP classified 352 (9•8%) patients as low risk and potentially suitable for early discharge. A major adverse cardiac event occurred in three (0•9%) of these patients, giving the ADP a sensitivity of 99•3% (95% CI 97•9–99•8), a negative predictive value of 99•1% (97•3–99•8), and a specificity of 11•0% (10•0–12•2). Interpretation: This novel ADP identifies patients at very low risk of a short-term major adverse cardiac event who might be suitable for early discharge. Such an approach could be used to decrease the overall observation periods and admissions for chest pain. The components needed for the implementation of this strategy are widely available. The ADP has the potential to affect health-service delivery worldwide.

Reduced electron recombination of dye-sensitized solar cells based on TiO 2 spheres consisting of ultrathin nanosheets with [001] facet exposed

An anatase TiO 2 material with hierarchically structured spheres consisting of ultrathin nanosheets with 100% of the [001] facet exposed was employed to fabricate dye-sensitized solar cells (DSC s). Investigation of the electron transport and back reaction of the DSCs by electrochemical impedance spectroscopy showed that the spheres had a threefold lower electron recombination rate compared to the conventional TiO 2 nanoparticles. In contrast, the effective electron diffusion coefficient, D n, was not sensitive to the variation of the TiO 2 morphology. The TiO 2 spheres showed the same Dn as that of the nanoparticles. The influence of TiCl 4 post-treatment on the conduction band of the TiO 2 spheres and on the kinetics of electron transport and back reactions was also investigated. It was found that the TiCl 4 post-treatment caused a downward shift of the TiO 2 conduction band edge by 30 meV. Meanwhile, a fourfold increase of the effective electron lifetime of the DSC was also observed after TiCl4 treatment. The synergistic effect of the variation of the TiO 2 conduction band and the electron recombination determined the open-circuit voltage of the DSC. © 2012 Wang et al.

Computational design of cyclic nitroxides as efficient redox mediators for dye-sensitized solar cells

Cyclic nitroxide radicals represent promising alternatives to the iodine-based redox mediator commonly used in dye-sensitized solar cells (DSSCs). To date DSSCs with nitroxide-based redox mediators have achieved energy conversion efficiencies of just over 5 % but efficiencies of over 15 % might be achievable, given an appropriate mediator. The efficacy of the mediator depends upon two main factors: it must reversibly undergo one-electron oxidation and it must possess an oxidation potential in a range of 0.600-0.850 V (vs. a standard hydrogen electrode (SHE) in acetonitrile at 25 °C). Herein, we have examined the effect that structural modifications have on the value of the oxidation potential of cyclic nitroxides as well as the reversibility of the oxidation process. These included alterations to the N-containing skeleton (pyrrolidine, piperidine, isoindoline, azaphenalene, etc.), as well as the introduction of different substituents (alkyl-, methoxy-, amino-, carboxy-, etc.) to the ring. Standard oxidation potentials were calculated using high-level ab initio methodology that was demonstrated to be very accurate (with a mean absolute deviation from experimental values of only 16 mV). An optimal value of 1.45 for the electrostatic scaling factor for UAKS radii in acetonitrile solution was obtained. Established trends in the values of oxidation potentials were used to guide molecular design of stable nitroxides with desired E° ox and a number of compounds were suggested for potential use as enhanced redox mediators in DSSCs. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

The effect of mill orientation angle on bagasse moisture content

THIS PAPER DESCRIBES an experimental investigation to explore a concept designed to reduce the moisture content of bagasse. It takes advantage of gravity to separate juice from bagasse by feeding bagasse upwards into the nip of the mill while juice drains downwards under gravity. The investigation found that orienting the feed to a mill upwards does reduce bagasse moisture content and that the benefit is expected to be greater than two units of moisture. While an advantage was found in orienting the feed up to 50° above the horizontal, no extra benefit was found in increasing the angle higher (up to 60° was explored) and so a 50° orientation was identified as the preferred angle for this design concept.

