Reliability of point-of-care testing of INR in acute stroke

Background In the emergency department, portable point-of-care testing (POCT) coagulation devices may facilitate stroke patient care by providing rapid International Normalized Ratio (INR) measurement. The objective of this study was to evaluate the reliability, validity, and impact on clinical decision-making of a POCT device for INR testing in the setting of acute ischemic stroke (AIS). Methods A total of 150 patients (50 healthy volunteers, 51 anticoagulated patients, 49 AIS patients) were assessed in a tertiary care facility. The INR's were measured using the Roche Coaguchek S and the standard laboratory technique. Results The interclass correlation coefficient and 95% confidence interval between overall POCT device and standard laboratory value INRs was high (0.932 (0.69 - 0.78). In the AIS group alone, the correlation coefficient and 95% CI was also high 0.937 (0.59 - 0.74) and diagnostic accuracy of the POCT device was 94%. Conclusions When used by a trained health professional in the emergency department to assess INR in acute ischemic stroke patients, the CoaguChek S is reliable and provides rapid results. However, as concordance with laboratory INR values decreases with higher INR values, it is recommended that with CoaguChek S INRs in the > 1.5 range, a standard laboratory measurement be used to confirm the results.

The Cougar Point tuff: Implications for thermochemical zonation and longevity of high-temperature, large-volume silicic magmas of the Miocene Yellowstone hotspot

The 12.7-10.5 Ma Cougar Point Tuff in southern Idaho, USA, consists of 10 large-volume (>10²-10³ km³ each), high-temperature (800-1000 °C), rhyolitic ash-flow tuffs erupted from the Bruneau-Jarbidge volcanic center of the Yellowstone hotspot. These tuffs provide evidence for compositional and thermal zonation in pre-eruptive rhyolite magma, and suggest the presence of a long-lived reservoir that was tapped by numerous large explosive eruptions. Pyroxene compositions exhibit discrete compositional modes with respect to Fe and Mg that define a linear spectrum punctuated by conspicuous gaps. Airfall glass compositions also cluster into modes, and the presence of multiple modes indicates tapping of different magma volumes during early phases of eruption. Equilibrium assemblages of pigeonite and augite are used to reconstruct compositional and thermal gradients in the pre-eruptive reservoir. The recurrence of identical compositional modes and of mineral pairs equilibrated at high temperatures in successive eruptive units is consistent with the persistence of their respective liquids in the magma reservoir. Recurrence intervals of identical modes range from 0.3 to 0.9 Myr and suggest possible magma residence times of similar duration. Eruption ages, magma temperatures, Nd isotopes, and pyroxene and glass compositions are consistent with a long-lived, dynamically evolving magma reservoir that was chemically and thermally zoned and composed of multiple discrete magma volumes.

Suitability of diodes for point dose measurements in IMRT/VMAT beams

This study investigated a potential source of inaccuracy for diode measurements in modulated beams; the effect of diode housing asymmetry on measurement results. The possible effects of diode housing asymmetry on the measurement of steep dose gradients were evaluated by measuring 5x5 cm2 beam profiles, with three cylindrical diodes and two commonly used ionization chambers, with each dosimeter positioned in a 3D scanning water tank with its stem perpendicular to the beam axis (horizontal) and parallel to the direction of scanning. The resulting profiles were used to compare the penumbrae measured with the diode stem pointing into (equivalent to a “stem-first” setup) and out of the field (equivalent to a “stem-last” setup) in order to evaluate the effects of dosimeter alignment and thereby identify the effects of dosimeter asymmetry. The stem-first and stem-last orientations resulted in differences of up to 0.2 mm in the measured 20-80% penumbra widths and differences of up to 0.4 mm in the off axis position of the 90% isodose. These differences, which are smaller than previously reported for older model dosimeters, were apparent in the profile results for both diodes and small volume ionization chambers. As an extension to this study, the practical use of all five dosimeters was exemplified by measuring point doses in IMRT test beams. These measurements showed good agreement (within 2%) between the diodes and the small volume ionization chamber, with all of these dosimeters being able to identify a region 3% under-dosage which was not identified by a larger volume (6 mm diameter) ionization chamber. The results of this work should help to remove some of the barriers to the use of diodes for modulated radiotherapy dosimetry in the future.

Positioning the nursing librarian on the wards: nursing grand rounds with a difference

The concept nursing grand rounds (NGR) has been reported in the nursing literature since the 1960s. Many of the reported initiatives are based on a presentation forum in the manner of medical grand rounds, as an approach to undergraduate education, or as a means to monitor patients. Among the points of difference in the design of the pilot project undertaken in a busy surgical ward to investigate the effectiveness of NGR in increasing nurses work satisfaction was the inclusion of the nursing librarian as an integral part of the NGR team and processes which previously has not reported in the literature. The nursing librarian’s role was to search the literature and find the best evidence on the predetermined patient topic prior to the NGR to enable the nurse presenting to integrate the research findings into the presentation of the patient. The nursing librarian attended each NGR and commented where appropriate on the level of evidence. Nurses discussed current practice and the impact the retrieved literature would have on patient care comparing best practice with current practice. Outcomes of this project include in some cases change in practice, change in culture where NGRs are now embedded into ward culture, NGR extended to other wards, enthusiasm for EBP, the initiation of a “super searcher” model where the nursing librarian is more of a consultant and develops the searching skills of nominated nurses who become the resource on the ward.

