Comparison of high sensitivity troponin T and I assays in the diagnosis of non-ST elevation acute myocardial infarction in emergency patients with chest pain

Objectives: Concentrations of troponin measured with high sensitivity troponin assays are raised in a number of emergency department (ED) patients; however many are not diagnosed with acute myocardial infarction (AMI). Clinical comparisons between the early use (2 h after presentation) of high sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) assays for the diagnosis of AMI have not been reported. Design and methods: Early (0 h and 2 h) hs-cTnT and hs-cTnI assay results in 1571 ED patients with potential acute coronary syndrome (ACS) without ST elevation on electrocardiograph (ECG) were evaluated. The primary outcome was diagnosis of index MI adjudicated by cardiologists using the local cTnI assay results taken ≥6 h after presentation, ECGs and clinical information. Stored samples were later analysed with hs-cTnT and hs-cTnI assays. Results: The ROC analysis for AMI (204 patients; 13.0%) for hs-cTnT and hs-cTnI after 2 h was 0.95 (95% CI: 0.94–0.97) and 0.98 (95% CI: 0.97–0.99) respectively. The sensitivity, specificity, PLR, and NLR of hs-cTnT and hs-cTnI for AMI after 2 h were 94.1% (95% CI: 90.0–96.6) and 95.6% (95% CI: 91.8–97.7), 79.0% (95% CI: 76.8–81.1) and 92.5% (95% CI: 90.9–93.7), 4.48 (95% CI: 4.02–5.00) and 12.86 (95% CI: 10.51–15.31), and 0.07 (95% CI: 0.04–0.13) and 0.05 (95% CI:0.03–0.09) respectively. Conclusions: Exclusion of AMI 2 h after presentation in emergency patients with possible ACS can be achieved using hs-cTnT or hs-cTnI assays. Significant differences in specificity of these assays are relevant and if using the hs-cTnT assay, further clinical assessment in a larger proportion of patients would be required.

Stabilization of parametric roll resonance with active u-tanks via Lyapunov control design

Parametric ship roll resonance is a phenomenon where a ship can rapidly develop high roll motion while sailing in longitudinal waves. This effect can be described mathematically by periodic changes of the parameters of the equations of motion, which lead to a bifurcation. In this paper, the control design of an active u-tank stabilizer is carried out using Lyapunov theory. A nonlinear backstepping controller is developed to provide global exponential stability of roll. An extension of commonly used u-tank models is presented to account for large roll angles, and the control design is tested via simulation on a high-fidelity model of a vessel under parametric roll resonance.

Hip and knee kinematics display complex and time-varying sagittal kinematics during repetitive stepping: Implications for design of a functional fatigue model of the knee extensors and flexors

The validity of fatigue protocols involving multi-joint movements, such as stepping, has yet to be clearly defined. Although surface electromyography can monitor the fatigue state of individual muscles, the effects of joint angle and velocity variation on signal parameters are well established. Therefore, the aims of this study were to i) describe sagittal hip and knee kinematics during repetitive stepping ii) identify periods of high inter-trial variability and iii) determine within-test reliability of hip and knee kinematic profiles. A group of healthy men (N = 15) ascended and descended from a knee-high platform wearing a weighted vest (10%BW) for 50 consecutive trials. The hip and knee underwent rapid flexion and extension during step ascent and descent. Variability of hip and knee velocity peaked between 20-40% of the ascent phase and 80-100% of the descent. Significant (p<0.05) reductions in joint range of motion and peak velocity during step ascent were observed, while peak flexion velocity increased during descent. Healthy individuals use complex hip and knee motion to negotiate a knee-high step with kinematic patterns varying across multiple repetitions. These findings have important implications for future studies intending to use repetitive stepping as a fatigue model for the knee extensors and flexors.

A design approach to the study of people's experiences with technologies in the context of public transport

Relevant to the study of people’s attitudes towards public transport use is the consideration to the role of technology as part of the travel experience. Technologies aim to enhance daily tasks but tend to change the way people interact with products and can be perceived as difficult to use. This is critical in the context of “public use” where products and services are to be used by the population at large: adults, children, elderly, people with disabilities, and tourists. From different perspectives, the topic of users and the use of technologies have been studied in the social sciences and human computer interaction fields; however, earlier approaches fail to address the ways in which experiential knowledge informs people’s interactions with products and technologies, and how such information could guide the design of future technologies. This paper describes a pilot study, part of a larger ongoing exploratory research that investigates people’s experiences with infrastructure, systems, and technologies in the context of public transport. The methodological approach included focus groups, field observations, and retrospective verbal reports. At this stage, the study found that four context led factors were the primary source of reference informing participants’ actions and interactions; they are: (i) context >> experience, (ii) context >> interface, (iii) context >> knowledge, (iv) context >> emotion.

