Pedunculopontine nucleus deep brain stimulation produces sustained improvement in primary progressive freezing of gait

Objective: To assess the efficacy of bilateral pedunculopontine nucleus (PPN) deep brain stimulation (DBS) as a treatment for primary progressive freezing of gait (PPFG). ------ ----- Methods: A patient with PPFG underwent bilateral PPN-DBS and was followed clinically for over 14 months. ------ ----- Results: The PPFG patient exhibited a robust improvement in gait and posture following PPN-DBS. When PPN stimulation was deactivated, postural stability and gait skills declined to pre-DBS levels, and fluoro-2-deoxy-d-glucose positron emission tomography revealed hypoactive cerebellar and brainstem regions, which significantly normalised when PPN stimulation was reactivated. ------ ----- Conclusions: This case demonstrates that the advantages of PPN-DBS may not be limited to addressing freezing of gait (FOG) in idiopathic Parkinson's disease. The PPN may also be an effective DBS target to address other forms of central gait failure.

Strength improvement methods for back to back Litesteel beams

LiteSteel Beam (LSB) is a new cold-formed steel beam produced by OneSteel Australian Tube Mills (OATM). The new beam is effectively a channel section with two rectangular hollow flanges and a slender web, and is manufactured using patented dual electric resistance welding and automated roll-forming technologies. OATM is promoting the use of LSBs as flexural members in residential construction. When LSBs are used as back to back built-up sections, they are likely to improve their moment capacity. However, the research project conducted on the flexural behaviour of back to back built-up LSBs showed that the detrimental effects of lateral distortional buckling in single LSB members appear to remain with back to back built-up LSB members. The ultimate moment capacity of back to back LSB member is also affected by lateral distortional buckling failure. Therefore an investigation was conducted with an aim to develop suitable strength improvement methods, which are likely to mitigate lateral distortional buckling effects and hence improve the flexural strengths of back to back LSB members. This paper presents the details of this investigation, the results and recommendations for the most suitable and cost-effective method, which significantly improves the moment capacities of back to back LSB members.

Assessing genetic diversity in cultured aquatic species : the Sydney Rock Oyster (Saccostrea glomerata) stock improvement program as a model

Genetic variation is the resource animal breeders exploit in stock improvement programs. Both the process of selection and husbandry practices employed in aquaculture will erode genetic variation levels overtime, hence the critical resource can be lost and this may compromise future genetic gains in breeding programs. The amount of genetic variation in five lines of Sydney Rock Oyster (SRO) that had been selected for QX (Queensland unknown) disease resistance were examined and compared with that in a wild reference population using seven specific SRO microsatellite loci. The five selected lines had significantly lower levels of genetic diversity than did the wild reference population with allelic diversity declining approximately 80%, but impacts on heterozygosity per locus were less severe. Significant deficiencies in heterozygotes were detected at six of the seven loci in both mass selected lines and the wild reference population. Against this trend however, a significant excess of heterozygotes was recorded at three loci Sgo9, Sgo14 and Sgo21 in three QX disease resistant lines (#2, #5 and #13). All populations were significantly genetic differentiated from each other based on pairwise FST values. A neighbour joining tree based on DA genetic distances showed a clear separation between all culture and wild populations. Results of this study show clearly, that the impacts of the stock improvement program for SRO has significantly eroded natural levels of genetic variation in the culture lines. This could compromise long-term genetic gains and affect sustainability of the SRO breeding program over the long-term.

Stability boundary analysis of the dynamic voltage restorer in weak systems with dynamic loads

In this contribution, a stability analysis for a dynamic voltage restorer (DVR) connected to a weak ac system containing a dynamic load is presented using continuation techniques and bifurcation theory. The system dynamics are explored through the continuation of periodic solutions of the associated dynamic equations. The switching process in the DVR converter is taken into account to trace the stability regions through a suitable mathematical representation of the DVR converter. The stability regions in the Thevenin equivalent plane are computed. In addition, the stability regions in the control gains space, as well as the contour lines for different Floquet multipliers, are computed. Besides, the DVR converter model employed in this contribution avoids the necessity of developing very complicated iterative map approaches as in the conventional bifurcation analysis of converters. The continuation method and the DVR model can take into account dynamics and nonlinear loads and any network topology since the analysis is carried out directly from the state space equations. The bifurcation approach is shown to be both computationally efficient and robust, since it eliminates the need for numerically critical and long-lasting transient simulations.

