Clinical Accuracy of the MedGem Indirect Calorimeter for Measuring Resting Energy Expenditure in Cancer Patients

OBJECTIVE: To compare, in patients with cancer and in healthy subjects, measured resting energy expenditure (REE) from traditional indirect calorimetry to a new portable device (MedGem) and predicted REE. DESIGN: Cross-sectional clinical validation study. SETTING: Private radiation oncology centre, Brisbane, Australia. SUBJECTS: Cancer patients (n = 18) and healthy subjects (n = 17) aged 37-86 y, with body mass indices ranging from 18 to 42 kg/m(2). INTERVENTIONS: Oxygen consumption (VO(2)) and REE were measured by VMax229 (VM) and MedGem (MG) indirect calorimeters in random order after a 12-h fast and 30-min rest. REE was also calculated from the MG without adjustment for nitrogen excretion (MGN) and estimated from Harris-Benedict prediction equations. Data were analysed using the Bland and Altman approach, based on a clinically acceptable difference between methods of 5%. RESULTS: The mean bias (MGN-VM) was 10% and limits of agreement were -42 to 21% for cancer patients; mean bias -5% with limits of -45 to 35% for healthy subjects. Less than half of the cancer patients (n = 7, 46.7%) and only a third (n = 5, 33.3%) of healthy subjects had measured REE by MGN within clinically acceptable limits of VM. Predicted REE showed a mean bias (HB-VM) of -5% for cancer patients and 4% for healthy subjects, with limits of agreement of -30 to 20% and -27 to 34%, respectively. CONCLUSIONS: Limits of agreement for the MG and Harris Benedict equations compared to traditional indirect calorimetry were similar but wide, indicating poor clinical accuracy for determining the REE of individual cancer patients and healthy subjects.

Tuning the valence of the cerium center in (Na)phthalocyaninato and porphyrinato cerium double-deckers by changing the nature of the tetrapyrrole ligands

A series of 7 cerium double-decker complexes with various tetrapyrrole ligands including porphyrinates, phthalocyaninates, and 2,3-naphthalocyaninates have been prepared by previously described methodologies and characterized with elemental analysis and a range of spectroscopic methods. The molecular structures of two heteroleptic \[(na)phthalocyaninato](porphyrinato) complexes have also been determined by X-ray diffraction analysis which exhibit a slightly distorted square antiprismatic geometry with two domed ligands. Having a range of tetrapyrrole ligands with very different electronic properties, these compounds have been systematically investigated for the effects of ligands on the valence of the cerium center. On the basis of the spectroscopic (UV−vis, near-IR, IR, and Raman), electrochemical, and structural data of these compounds and compared with those of the other rare earth(III) counterparts reported earlier, it has been found that the cerium center adopts an intermediate valence in these complexes. It assumes a virtually trivalent state in cerium bis(tetra-tert-butylnaphthalocyaninate) as a result of the two electron rich naphthalocyaninato ligands, which facilitate the delocalization of electron from the ligands to the metal center. For the rest of the cerium double-deckers, the cerium center is predominantly tetravalent. The valences (3.59−3.68) have been quantified according to their LIII-edge X-ray absorption near-edge structure (XANES) profiles.

A maintenance-data-model of enterprise resource planning

Two distinct maintenance-data-models are studied: a government Enterprise Resource Planning (ERP) maintenance-data-model, and the Software Engineering Industries (SEI) maintenance-data-model. The objective is to: (i) determine whether the SEI maintenance-data-model is sufficient in the context of ERP (by comparing with an ERP case), (ii) identify whether the ERP maintenance-data-model in this study has adequately captured the essential and common maintenance attributes (by comparing with the SEI), and (iii) proposed a new ERP maintenance-data-model as necessary. Our findings suggest that: (i) there are variations to the SEI model in an ERP-context, and (ii) there are rooms for improvements in our ERP case’s maintenance-data-model. Thus, a new ERP maintenance-data-model capturing the fundamental ERP maintenance attributes is proposed. This model is imperative for: (i) enhancing the reporting and visibility of maintenance activities, (ii) monitoring of the maintenance problems, resolutions and performance, and (iii) helping maintenance manager to better manage maintenance activities and make well-informed maintenance decisions.