Passenger experience and their implications for airports retail environment design

This project develops new knowledge on the full range of activities and interactions that make up airport passengers' retail experiences. The practical application of this new knowledge will improve the design of airport retail environments and will, in turn, improve passenger experiences, leading to further growth in the airport retail market. The novel methodological approach developed allowed for a new and deeper understanding of how passengers actually experience airport retail environments. Four significant outcomes were discovered: (i) the categorisation of the full range of retail activities and interactions passengers actually undertake, (ii) a new understanding of how passengers use and experience their free airport time, (iii) two new passenger market segments, and (iv) two passenger retail experience tools, with these identifying the broad range of airport-specific factors which influence passengers retail experiences.

Multiphase experiments with at least one later laboratory phase. I. orthogonal designs

The paper provides a systematic approach to designing the laboratory phase of a multiphase experiment, taking into account previous phases. General principles are outlined for experiments in which orthogonal designs can be employed. Multiphase experiments occur widely, although their multiphase nature is often not recognized. The need to randomize the material produced from the first phase in the laboratory phase is emphasized. Factor-allocation diagrams are used to depict the randomizations in a design and the use of skeleton analysis-of-variance (ANOVA) tables to evaluate their properties discussed. The methods are illustrated using a scenario and a case study. A basis for categorizing designs is suggested. This article has supplementary material online.

STOF Model : critical design issues and critical success factors

In this chapter we will make the transition towards the design of business models and the related critical issues. We develop a model that helps us understand the causalities that play a role in understanding the viability and feasibility of the business models, i.e. long-term profitability and market adoption. We argue that designing viable business models requires balancing the requirements and interests of the actors involved, within and between the various business model domains. Requirements in the service domain guide the design choices in the technology domain, which in turn affect network formation and the financial arrangements. It is important to understand the Critical Design Issues (CDIs) involved in business models and their interdependencies. In this chapter, we present the Critical Design Issues involved in designing mobile service business models, and demonstrate how they are linked to the Critical Success Factors (CSFs) with regard to business model viability. This results in a causal model for understanding business model viability, as well as providing grounding for the business model design approach outlined in Chapter 5.

The phenomenological approach : a framework to design markets

An approach is proposed and applied to five industries to prove how phenomenology can be valuable in rethinking consumer markets (Popp & Holt, 2013). The purpose of this essay is to highlight the potential implications that 'phenomenological thinking' brings for competitiveness and innovation (Sanders, 1982), hence helping managers being more innovative in their strategic marketing decisions (i.e. market creation, positioning, branding). Phenomenology is in fact a way of thinking − besides and before being a qualitative research procedure − a very practical exercise that strategic managers can master and apply in the same successful way as other scientists have already done in their fields of study (e.g. sociology, psychology, psychiatry, and anthropology). Two fundamental considerations justify this research: a lack of distinctiveness among firms due to high levels of competition and consumers no longer knowing what they want (i.e. no more needs). The authors will show how the classical mental framework generally used to study markets by practitioners appears on the one hand to be established and systematic in the life of a company, while on the other is no longer adequate to meet the needs of innovation required to survive. To the classic principles of objectivity, generality, and psycho-sociology the authors counterpose the imaginary, eidetic-phenomenological reduction, and an existential perspective. From a theoretical point of view, this paper introduces a set of functioning rules applicable to achieve innovation in any market and useful to identify cultural practices inherent in the act of consumption.

Enriching the "I" in Bim : a BIM-Specifications (Bimspecs) approach

This paper conceptualizes a framework for bridging the BIM-Specifications divide by embedding project-specific information in BIM objects by means of a product library. We demonstrate how model information, enriched with data at various levels of development (LODs), can evolve simultaneously with design and construction using a window object embedded in a wall as life-cycle phase exemplars at different levels of granularity. The conceptual approach is informed by the need for exploring an approach that takes cognizance of the limitations of current modelling tools in enhancing the information content of BIM models. Therefore, this work attempts to answer the question, “How can the modelling of building information be enhanced throughout the life-cycle phases of buildings utilizing building specification information?”