Right-angle crash vulnerability of motorcycles at signalized intersections : mixed logit analysis

Motorcycles are particularly vulnerable in right-angle crashes at signalized intersections. The objective of this study is to explore how variations in roadway characteristics, environmental factors, traffic factors, maneuver types, human factors as well as driver demographics influence the right-angle crash vulnerability of motorcycles at intersections. The problem is modeled using a mixed logit model with a binary choice category formulation to differentiate how an at-fault vehicle collides with a not-at-fault motorcycle in comparison to other collision types. The mixed logit formulation allows randomness in the parameters and hence takes into account the underlying heterogeneities potentially inherent in driver behavior, and other unobserved variables. A likelihood ratio test reveals that the mixed logit model is indeed better than the standard logit model. Night time riding shows a positive association with the vulnerability of motorcyclists. Moreover, motorcyclists are particularly vulnerable on single lane roads, on the curb and median lanes of multi-lane roads, and on one-way and two-way road type relative to divided-highway. Drivers who deliberately run red light as well as those who are careless towards motorcyclists especially when making turns at intersections increase the vulnerability of motorcyclists. Drivers appear more restrained when there is a passenger onboard and this has decreased the crash potential with motorcyclists. The presence of red light cameras also significantly decreases right-angle crash vulnerabilities of motorcyclists. The findings of this study would be helpful in developing more targeted countermeasures for traffic enforcement, driver/rider training and/or education, safety awareness programs to reduce the vulnerability of motorcyclists.

Effectiveness of red light cameras on the right-angle crash involvement of motorcycles

Red light cameras (RLC) have been used to reduce right-angle collisions at signalized intersections. However, the effect of RLCs on motorcycle crashes has not been well investigated. The objective of this study is to evaluate the effectiveness of RLCs on motorcycle safety in Singapore. This is done by comparing their exposure, proneness of at-fault right-angle crashes as well as the resulting right-angle collisions at RLC with those at non-RLC sites. Estimating the crash vulnerability from not-at-fault crash involvements, the study shows that with a RLC, the relative crash vulnerability or crash-involved exposure of motorcycles at right-angle crashes is reduced. Furthermore, field investigation of motorcycle maneuvers reveal that at non-RLC arms, motorcyclists usually queue beyond the stop-line, facilitating an earlier discharge and hence become more exposed to the conflicting stream. However at arms with a RLC, motorcyclists are more restrained to avoid activating the RLC and hence become less exposed to conflicting traffic during the initial period of the green. The study also shows that in right-angle collisions, the proneness of at-fault crashes of motorcycles is lowest among all vehicle types. Hence motorcycles are more likely to be victims than the responsible parties in right-angle crashes. RLCs have also been found to be very effective in reducing at-fault crash involvements of other vehicle types which may implicate exposed motorcycles in the conflicting stream. Taking all these into account, the presence of RLCs should significantly reduce the vulnerability of motorcycles at signalized intersections.

Aspect oriented business process modeling with precedence

Complexity is a major concern which is aimed to be overcome by people through modeling. One way of reducing complexity is separation of concerns, e.g. separation of business process from applications. One sort of concerns are cross-cutting concerns i.e. concerns which are scattered and tangled through one of several models. In business process management, examples of such concerns are security and privacy policies. To deal with these cross-cutting concerns, the aspect orientated approach was introduced in the software development area and recently also in the business process management area. The work presented in this paper elaborates on aspect oriented process modelling. It extends earlier work by defining a mechanism for capturing multiple concerns and specifying a precedence order according to which they should be handled in a process. A formal syntax of the notation is presented precisely capturing the extended concepts and mechanisms. Finally, the relevant of the approach is demonstrated through a case study.

