A real-time abnormality detection system for intensive care management

Detecting abnormalities from multiple correlated time series is valuable to those applications where a credible realtime event prediction system will minimize economic losses (e.g. stock market crash) and save lives (e.g. medical surveillance in the operating theatre). For example, in an intensive care scenario, anesthetists perform a vital role in monitoring the patient and adjusting the flow and type of anesthetics to the patient during an operation. An early awareness of possible complications is vital for an anesthetist to correctly react to a given situation. In this demonstration, we provide a comprehensive medical surveillance system to effectively detect abnormalities from multiple physiological data streams for assisting online intensive care management. Particularly, a novel online support vector regression (OSVR) algorithm is developed to approach the problem of discovering the abnormalities from multiple correlated time series for accuracy and real-time efficiency. We also utilize historical data streams to optimize the precision of the OSVR algorithm. Moreover, this system comprises a friendly user interface by integrating multiple physiological data streams and visualizing alarms of abnormalities. © 2013 IEEE.

Improving child and family outcomes following complicated births requiring admission to neonatal intensive care units

This paper reviews current research regarding the impact of birth complications, such as preterm labour, on parents and the nuclear family system. Specifically, how parents cope with the neonatal intensive care unit (NICU) experience and the associated decision-making tasks required during complicated births will be investigated. Consequences of poor adaptation to prematurity for the parent, family and infant relationships will also be discussed. The importance of informed decision-making, perceived control, self-esteem and the benefits of certain strategies, such as kangaroo care (skin-to-skin contact), in the facilitation of greater levels of attachment and improved relationships, will be highlighted. The paper concludes with suggestions for future research areas to focus on finding better ways to prepare and support parents in these situations, thus improving the quality of relationships between parents and with their child.

Nature, extent and antecedents of risk managment practices in knowledge-intensive firms

This study provides empirical evidence on the nature and extent of risks faced by Small to Medium-Sized Knowledge Intensive Firms (SMKIFs) and the risk management approaches adopted by them. The study also assesses the effects of selected organisational factors such as industry, entity size and risk governance leadership on the commitment by SMKIFs to using an Enterprise Risk Management (ERM) approach. Data was obtained through a questionnaire survey of SMKIFs in the state of Victoria, Australia which were either in the bio-technology (bio-tech) or the accounting and legal (business services) industry sectors. Based on a total of 104 (13%) useable responses from senior managers in charge of risk management, some of the key findings include the identification of the top three risks faced by SMKIFs being (i) potential damage to firm’s reputation, (ii) inability to recruit and retain workers who have appropriate skills and expertise, and (iii) increase in costs. Interestingly, while 51% of the respondents described their firms as being willing to or keen to take risks, 38% saw their firms as being either preferring not to take risks or refuse to take risks, with the remainder of the firms (11%) viewed as neutral. The data also indicates that more than half of the respondent firms (54%) had established either a complete or a partial ERM system. Further, data analysis based on a binary logit regression model indicates bio-techs, firm size and directors’ support of risk management as key predictors of ERM implementation in SMKIFs.

Knowledge sharing in professional accountancy firms : the effects of task complexity and management control system

Numerous empirical studies on knowledge management have focused on effectiveness of enablers such as organizational structure (Bennett and Gabriel, 1999; Gold et al., 2001), technology (Gold et al., 2001; O’Dell and Grayson, 1998), culture (DeLong and Fahey, 2000; Gupta and Govindarajan, 2000), managerial system (Nonaka, 1994; Sveiby, 1997) and strategy (Bierly and Chakrabarti, 1996; Holsapple and Joshi, 2001) on knowledge sharing. These enablers are organizational infrastructure or mechanism for facilitating the sharing of knowledge in a firm. In knowledge-intensive firms, task complexity and management control systems (MCS) can potentially affect the mode and effectiveness of knowledge sharing. However, these two factors have not been distinctly and explicitly investigated and discussed in literature relevant to the domain of knowledge sharing and management. This study proposes to examine how task complexity and the design of MCS could be the key determinants of the mode and effectiveness of knowledge sharing in professional accounting firms or practices.

