Developing an evidence-based clinical pathway for the assessment, diagnosis and management of acute Charcot Neuro-Arthropathy : a systematic review

Background: Charcot Neuro-Arthropathy (CN) is one of the more devastating complications of diabetes. To the best of the authors' knowledge, it appears that no clinical tools based on a systematic review of existing literature have been developed to manage acute CN. Thus, the aim of this paper was to systematically review existing literature and develop an evidence-based clinical pathway for the assessment, diagnosis and management of acute CN in patients with diabetes. Methods: Electronic databases (Medline, PubMed, CINAHL, Embase and Cochrane Library), reference lists, and relevant key websites were systematically searched for literature discussing the assessment, diagnosis and/or management of acute CN published between 2002-2012. At least two independent investigators then quality rated and graded the evidence of each included paper. Consistent recommendations emanating from the included papers were then fashioned in a clinical pathway. Results: The systematic search identified 267 manuscripts, of which 117 (44%) met the inclusion criteria for this study. Most manuscripts discussing the assessment, diagnosis and/or management of acute CN constituted level IV (case series) or EO (expert opinion) evidence. The included literature was used to develop an evidence-based clinical pathway for the assessment, investigations, diagnosis and management of acute CN. Conclusions: This research has assisted in developing a comprehensive, evidence-based clinical pathway to promote consistent and optimal practice in the assessment, diagnosis and management of acute CN. The pathway aims to support health professionals in making early diagnosis and providing appropriate immediate management of acute CN, ultimately reducing its associated complications such as amputations and hospitalisations.

Application of cepstrum pre-whitening for the diagnosis of bearing faults under variable speed conditions

Diagnostics of rolling element bearings involves a combination of different techniques of signal enhancing and analysis. The most common procedure presents a first step of order tracking and synchronous averaging, able to remove the undesired components, synchronous with the shaft harmonics, from the signal, and a final step of envelope analysis to obtain the squared envelope spectrum. This indicator has been studied thoroughly, and statistically based criteria have been obtained, in order to identify damaged bearings. The statistical thresholds are valid only if all the deterministic components in the signal have been removed. Unfortunately, in various industrial applications, characterized by heterogeneous vibration sources, the first step of synchronous averaging is not sufficient to eliminate completely the deterministic components and an additional step of pre-whitening is needed before the envelope analysis. Different techniques have been proposed in the past with this aim: The most widely spread are linear prediction filters and spectral kurtosis. Recently, a new technique for pre-whitening has been proposed, based on cepstral analysis: the so-called cepstrum pre-whitening. Owing to its low computational requirements and its simplicity, it seems a good candidate to perform the intermediate pre-whitening step in an automatic damage recognition algorithm. In this paper, the effectiveness of the new technique will be tested on the data measured on a full-scale industrial bearing test-rig, able to reproduce the harsh conditions of operation. A benchmark comparison with the traditional pre-whitening techniques will be made, as a final step for the verification of the potentiality of the cepstrum pre-whitening.

Effectiveness of MED for Fault Diagnosis in Roller Bearings

Diagnostics of rolling element bearings is usually performed by means of vibration signals measured by accelerometers placed in the proximity of the bearing under investigation. The aim is to monitor the integrity of the bearing components, in order to avoid catastrophic failures, or to implement condition based maintenance strategies. In particular, the trend in this field is to combine in a single algorithm different signal-enhancement and signal-analysis techniques. Among the first ones, Minimum Entropy Deconvolution (MED) has been pointed out as a key tool able to highlight the effect of a possible damage in one of the bearing components within the vibration signal. This paper presents the application of this technique to signals collected on a simple test-rig, able to test damaged industrial roller bearings in different working conditions. The effectiveness of the technique has been tested, comparing the results of one undamaged bearing with three bearings artificially damaged in different locations, namely on the inner race, outer race and rollers. Since MED performances are dependent on the filter length, the most suitable value of this parameter is defined on the basis of both the application and measured signals. This represents an original contribution of the paper.