Validity and reliability of hallux valgus angle measured on digital photographs

STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To investigate the reliability and concurrent validity of photographic measurements of hallux valgus angle compared to radiographs as the criterion standard. BACKGROUND: Clinical assessment of hallux valgus involves measuring alignment between the first toe and metatarsal on weight-bearing radiographs or visually grading the severity of deformity with categorical scales. Digital photographs offer a noninvasive method of measuring deformity on an exact scale; however, the validity of this technique has not previously been established. METHODS: Thirty-eight subjects (30 female, 8 male) were examined (76 feet, 54 with hallux valgus). Computer software was used to measure hallux valgus angle from digital records of bilateral weight-bearing dorsoplantar foot radiographs and photographs. One examiner measured 76 feet on 2 occasions 2 weeks apart, and a second examiner measured 40 feet on a single occasion. Reliability was investigated by intraclass correlation coefficients and validity by 95% limits of agreement. The Pearson correlation coefficient was also calculated. RESULTS: Intrarater and interrater reliability were very high (intraclass correlation coefficients greater than 0.96) and 95% limits of agreement between photographic and radiographic measurements were acceptable. Measurements from photographs and radiographs were also highly correlated (Pearson r = 0.96). CONCLUSIONS: Digital photographic measurements of hallux valgus angle are reliable and have acceptable validity compared to weight-bearing radiographs. This method provides a convenient and precise tool in assessment of hallux valgus, while avoiding the cost and radiation exposure associated with radiographs.

Development of a gas nanosensor node powered by solar cells

This work focuses on the development of a stand-alone gas nanosensor node, powered by solar energy to track concentration of polluted gases such as NO2, N2O, and NH3. Gas sensor networks have been widely developed over recent years, but the rise of nanotechnology is allowing the creation of a new range of gas sensors [1] with higher performance, smaller size and an inexpensive manufacturing process. This work has created a gas nanosensor node prototype to evaluate future field performance of this new generation of sensors. The sensor node has four main parts: (i) solar cells; (ii) control electronics; (iii) gas sensor and sensor board interface [2-4]; and (iv) data transmission. The station is remotely monitored through wired (ethernet cable) or wireless connection (radio transmitter) [5, 6] in order to evaluate, in real time, the performance of the solar cells and sensor node under different weather conditions. The energy source of the node is a module of polycrystalline silicon solar cells with 410cm2 of active surface. The prototype is equipped with a Resistance-To-Period circuit [2-4] to measure the wide range of resistances (KΩ to GΩ) from the sensor in a simple and accurate way. The system shows high performance on (i) managing the energy from the solar panel, (ii) powering the system load and (iii) recharging the battery. The results show that the prototype is suitable to work with any kind of resistive gas nanosensor and provide useful data for future nanosensor networks.

How important is length? : mechanical testing and measurement of a cemented, polished, tapered femoral implant

Total hip arthroplasty (THA) has a proven clinical record for providing pain relief and return of function to patients with disabling arthritis. There are many successful options for femoral implant design and fixation. Cemented, polished, tapered femoral implants have been shown to have excellent results in national joint registries and long-term clinical series. These implants are usually 150mm long at their lateral aspect. Due to their length, these implants cannot always be offered to patients due to variations in femoral anatomy. Polished, tapered implants as short as 95mm exist, however their small proximal geometry (neck offset and body size) limit their use to smaller stature patients. There is a group of patients in which a shorter implant with a maintained proximal body size would be advantageous. There are also potential benefits to a shorter implant in standard patient populations such as reduced bone removal due to reduced reaming, favourable loading of the proximal femur, and the ability to revise into good proximal bone stock if required. These factors potentially make a shorter implant an option for all patient populations. The role of implant length in determining the stability of a cemented, polished, tapered femoral implant is not well defined by the literature. Before changes in implant design can be made, a better understanding of the role of each region in determining performance is required. The aim of the thesis was to describe how implant length affects the stability of a cemented, polished, tapered femoral implant. This has been determined through an extensive body of laboratory testing. The major findings are that for a given proximal body size, a reduction in implant length has no effect on the torsional stability of a polished, tapered design, while a small reduction in axial stability should be expected. These findings are important because the literature suggests that torsional stability is the major determinant of long-term clinical performance of a THA system. Furthermore, a polished, tapered design is known to be forgiving of cement-implant interface micromotion due to the favourable wear characteristics. Together these findings suggest that a shorter polished, tapered implant may be well tolerated. The effect of a change in implant length on the geometric characteristics of polished, tapered design were also determined and applied to the mechanical testing. Importantly, interface area does play a role in stability of the system; however it is the distribution of the interface and not the magnitude of the area that defines stability. Taper angle (at least in the range of angles seen in this work) was shown not to be a determinant of axial or torsional stability. A range of implants were tested, comparing variations in length, neck offset and indication (primary versus cement-in-cement revision). At their manufactured length, the 125mm implants were similar to their longer 150mm counterparts suggesting that they may be similarly well tolerated in the clinical environment. However, the slimmer cement-in-cement revision implant was shown to have a poorer mechanical performance, suggesting their use in higher demand patients may be hazardous. An implant length of 125mm has been shown to be quite stable and the results suggest that a further reduction to 100mm may be tolerated. However, further work is required. A shorter implant with maintained proximal body size would be useful for the group of patients who are unable to access the current standard length implants due to variations in femoral anatomy. Extending the findings further, the similar function with potential benefits of a shorter implant make their application to all patients appealing.