Theorizing in design science research : an abstraction layers framework

For Design Science Research (DSR) to gain wide credence as a research paradigm in Information Systems (IS), it must contribute to theory. “Theory cannot be improved until we improve the theorizing process, and we cannot improve the theorizing process until we describe it more explicitly, operate it more self-consciously, and decouple it from validation more deliberately” (Weick 1989, p. 516). With the aim of improved design science theorizing, we propose a DSR abstraction-layers framework that integrates, interlates, and harmonizes key methodological notions, primary of which are: 1) the Design Science (DS), Design Research (DR), and Routine Design (RD) distinction (Winter 2008); 2) Multi Grounding in IS Design Theory (ISDT) (Goldkuhl & Lind 2010); 3) the Idealized Model for Theory Development (IM4TD) (Fischer & Gregor 2011); and 4) the DSR Theorizing Framework (Lee et al. 2011). Though theorizing, or the abstraction process, has been the subject of healthy discussion in DSR, important questions remain. With most attention to date having focused on theorizing for Design Research (DR), a key stimulus of the layered view was the realization that Design Science (DS) produces abstract knowledge at a higher level of generality. The resultant framework includes four abstraction layers: (i) Design Research (DR) 1st Abstract Layer, (ii) Design Science (DS) 2nd Abstract Layer, (iii) DSR Incubation 3rd Layer, and (iv) Routine Design 4th Layer. Differentiating and inter-relating these layers will aid DSR researchers to discover, position, and amplify their DSR contributions. Additionally, consideration of the four layers can trigger creative perspectives that suggest unplanned outputs. The first abstraction layer, including its alternative patterns of activity, is well recognized in the literature. The other layers, however, are less well recognized; and the integrated representation of layers is novel.

Sitooter-i

As part of the process of renewing its City Centre Master Plan, Brisbane City Council and its CBD are hosting an Ideas Fiesta between April 11th- 3rd May 2013. It hopes to generate new ideas, showcase design concepts, and stimulate interest in imagining the future of the city centre. Events will be held in a variety of city outdoor spaces, streets, laneways and venues to identify catalyst projects and explore design ideas for the city centre. In the City Botanic Gardens ‘Sunday reserved for you’ on 21st April and ‘A shot of green’ on Wednesday 24th April are some of the events planned and are the setting for innovative items of park furniture and other activities. A sitooterie (Scottish) is an outdoor space to sit… a place to enjoy nature. This Sitooter-i has been digitally designed for CNC fabrication with the ergonomics of reclining, lounging, just sitting or jumping around in mind. It was assembled by staff and students from Queensland University of Technology and is made from locally sourced plywood components which are easily dismantled for re-use elsewhere. But this Sitooter-i inspired by natural forms is also both physically and technologically interactive. Sensors record sound, light and temperature in their interactions with users. This data may be relayed as LED lights played in rhythm along frame edges or used by Brisbane City Council to assess frequency and style of use, perhaps revealing the effectiveness of its performance and the preferences of its users. See: http://sitooteri.wordpress.com/

Design and experimental testing of air slab caps which convert commercial electron diodes into dual purpose, correction-free diodes for small field dosimetry

Purpose Two diodes which do not require correction factors for small field relative output measurements are designed and validated using experimental methodology. This was achieved by adding an air layer above the active volume of the diode detectors, which canceled out the increase in response of the diodes in small fields relative to standard field sizes. Methods Due to the increased density of silicon and other components within a diode, additional electrons are created. In very small fields, a very small air gap acts as an effective filter of electrons with a high angle of incidence. The aim was to design a diode that balanced these perturbations to give a response similar to a water-only geometry. Three thicknesses of air were placed at the proximal end of a PTW 60017 electron diode (PTWe) using an adjustable “air cap”. A set of output ratios (ORfclin Det ) for square field sizes of side length down to 5 mm was measured using each air thickness and compared to ORfclin Det measured using an IBA stereotactic field diode (SFD). k fclin, f msr Qclin,Qmsr was transferred from the SFD to the PTWe diode and plotted as a function of air gap thickness for each field size. This enabled the optimal air gap thickness to be obtained by observing which thickness of air was required such that k fclin, f msr Qclin,Qmsr was equal to 1.00 at all field sizes. A similar procedure was used to find the optimal air thickness required to make a modified Sun Nuclear EDGE detector (EDGEe) which s “correction-free” in small field relative dosimetry. In addition, the feasibility of experimentally transferring k fclin, f msr Qclin,Qmsr values from the SFD to unknown diodes was tested by comparing the experimentally transferred k fclin, f msr Qclin,Qmsr values for unmodified PTWe and EDGEe diodes to Monte Carlo simulated values. Results 1.0 mm of air was required to make the PTWe diode correction-free. This modified diode (PTWeair) produced output factors equivalent to those in water at all field sizes (5–50 mm). The optimal air thickness required for the EDGEe diode was found to be 0.6 mm. The modified diode (EDGEeair) produced output factors equivalent to those in water, except at field sizes of 8 and 10 mm where it measured approximately 2% greater than the relative dose to water. The experimentally calculated k fclin, f msr Qclin,Qmsr for both the PTWe and the EDGEe diodes (without air) matched Monte Carlo simulated results, thus proving that it is feasible to transfer k fclin, f msr Qclin,Qmsr from one commercially available detector to another using experimental methods and the recommended experimental setup. Conclusions It is possible to create a diode which does not require corrections for small field output factor measurements. This has been performed and verified experimentally. The ability of a detector to be “correction-free” depends strongly on its design and composition. A nonwater-equivalent detector can only be “correction-free” if competing perturbations of the beam cancel out at all field sizes. This should not be confused with true water equivalency of a detector.