Continuous disclosure compliance: Does corporate governance matter?

Our study investigates the quality of firms’ continuous disclosure compliance during mandatory continuous disclosure reform, and whether the compliance quality is impacted by corporate governance, using the New Zealand market as the setting. We use a novel coding of different categories of disclosures (nonroutine, non-procedural and internal), which represents the extent of proprietary insider information inherent in disclosures, to evaluate firms’compliance quality. Our findings provide evidence that firms’ compliance quality improved after the reform, and this improvement is inconsistently impacted by corporate gvernance. Our findings provide important implications for regulators in their quest for a superior disclosure regime

Active awareness : supporting the intentional disclosure of awareness information in collaborative systems

This thesis opens up the design space for awareness research in CSCW and HCI. By challenging the prevalent understanding of roles in awareness processes and exploring different mechanisms for actively engaging users in the awareness process, this thesis provides a better understanding of the complexity of these processes and suggests practical solutions for designing and implementing systems that support active awareness. Mutual awareness, a prominent research topic in the fields of Computer-Supported Cooperative Work (CSCW) and Human-Computer Interaction (HCI) refers to a fundamental aspect of a person’s work: their ability to gain a better understanding of a situation by perceiving and interpreting their co-workers actions. Technologically-mediated awareness, used to support co-workers across distributed settings, distinguishes between the roles of the actor, whose actions are often limited to being the target of an automated data gathering processes, and the receiver, who wants to be made aware of the actors’ actions. This receiver-centric view of awareness, focusing on helping receivers to deal with complex sets of awareness information, stands in stark contrast to our understanding of awareness as social process involving complex interactions between both actors and receivers. It fails to take into account an actors’ intimate understanding of their own activities and the contribution that this subjective understanding could make in providing richer awareness information. In this thesis I challenge the prevalent receiver-centric notion of awareness, and explore the conceptual foundations, design, implementation and evaluation of an alternative active awareness approach by making the following five contributions. Firstly, I identify the limitations of existing awareness research and solicit further evidence to support the notion of active awareness. I analyse ethnographic workplace studies that demonstrate how actors engage in an intricate interplay involving the monitoring of their co-workers progress and displaying aspects of their activities that may be of relevance to others. The examination of a large body of awareness research reveals that while disclosing information is a common practice in face-to-face collaborative settings it has been neglected in implementations of technically mediated awareness. Based on these considerations, I introduce the notion of intentional disclosure to describe the action of users actively and deliberately contributing awareness information. I consider challenges and potential solutions for the design of active awareness. I compare a range of systems, each allowing users to share information about their activities at various levels of detail. I discuss one of the main challenges to active awareness: that disclosing information about activities requires some degree of effort. I discuss various representations of effort in collaborative work. These considerations reveal that there is a trade-off between the richness of awareness information and the effort required to provide this information. I propose a framework for active awareness, aimed to help designers to understand the scope and limitations of different types of intentional disclosure. I draw on the identified richness/effort trade-off to develop two types of intentional disclosure, both of which aim to facilitate the disclosure of information while reducing the effort required to do so. For both of these approaches, direct and indirect disclosure, I delineate how they differ from related approaches and define a set of design criteria that is intended to guide their implementation. I demonstrate how the framework of active awareness can be practically applied by building two proof-of-concept prototypes that implement direct and indirect disclosure respectively. AnyBiff, implementing direct disclosure, allows users to create, share and use shared representations of activities in order to express their current actions and intentions. SphereX, implementing indirect disclosure, represents shared areas of interests or working context, and links sets of activities to these representations. Lastly, I present the results of the qualitative evaluation of the two prototypes and analyse the results with regard to the extent to which they implemented their respective disclosure mechanisms and supported active awareness. Both systems were deployed and tested in real world environments. The results for AnyBiff showed that users developed a wide range of activity representations, some unanticipated, and actively used the system to disclose information. The results further highlighted a number of design considerations relating to the relationship between awareness and communication, and the role of ambiguity. The evaluation of SphereX validated the feasibility of the indirect disclosure approach. However, the study highlighted the challenges of implementing cross-application awareness support and translating the concept to users. The study resulted in design recommendations aimed to improve the implementation of future systems.