Critical ethnographic study of an intensive care unit in Hong Kong

This critical ethnographic study was initiated to explore the ways in which the concepts of caring and caring practices were constructed by nurses working in an intensive care unit in a Hong Kong hospital using a broadly Habermasian critical framework. A reform of the health care system has disturbed both the nurses and the structure of nursing.

An automatic application signature construction system for unknown traffic

Identifying applications and classifying network traffic flows according to their source applications are critical for a broad range of network activities. Such a decision can be based on packet header fields, packet payload content, statistical characteristics of traffic and communication patterns of network hosts. However, most present techniques rely on some sort of apriori knowledge, which means they require labor-intensive preprocessing before running and cannot deal with previously unknown applications. In this paper, we propose a traffic classification system based on application signatures, with a novel approach to fully automate the process of deriving signatures from unidentified traffic. The key idea is to integrate statistics-based flow clustering with payload-based signature matching method, so as to eliminate the requirement of pre-labeled training data sets. We evaluate the efficiency of our approach using real-world traffic trace, and the results indicate that signature classifiers built from clustered data and pre-labeled data are able to achieve similar high accuracy better than 99%.

The uptake of an early warning system in an Australian emergency department : a pilot study

Objectives: To evaluate the uptake of an emergency department early warning system (ED EWS) for recognition of, and response to, clinical deterioration.

Design, setting and participants: A descriptive exploratory study conducted in an urban district hospital in Melbourne, Australia. Systematic sampling was used to identify every 10th patient for whom the ED EWS was activated from May 2009 to May 2011.

Main outcome measures: Patient characteristics, ED system data and ED EWS activation characteristics.

Results: ED EWS activation occurred in 1.5% of ED patients; 204 patients were included in this pilot study. The median age was 65.1 years (interquartile range [IQR], 47.8-77.5 years), 89.2% of patients were classified as triage category 2 or 3, and 82.4% of patients were seen by medical staff before ED EWS activation. Hypotension (27.7%) and tachycardia (23.7%) were the most common reasons for ED EWS activation. Median duration of clinical instability was 39 minutes (IQR, 5- 129 minutes). Nurses made 93.1% of ED EWS activations. Median time between documenting physiological abnormalities and ED EWS activation was 5 minutes (IQR, 0- 20). Most patients (57.8%) required hospital admission: 4.4% of patients required intensive care unit admission.

Conclusions: The ED EWS resulted in at least two formal reports of clinical deterioration in ED patients per day, indicating reasonable uptake by clinicians. A greater understanding of clinical deterioration in ED patients is warranted to inform an evidence-based approach to recognition of, and response to, clinical deterioration in ED patients.