Frequency-motivated observer design for the prediction of parametric roll resonance control applications in marine systems

This work deals with estimators for predicting when parametric roll resonance is going to occur in surface vessels. The roll angle of the vessel is modeled as a second-order linear oscillatory system with unknown parameters. Several algorithms are used to estimate the parameters and eigenvalues of the system based on data gathered experimentally on a 1:45 scale model of a tanker. Based on the estimated eigenvalues, the system predicts whether or not parametric roll occurred. A prediction accuracy of 100% is achieved for regular waves, and up to 87.5% for irregular waves.

A collaborative rapid persona-building workshop : creating design personas with health researchers

In the HealthMap project for People With HIV, (PWHIV) designers employed a collaborative rapid ‘persona-building' workshop with health researchers to develop patient personas that embodied patient-centred design goals and contextual awareness from a variety of qualitative and quantitative data. On reflection, this collaborative rapid workshop was a process for drawing together the divergent user research insights and expertise of stakeholders into focus for a chronic disease self-management design. This paper discusses, (i) an analysis of the transcript of the workshop and, (ii) interviews with five practising senior designers, in order to reflect on how the persona-building process was enacted and its role in the HealthMap design evolution. The collaborative rapid persona-building methodology supported: embedding user research insights, eliciting domain expertise, introducing design thinking, facilitating stakeholder collaboration and defining early design requirements. The contribution of this paper is to model the process of collaborative rapid persona-building and to introduce the collaborative rapid persona-building framework as a method to generate design priorities from domain expertise and user research data.

Reterritorializing multimodal design in the classroom through a socially mediated Indigenous heritage

National or International Significance Flows of cultural heritage in textual practices are vital to sustaining Indigenous communities - a national and international priority (Commonwealth of Australia, 2011). Indigenous heritage, whether passed on by oral tradition or ubiquitous social media, can be seen as a "conversation between the past and the future" (Fairclough, 2012, p. xv). Indigenous heritage involves appropriating memories within a cultural flow to pass on a spiritual legacy. This presentation reports ethnographic research of social media practices in a small independent Aboriginal school in Southeast Queensland, Australia that is resided over by the Yuggera elders and an Aboriginal principal. Quality of Research The purpose was to rupture existing notions of white literacies in schools, and to deterritorialize the uses of digital media by dominant cultures in the public sphere. Examples of learning experiences included the following: i. Integrating Indigenous language and knowledge into media text production; ii. Classroom visits from Indigenous elders; and iii. Publishing oral histories through digital scrapbooking. The program aligned with the Australian National Curriculum English (ACARA, 2014), which mandates the teaching of multimodal text creation. Data sources included a class set of digital scrapbooks collaboratively created in a preparatory-one primary classroom. The digital scrapbooks combined digitally encoded words, images of material artifacts, and digital music files. A key feature of the writing and digital design task was to retell and digitally display and archive a cultural narrative of significance to the Indigenous Australian community and its memories and material traces of the past for the future. Data analysis of the students' digital stories involved the application of key themes of negotiated, material, and digitally mediated forms of heritage practice. It drew on Australian Indigenous research by Keddie et al. (2013) to guard against the homogenizing of culture that can arise from a focus on a static view of culture. The interpretation of findings located Indigenous appropriation of social media within broader racialized politics that enables Indigenous literacy to be understood as a dynamic, negotiated, and transgenerational flows of practice. It demonstrates that Indigenous children's use of media production reflects "shifting and negotiated identities" in response to changing media environments that can function to sustain Indigenous cultural heritages (Appadurai, 1696, p. xv). Impact on practice, policy or theory The findings are important for teachers at a time when Aboriginal and Torres Strait Islander Histories and Cultures is a cross-curricular policy priority in the Australian Curriculum (ACARA, 2014). The findings show how curriculum policies can be applied to classroom practice in ways that are epistemologically consistent with Indigenous ways of knowing and being. Theoretically, it demonstrates how the children's experiences of culture are layered over time, as successive generations inherit, interweave, and hear others' cultural stories or maps. Practically, recommendations are provided for an approach to appropriating social media in schools that explicitly attends to the dynamic nature of Indigenous practices, negotiated through intercultural constructions and flows, and opening space for a critical anti-racist approach to multimodal text production. Timeliness The research is timely in the context of the accessibility and role of digital and multimodal forms of communication, including for Aboriginal and Torres Strait Islander communities.