Fetal Alcohol Spectrum Disorder diagnosis and counselling

The Foetal Alcohol Syndrome has long gone unrecognised and undiagnosed in Australia. In the last few years of the 21st Century (2010-14) health practitioners are finally seeking ways of diagnosing the effects of alcohol in pregnancy on the next generation. The author offers a power point presentation which gives guidance on making an accurate diagnosis.

Court stands firm on disclosure via subpoena

In Elders Rural Services Australia Ltd v Gooden [2014] QDC 22 Reid DCJ considered the interaction of the procedures under the Uniform Civil Procedure Rules 1999 (Qld)relating to disclosure by parties to a proceeding and the subpoena process, in the context of a proceeding commenced by originating application.

Application of machine learning technique in wind turbine fault diagnosis

In this study, a machine learning technique called anomaly detection is employed for wind turbine bearing fault detection. Basically, the anomaly detection algorithm is used to recognize the presence of unusual and potentially faulty data in a dataset, which contains two phases: a training phase and a testing phase. Two bearing datasets were used to validate the proposed technique, fault-seeded bearing from a test rig located at Case Western Reserve University to validate the accuracy of the anomaly detection method, and a test to failure data of bearings from the NSF I/UCR Center for Intelligent Maintenance Systems (IMS). The latter data set was used to compare anomaly detection with SVM, a previously well-known applied method, in rapidly finding the incipient faults.

Fault diagnosis of low speed bearing based on acoustic emission signal and multi-class relevance vector machine

This study presents an acoustic emission (AE) based fault diagnosis for low speed bearing using multi-class relevance vector machine (RVM). A low speed test rig was developed to simulate the various defects with shaft speeds as low as 10 rpm under several loading conditions. The data was acquired using anAEsensor with the test bearing operating at a constant loading (5 kN) andwith a speed range from20 to 80 rpm. This study is aimed at finding a reliable method/tool for low speed machines fault diagnosis based on AE signal. In the present study, component analysis was performed to extract the bearing feature and to reduce the dimensionality of original data feature. The result shows that multi-class RVM offers a promising approach for fault diagnosis of low speed machines.

Disclosure of climate change-related corporate governance practices

Based on a survey of climate change experts in different stakeholder groups and interviews with corporate climate change managers, this study provides insights into the gap between what information stakeholders expect and what Australian corporations disclose. This paper focuses on annual reports and sustainability reports with specific reference to the disclosure of climate change-related corporate governance practices. The findings culminate in the refinement of a best practice index for the disclosure of climate-change-related corporate governance practises. Interview results indicate that the low levels of disclosures made by Australian companies may be due to a number of factors. These include a potential expectations gap, the absence of pressure from powerful stakeholders, a concern for stakeholder information overload, the cost of providing information, limited perceived accountability for climate change, and preferring other media for disclosure.

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.

Prenatal diagnosis, genetics and reproductive decision-making

Recent developments in genetic science will potentially have a significant impact on reproductive decision-making by adding to the list of conditions which can be diagnosed through prenatal diagnosis. This article analyses the jurisdictional variations that exist in Australian abortion laws and examines the extent to which Australian abortion laws specifically provide for termination of pregnancy on the grounds of fetal disability. The article also examines the potential impact of pre-implantation genetic diagnosis on reproductive decision-making and considers the meaning of reproductive autonomy in the context of the new genetics.

Disclosure obligations - Personal Injuries Proceedings Act 2002

In Huag v Jupiters Limited [2007] QSC 068, Lyons J considered the extent of the obligations imposed upon a respondent under the Personal Injuries Proceedings Act 2002 to disclose documents and information.