Role of intensive training in the growth and maturation of artistic gymnasts

Short stature and later maturation of youth artistic gymnasts are often attributed to the effects of intensive training from a young age. Given limitations of available data, inadequate specification of training, failure to consider other factors affecting growth and maturation, and failure to address epidemiological criteria for causality, it has not been possible thus far to establish cause–effect relationships between training and the growth and maturation of young artistic gymnasts. In response to this ongoing debate, the Scientific Commission of the International Gymnastics Federation (FIG) convened a committee to review the current literature and address four questions: (1) Is there a negative effect of training on attained adult stature? (2) Is there a negative effect of training on growth of body segments? (3) Does training attenuate pubertal growth and maturation, specifically, the rate of growth and/or the timing and tempo of maturation? (4) Does training negatively influence the endocrine system, specifically hormones related to growth and pubertal maturation? The basic information for the review was derived from the active involvement of committee members in research on normal variation and clinical aspects of growth and maturation, and on the growth and maturation of artistic gymnasts and other youth athletes. The committee was thus thoroughly familiar with the literature on growth and maturation in general and of gymnasts and young athletes. Relevant data were more available for females than males. Youth who persisted in the sport were a highly select sample, who tended to be shorter for chronological age but who had appropriate weight-for-height. Data for secondary sex characteristics, skeletal age and age at peak height velocity indicated later maturation, but the maturity status of gymnasts overlapped the normal range of variability observed in the general population. Gymnasts as a group demonstrated a pattern of growth and maturation similar to that observed among short-, normal-, late-maturing individuals who were not athletes. Evidence for endocrine changes in gymnasts was inadequate for inferences relative to potential training effects. Allowing for noted limitations, the following conclusions were deemed acceptable: (1) Adult height or near adult height of female and male artistic gymnasts is not compromised by intensive gymnastics training. (2) Gymnastics training does not appear to attenuate growth of upper (sitting height) or lower (legs) body segment lengths. (3) Gymnastics training does not appear to attenuate pubertal growth and maturation, neither rate of growth nor the timing and tempo of the growth spurt. (4) Available data are inadequate to address the issue of intensive gymnastics training and alterations within the endocrine system.

Characteristics and outcomes of patients requiring rapid response system activation within 24 hours of emergency admission

Objectives: 

Remote monitoring system enabling cloud technology upon smart phones and inertial sensors for human kinematics

Stroke is a common neurological condition which is becoming increasingly common as the population ages. This entails healthcare monitoring systems suitable for home use, with remote access for medical professionals and emergency responders. The mobile phone is becoming the easy access tool for self-evaluation of health, but it is hindered by inherent problems including computational power and storage capacity. This research proposes a novel cloud based architecture of a biomedical system for a wearable motion kinematic analysis system which mitigates the above mentioned deficiencies of mobile devices. The system contains three subsystems: 1. Bio Kin WMS for measuring the acceleration and rotation of movement 2. Bio Kin Mobi for Mobile phone based data gathering and visualization 3. Bio Kin Cloud for data intensive computations and storage. The system is implemented as a web system and an android based mobile application. The web system communicates with the mobile application using an encrypted data structure containing sensor data and identifiable headings. The raw data, according to identifiable headings, is stored in the Amazon Relational Database Service which is automatically backed up daily. The system was deployed and tested in Amazon Web Services.

Findings of the first ANZICS conference on the role of intensive care in Rapid Response Teams.

Rapid Response Teams (RRTs) are specialised teams introduced into hospitals to improve the outcomes of deteriorating ward patients. Although Rapid Response Systems (RRSs) were developed by the intensive care unit (ICU) community, there is variability in their delivery, and consultant involvement, supervision and leadership appears to be relatively infrequent. In July 2014, the Australian and New Zealand Intensive Care Society (ANZICS) convened the first conference on the role of intensive care medicine in RRTs in Australia and New Zealand. The conference explored RRSs in the broader role of patient safety, resourcing and staffing of RRTs, effect on ICU workload, different RRT models, the outcomes of RRT patients and original research projects in the area of RRSs. Issues around education and training of both ICU registrars and nurses were examined, and the role of team training explored. Measures to assess the effectiveness of the RRS and RRT at the level of health system and hospital, team performance and team effectiveness were discussed, and the need to develop a bi-national ANZICS RRT patient database was presented. Strategies to prevent patient deterioration in the 'pre-RRT' period were discussed, including education of ward nurses and doctors, as well as an overarching governance structure. The role of the ICU in deteriorating ward patients was debated and an integrated model of acute care presented. This article summarises the findings of the conference and presents recommendations on the role of intensive care medicine in RRTs in Australia and New Zealand.