Measuring impact: Positioning evaluation in the Australian arts and culture landscape

Arts culture organisations and funding authorities increasingly need to evaluate the impact of festivals, events and performances. Economic impacts are often privileged over 'soft data' about community experience and engagement. This new book offers a timely and scholarly demonstration of how cultural value and impact can be evaluated. It offers an innovative approach whereby the relationship developed between the researchers/evaluator and the commissioning arts and cultural producer provides an opportunity to rethink the traditional process of reporting back on value and impact through the singular entity of funds acquittal. Using three commissioned evaluations undertaken at an Australian university as an extended case study, the book investigates the two positions most often adopted by researchers/evaluators - embedded and collaborative, or external and distanced - and argues the merits and deficiencies of the two approaches. Offering an examination of how arts evaluation 'works' in theory and practice and more importantly, why it is needed now and in the future to demonstrate the reach and cultural gains from arts and cultural projects, this will be essential reading for students in arts management, professionals working in arts and cultural organisations, scholars working in association with creative industries and cultural development.

Finding the leverage point in the sustainability crisis: Global, national and regional Australian responses

From an economic perspective, the sustainability crisis is ultimately characterized by a worsening relationship between the resources required to support the global population and the ability of the earth to supply them. Despite the ever-increasing threat of a calamity, modern society appears unable to alter its course. The very systems which underpin global human endeavor seem to actively prevent meaningful change and the one irrepressible goal to which all societies seem to strive is the very thing that makes such endeavor ultimately life threatening: that of global growth. Using the Australian experience as an exemplar, this paper explores how the concept of growth infiltrates societal reactions to the crisis at various scales – global, national and regional. Analysis includes historic studies, a critique of current misconceptions around population demographics, comparative evaluation of various interventions in the Australian context and considerations around potential ways to address the crisis.

The discursive positioning of graduating teachers in accreditation of teacher education programs

This paper uses discourse analysis techniques associated with Foucauldian archaeology to examine a teacher education accreditation document from Australia to reveal how graduating teachers are constructed through the discourses presented. The findings reveal a discursive site of contestation within the document itself and a mismatch between the identified policy discourses and those from the academic archive. The authors suggest that rather than contradictory representations of what constitutes graduating teacher quality and professionalism, what is needed is an accreditation process that agrees on constructions of graduate identity and professional practice that enact an intellectual and reflexive form of professionalism.

Beyond social justice agendas: Indigenous knowledges in pre-service teacher education and practice in Australia

The space and positioning of Indigenous knowledges (IK) within Australian curricula and pedagogy are often contentious, informed by the broader Australian socio-cultural, political and economic landscape. Against changing educational policy, historically based on the myth of terra nullius, we discuss the shifting priorities for embedding Indigenous knowledges in educational practice in university and school curricula and pedagogy. In this chapter, we argue that personal and professional commitment to social justice is an important starting point for embedding Indigenous knowledges in the Australian school curricula and pedagogy. Developing teacher knowledge around embedding IK is required to enable teachers’ preparedness to navigate a contested historical/colonising space in curriculum decision-making, teaching and learning. We draw one mpirical data from a recent research project on supporting pre-service teachers as future curriculum leaders; the project was funded by the Office of Learning and Teaching (OLT). This project aimed to support future curriculum leaders to develop their knowledge of embedding IK at one Australian university. We propose supporting the embedding of IK in situ with pre-service teachers and their supervising teachers on practicum in real, sustained and affirming ways that shifts the recognition of IK from personal commitment to social justice in education, to one that values Indigenous knowledges as content to educate (Connell, 1993). We argue that sustained engagement with and appreciation of IKhas the potential to decolonise Australian curricula, shift policy directions and enhance race relations between Indigenous and non-Indigenous Australians .

Critical risk factors affecting the implementation of PPP waste-to-energy projects in China

Since 2003, Mainland China has been promoting the public–private partnership (PPP) procurement model in the waste-to-energy incineration sector to reduce the waste burying rate and improve environmental quality. Five critical risk factors (CRFs) that affect the construction and operation of waste-to-energy incineration projects have been identified from real-life risk events of 14 PPP waste-to-energy incineration plants through content analysis. These risk factors are insufficient waste supply, disposal of non-licensed waste, environmental risk, payment risk, and lack of supporting infrastructure. A recently completed PPP waste-to-energy incineration plant, the Shanghai Tianma project, was investigated to learn from the effective management of CRFs. First-hand data about the Shanghai Tianma project was collected, with a focus on project negotiation and concession agreement. Lessons learned about risk management were acquired. This paper presents a detailed study of the contractual structure, risk sharing scheme, risk response measures to CRFs, and project transfer of a PPP project. The study results will provide governments with management implications to prepare equitable concession agreements and benefit private investors by effectively mitigating and managing risks in future PPP waste-to-energy incineration projects.