Domestic energy monitoring in Victorian households with PV solar installations : feasibility report for GV Community Energy

Australia requires decisive action on climate change and issues of sustainability. The Urban Informatics Research Lab has been funded by the Queensland State Government to conduct a three year study (2009 – 2011) exploring ways to support Queensland residents in making more sustainable consumer and lifestyle choices. We conduct user-centred design research that inform the development of real-time, mobile, locational, networked information interfaces, feedback mechanisms and persuasive and motivational approaches that in turn assist in-situ decision making and environmental awareness in everyday settings. The study aims to deliver usable and useful prototypes offering individual and collective visualisations of ecological impact and opportunities for engagement and collaboration in order to foster a participatory and sustainable culture of life in Australia. Raising people’s awareness with environmental data and educational information does not necessarily trigger sufficient motivation to change their habits towards a more environmentally friendly and sustainable lifestyle. Our research seeks to develop a better understanding how to go beyond just informing and into motivating and encouraging action and change. Drawing on participatory culture, ubiquitous computing, and real-time information, the study delivers research that leads to viable new design approaches and information interfaces which will strengthen Australia’s position to meet the targets of the Clean Energy Future strategy, and contribute to the sustainability of a low-carbon future in Australia. As part of this program of research, the Urban Informatics Research Lab has been invited to partner with GV Community Energy Pty Ltd on a project funded by the Victorian Government Sustainability Fund. This feasibility report specifically looks at the challenges and opportunities of energy monitoring in households in Victoria that include a PV solar installation. The report is structured into two parts: In Part 1, we first review a range of energy monitoring solutions, both stand-alone and internet-enabled. This section primarily focusses on the technical capacilities. However, in order to understand this information and make an informed decision, it is crucial to understand the basic principles and limitations of energy monitoring as well as the opportunities and challenges of a networked approach towards energy monitoring which are discussed in Section 2.

CT and X-Ray analysis of sagittal curve changes following thoracoscopic anterior scoliosis surgery

Normal thoracic kyphosis Cobb angle for T5-T12 is most commonly reported as a range of 20-40º [1]. Patients with adolescent idiopathic scoliosis (AIS) exhibit a reduced thoracic kyphosis or hypokyphosis [2] accompanying the coronal and rotary distortion components. As a result, surgical restoration of the thoracic kyphosis while maintaining lumbar lordosis and overall sagittal balance is a critical aspect of achieving good clinical outcomes in AIS patients. Previous studies report an increase in thoracic kyphosis after anterior surgical approaches [3] and a flattening of sagittal contours following posterior approaches [4]. Difficulties with measuring sagittal parameters on radiographs are avoided with reformatted sagittal CT reconstructions due to the superior endplate clarity afforded by this imaging modality and are the subject of analysis in this study.