Towards designing an email classification system using multi-view based semi-supervised learning

The goal of email classification is to classify user emails into spam and legitimate ones. Many supervised learning algorithms have been invented in this domain to accomplish the task, and these algorithms require a large number of labeled training data. However, data labeling is a labor intensive task and requires in-depth domain knowledge. Thus, only a very small proportion of the data can be labeled in practice. This bottleneck greatly degrades the effectiveness of supervised email classification systems. In order to address this problem, in this work, we first identify some critical issues regarding supervised machine learning-based email classification. Then we propose an effective classification model based on multi-view disagreement-based semi-supervised learning. The motivation behind the attempt of using multi-view and semi-supervised learning is that multi-view can provide richer information for classification, which is often ignored by literature, and semi-supervised learning supplies with the capability of coping with labeled and unlabeled data. In the evaluation, we demonstrate that the multi-view data can improve the email classification than using a single view data, and that the proposed model working with our algorithm can achieve better performance as compared to the existing similar algorithms.

Clinical review criteria and medical emergency teams: evaluating a two-tier rapid response system

OBJECTIVES: To assess the prevalence of patients fulfilling clinical review criteria (CRC), to determine activation rates for CRC assessments, to compare baseline characteristics and outcomes of patients who fulfilled CRC with patients who did not, and to identify the documented nursing actions in response to CRC values. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional study using a retrospective medical record audit, in a universityaffiliated, tertiary referral hospital with a two-tier rapid response system in Melbourne, Australia. We used a convenience sample of hospital inpatients on general medical, surgical and specialist service wards admitted during a 24-hour period in 2013. MAIN OUTCOME MEASURES: Medical emergency team (MET) or code blue activation, unplanned intensive care unit admissions, hospital length of stay and inhospital mortality. For patients who fulfilled CRC or MET criteria during the 24- hour period, the specific criteria fulfilled, escalation treatments and outcomes were collected. RESULTS: Of the sample (N = 422), 81 patients (19%) fulfilled CRC on 109 occasions. From 109 CRC events, 66 patients (81%) had at least one observation fulfilling CRC, and 15 patients (18%) met CRC on multiple occasions. The documented escalation rate was 58 of 109 events (53%). The number of patients who fulfilled CRC and subsequent MET call activation criteria within 24 hours was significantly greater than the number who did not meet CRC (P < 0.001). CONCLUSIONS: About one in five patients reached CRC during the study period; these patients were about four times more likely to also fulfil MET call criteria. Contrary to hospital policy, escalation was not documented for about half the patients meeting CRC values. Despite the clarity of escalation procedures on the graphic observation chart, escalation remains an ongoing problem. Further research is needed on the impact on patient outcomes over time and to understand factors influencing staff response.

Trajectory of sedation assessment and sedative use in intubated and ventilated patients in intensive care: a clinical audit

Background: Sedation is crucial for the recovery of patients in intensive care units (ICUs). Maintaining comfort and safety promotes optimal care for critically ill patients. Purpose: To examine sedation assessment and management undertaken by health professionals for mechanically ventilated patients in one Australian ICU. Methods: A retrospective clinical audit was undertaken of medical records of all eligible, mechanically ventilated patients admitted to an ICU of an Australian metropolitan, teaching hospital over a 12-month period. A Sedation Audit Tool was used to collect data from the day of intubation to 5 days after intubation. Findings: Data were extracted from medical records of 150 patients. The Riker Sedation-Agitation Scale (SAS) was the scoring system used. Patients were unarousable or very sedated between 57% and 81% at some point during the study period, while between 5% and 11% were agitated, very agitated or extremely agitated across this time. Patients' sedation scores were not documented in between 3.3% and 23.3% of patients. Medications commonly used were propofol, midazolam, morphine, and fentanyl. There were 135 situations of adverse events, which related to patients pulling endotracheal tubes leading to malpositioning, patients biting endotracheal tubes causing desaturation, patient experiencing excessive agitation requiring restraint use, patients experiencing increased intracranial pressure above desired limits, patients self-extubating, and patients experiencing over-drowsiness leading to delays in extubation. Conclusions: Many patients were either very sedated or agitated at some point during the study period, and some patients experienced adverse outcomes associated with sedation practices. The findings inform future quality initiatives to improve sedation practices.