Optimal management of the critically Ill: Anaesthesia, monitoring, data capture, and point-of-care technological practices in ovine models of critical care

Animal models of critical illness are vital in biomedical research. They provide possibilities for the investigation of pathophysiological processes that may not otherwise be possible in humans. In order to be clinically applicable, the model should simulate the critical care situation realistically, including anaesthesia, monitoring, sampling, utilising appropriate personnel skill mix, and therapeutic interventions. There are limited data documenting the constitution of ideal technologically advanced large animal critical care practices and all the processes of the animal model. In this paper, we describe the procedure of animal preparation, anaesthesia induction and maintenance, physiologic monitoring, data capture, point-of-care technology, and animal aftercare that has been successfully used to study several novel ovine models of critical illness. The relevant investigations are on respiratory failure due to smoke inhalation, transfusion related acute lung injury, endotoxin-induced proteogenomic alterations, haemorrhagic shock, septic shock, brain death, cerebral microcirculation, and artificial heart studies. We have demonstrated the functionality of monitoring practices during anaesthesia required to provide a platform for undertaking systematic investigations in complex ovine models of critical illness.

Estimation of the time of a linear trend in monitoring survival time

Change point estimation is recognized as an essential tool of root cause analyses within quality control programs as it enables clinical experts to search for potential causes of change in hospital outcomes more effectively. In this paper, we consider estimation of the time when a linear trend disturbance has occurred in survival time following an in-control clinical intervention in the presence of variable patient mix. To model the process and change point, a linear trend in the survival time of patients who underwent cardiac surgery is formulated using hierarchical models in a Bayesian framework. The data are right censored since the monitoring is conducted over a limited follow-up period. We capture the effect of risk factors prior to the surgery using a Weibull accelerated failure time regression model. We use Markov Chain Monte Carlo to obtain posterior distributions of the change point parameters including the location and the slope size of the trend and also corresponding probabilistic intervals and inferences. The performance of the Bayesian estimator is investigated through simulations and the result shows that precise estimates can be obtained when they are used in conjunction with the risk-adjusted survival time cumulative sum control chart (CUSUM) control charts for different trend scenarios. In comparison with the alternatives, step change point model and built-in CUSUM estimator, more accurate and precise estimates are obtained by the proposed Bayesian estimator over linear trends. These superiorities are enhanced when probability quantification, flexibility and generalizability of the Bayesian change point detection model are also considered.

Separable spatiotemporal priors for convex reconstruction of time-varying 3D point clouds

Reconstructing 3D motion data is highly under-constrained due to several common sources of data loss during measurement, such as projection, occlusion, or miscorrespondence. We present a statistical model of 3D motion data, based on the Kronecker structure of the spatiotemporal covariance of natural motion, as a prior on 3D motion. This prior is expressed as a matrix normal distribution, composed of separable and compact row and column covariances. We relate the marginals of the distribution to the shape, trajectory, and shape-trajectory models of prior art. When the marginal shape distribution is not available from training data, we show how placing a hierarchical prior over shapes results in a convex MAP solution in terms of the trace-norm. The matrix normal distribution, fit to a single sequence, outperforms state-of-the-art methods at reconstructing 3D motion data in the presence of significant data loss, while providing covariance estimates of the imputed points.

Milling innovations at Rocky Point

This paper reviews the innovations that have been introduced in the milling train at Rocky Point mill since 2001 and provides some operational, performance and maintenance comparisons of the technologies in use. The decision to install BHEM mills in the #2 and #3 mill positions to complement the six-roll mills in the #1 and #4 mill positions has proven a good one. Satisfactory performance is being obtained by these mills while maintenance costs are significantly less. Very good #1 mill extraction and final bagasse moisture content are being achieved. The innovation of using Hägglunds hydraulic drives at higher speed…

Cumulative effects on the change of residual value in PPP projects: A comparative case study

Public private partnerships (PPPs) have been adopted widely to provide public facilities and services. According to the PPP agreement, PPP projects would be transferred to the public sector. However, problems related to the subsequent management of ongoing PPP projects have not been studied thoroughly. Residual value risk (RVR) can occur if the public sector cannot obtain the project in the desired conditions as required in the agreement when a project is being transferred. RVR has been identified as an important risk in PPPs and has greatly influenced the outputs of the projects. In order to further observe the change of residual value (RV) during the process of PPP projects and to reveal the internal mechanism for reducing the RVR, a comparative case study of two PPP projects in mainland China and Hong Kong was conducted. Based on the case study, different factors leading to RVR and a series of key risk indicators (KRIs) were identified. The comparison demonstrates that RVR is an important risk that could influence the success of PPP projects. The cumulative effects during the concession period can play significant roles in the occurrence of RVR. Additionally, the cumulative effects in different cases can make the RVR different because of different stakeholders’ efforts on the projects and ways to treat RVR. Finally, alternatives for the public sector to treat RVR were proposed. The findings of this research can reduce RVR and improve the performance of PPP projects.