A new unequal DC link voltage configuration for a single phase multilevel converter to reduce low order harmonics

Multilevel converters are used in high power and high voltage applications due to their attractive benefits in generating high quality output voltage. Increasing the number of voltage levels can lead to a reduction in lower order harmonics. Various modulation and control techniques are introduced for multilevel converters like Space Vector Modulation (SVM), Sinusoidal Pulse Width Modulation (SPWM) and Harmonic Elimination (HE) methods. Multilevel converters may have a DC link with equal or unequal DC voltages. In this paper a new modulation technique based on harmonic elimination method is proposed for those multilevel converters that have unequal DC link voltages. This new technique has better effect on output voltage quality and less Total Harmonic Distortion (THD) than other modulation techniques. In order to verify the proposed modulation technique, MATLAB simulations are carried out for a single-phase diode-clamped inverter.

Evaluation of financial incentives as a quality improvement strategy in the public hospital context : clinician attitudes, design variables, and economic costs

In 2008, a three-year pilot ‘pay for performance’ (P4P) program, known as ‘Clinical Practice Improvement Payment’ (CPIP) was introduced into Queensland Health (QHealth). QHealth is a large public health sector provider of acute, community, and public health services in Queensland, Australia. The organisation has recently embarked on a significant reform agenda including a review of existing funding arrangements (Duckett et al., 2008). Partly in response to this reform agenda, a casemix funding model has been implemented to reconnect health care funding with outcomes. CPIP was conceptualised as a performance-based scheme that rewarded quality with financial incentives. This is the first time such a scheme has been implemented into the public health sector in Australia with a focus on rewarding quality, and it is unique in that it has a large state-wide focus and includes 15 Districts. CPIP initially targeted five acute and community clinical areas including Mental Health, Discharge Medication, Emergency Department, Chronic Obstructive Pulmonary Disease, and Stroke. The CPIP scheme was designed around key concepts including the identification of clinical indicators that met the set criteria of: high disease burden, a well defined single diagnostic group or intervention, significant variations in clinical outcomes and/or practices, a good evidence, and clinician control and support (Ward, Daniels, Walker & Duckett, 2007). This evaluative research targeted Phase One of implementation of the CPIP scheme from January 2008 to March 2009. A formative evaluation utilising a mixed methodology and complementarity analysis was undertaken. The research involved three research questions and aimed to determine the knowledge, understanding, and attitudes of clinicians; identify improvements to the design, administration, and monitoring of CPIP; and determine the financial and economic costs of the scheme. Three key studies were undertaken to ascertain responses to the key research questions. Firstly, a survey of clinicians was undertaken to examine levels of knowledge and understanding and their attitudes to the scheme. Secondly, the study sought to apply Statistical Process Control (SPC) to the process indicators to assess if this enhanced the scheme and a third study examined a simple economic cost analysis. The CPIP Survey of clinicians elicited 192 clinician respondents. Over 70% of these respondents were supportive of the continuation of the CPIP scheme. This finding was also supported by the results of a quantitative altitude survey that identified positive attitudes in 6 of the 7 domains-including impact, awareness and understanding and clinical relevance, all being scored positive across the combined respondent group. SPC as a trending tool may play an important role in the early identification of indicator weakness for the CPIP scheme. This evaluative research study supports a previously identified need in the literature for a phased introduction of Pay for Performance (P4P) type programs. It further highlights the value of undertaking a formal risk assessment of clinician, management, and systemic levels of literacy and competency with measurement and monitoring of quality prior to a phased implementation. This phasing can then be guided by a P4P Design Variable Matrix which provides a selection of program design options such as indicator target and payment mechanisms. It became evident that a clear process is required to standardise how clinical indicators evolve over time and direct movement towards more rigorous ‘pay for performance’ targets and the development of an optimal funding model. Use of this matrix will enable the scheme to mature and build the literacy and competency of clinicians and the organisation as implementation progresses. Furthermore, the research identified that CPIP created a spotlight on clinical indicators and incentive payments of over five million from a potential ten million was secured across the five clinical areas in the first 15 months of the scheme. This indicates that quality was rewarded in the new QHealth funding model, and despite issues being identified with the payment mechanism, funding was distributed. The economic model used identified a relative low cost of reporting (under $8,000) as opposed to funds secured of over $300,000 for mental health as an example. Movement to a full cost effectiveness study of CPIP is supported. Overall the introduction of the CPIP scheme into QHealth has been a positive and effective strategy for engaging clinicians in quality and has been the catalyst for the identification and monitoring of valuable clinical process indicators. This research has highlighted that clinicians are supportive of the scheme in general; however, there are some significant risks that include the functioning of the CPIP payment mechanism. Given clinician support for the use of a pay–for-performance methodology in QHealth, the CPIP scheme has the potential to be a powerful addition to a multi-faceted suite of quality improvement initiatives within QHealth.

Car following model improvement for traffic safety metrics reproduction

Car Following models have a critical role in all microscopic traffic simulation models. Current microscopic simulation models are unable to mimic the unsafe behaviour of drivers as most are based on presumptions about the safe behaviour of drivers. Gipps model is a widely used car following model embedded in different micro-simulation models. This paper examines the Gipps car following model to investigate ways of improving the model for safety studies application. The paper puts forward some suggestions to modify the Gipps model to improve its capabilities to simulate unsafe vehicle movements (vehicles with safety indicators below critical thresholds). The result of the paper is one step forward to facilitate assessing and predicting safety at motorways using microscopic simulation. NGSIM as a rich source of vehicle trajectory data for a motorway is used to extract its relatively risky events. Short following headways and Time To Collision are used to assess critical safety event within traffic flow. The result shows that the modified proposed car following to a certain extent predicts the unsafe trajectories with smaller error values than the generic Gipps model.

A systematic approach to evaluate the process improvement in lean manufacturing organizations

Numerous tools and techniques have been developed to eliminate or reduce waste and carry out Lean concepts in the manufacturing environment. However, in practice, manufacturers encounter difficulties to clearly identify the weaknesses of the existing processes in order to address them by implementing Lean tools. Moreover, selection and implementation of appropriate Lean strategies to address the problems identified is a challenging task. According best of authors‟ knowledge, there is no method available to quantitatively evaluate the cost and benefits of implementing a Lean strategy to address the weaknesses in the manufacturing process. Therefore, benefits of Lean approaches cannot be clearly established. The authors developed a methodology to quantitatively measure the performances of a manufacturing system in detecting the causes of inefficiencies and to select appropriate Lean strategies to address the problems identified. The proposed methodology demonstrates that the Lean strategies should be implemented based on the contexts of the organization and identified problem in order to achieve maximum cost benefits. Finally, a case study has been presented to demonstrate how the procedure developed works in practical situation.

Constructability improvement in sea water intake structure

Purpose The purpose of this paper is to explore the process, and analyse the implementation of constructability improvement and innovation result during the planning and design for sea water intake structure of fertilizer plant project. Design/methodology/approach The research methodology approach is case study method at project level. This constructability improvement process was investigated by using constructability implementation check lists, direct observation, documented lesson learned analysis and key personnel interviews. Findings The case study shows that the implementation of constructability during planning and design stage for this sea water intake structure has increased the project performance as well as improved the schedule by 5 months (14.21%) and reduced the project cost by 15.35%. Research limitations/implications This case study was limited to three (3) previous sea water intake projects as references and one (1) of new method sea water intake structure at fertilizer plant project. Practical implications A constructability improvement check list using theory and lesson learned for the specific construction project was documented. Originality/value The findings support the relevant study of constructability and provide specific lesson learned for three (3) previous project and one (1) of the new innovation method of the construction project and documented by the company.