Access all

Access All was performance produced following a three-month mentorship in web-based performance that I was commissioned to conduct for the performance company Igneous. This live, triple-site performance event for three performers in three remote venues was specifically designed for presentation at Access Grid Nodes - conference rooms located around the globe equipped with a high end, open source computer teleconferencing technology that allowed multiple nodes to cross-connect with each other. Whilst each room was setup somewhat differently they all deployed the same basic infrastructre of multiple projectors, cameras, and sound as well as a reconfigurable floorspace. At that time these relatively formal setups imposed a clear series of limitations in terms of software capabilities and basic infrastructure and so there was much interest in understanding how far its capabilities might be pushed.----- Numerous performance experiments were undertaken between three Access Grid nodes in QUT Brisbane, VISLAB Sydney and Manchester Supercomputing Centre, England, culminating in the public performance staged simultaneously between the sites with local audiences at each venue and others online. Access All was devised in collaboration with interdisciplinary performance company Bonemap, Kelli Dipple (Interarts curator, Tate Modern London) and Mike Stubbs British curator and Director of FACT (Liverpool).----- This period of research and development was instigated and shaped by a public lecture I had earlier delivered in Sydney for the ‘Global Access Grid Network, Super Computing Global Conference’ entitled 'Performance Practice across Electronic Networks'. The findings of this work went on to inform numerous future networked and performative works produced from 2002 onwards.

Creating a therapeutic environment : a non-randomised controlled trial of a quiet time intervention for patients in acute care

Background: Noise is a significant barrier to sleep for acute care hospital patients, and sleep has been shown to be therapeutic for health, healing and recovery. Scheduled quiet time interventions to promote inpatient rest and sleep have been successfully trialled in critical care but not in acute care settings. Objectives: The study aim was to evaluate as cheduled quiet time intervention in an acute care setting. The study measured the effect of a scheduled quiet time on noise levels, inpatients’ rest and sleep behaviour, and wellbeing. The study also examined the impact of the intervention on patients’, visitors’ and health professionals’ satisfaction, and organisational functioning. Design: The study was a multi-centred non-randomised parallel group trial. Settings: The research was conducted in the acute orthopaedic wards of two major urban public hospitals in Brisbane, Australia. Participants: All patientsadmitted to the two wards in the5-month period of the study were invited to participate, withafinalsample of 299 participants recruited. This sample produced an effect size of 0.89 for an increase in the number of patients asleep during the quiet time. Methods: Demographic data were collected to enable comparison between groups. Data for noise level, sleep status, sleepiness and well being were collected using previously validated instruments: a Castle Model 824 digital sound level indicator; a three point sleep status scale; the Epworth Sleepiness Scale; and the SF12 V2 questionnaire. The staff, patient and visitor surveys on the experimental ward were adapted from published instruments. Results: Significant differences were found between the two groups in mean decibel level and numbers of patients awake and asleep. The difference in mean measured noise levels between the two environments corresponded to a ‘perceived’ difference of 2 to 1. There were significant correlations between average decibel level and number of patients awake and asleep in the experimental group, and between average decibel level and number of patients awake in the control group. Overall, patients, visitors and health professionals were satisfied with the quiet time intervention. Conclusions: The findings show that a quiet time intervention on an acute care hospital ward can affect noise level and patient sleep/wake patterns during the intervention period. The overall strongly positive response from surveys suggests that scheduled quiet time would be a positively perceived intervention with therapeutic benefit.

Power network in the loop : subsystem testing using a switching amplifier

“Hardware in the Loop” (HIL) testing is widely used in the automotive industry. The sophisticated electronic control units used for vehicle control are usually tested and evaluated using HIL-simulations. The HIL increases the degree of realistic testing of any system. Moreover, it helps in designing the structure and control of the system under test so that it works effectively in the situations that will be encountered in the system. Due to the size and the complexity of interaction within a power network, most research is based on pure simulation. To validate the performance of physical generator or protection system, most testing is constrained to very simple power network. This research, however, examines a method to test power system hardware within a complex virtual environment using the concept of the HIL. The HIL testing for electronic control units and power systems protection device can be easily performed at signal level. But performance of power systems equipments, such as distributed generation systems can not be evaluated at signal level using HIL testing. The HIL testing for power systems equipments is termed here as ‘Power Network in the Loop’ (PNIL). PNIL testing can only be performed at power level and requires a power amplifier that can amplify the simulation signal to the power level. A power network is divided in two parts. One part represents the Power Network Under Test (PNUT) and the other part represents the rest of the complex network. The complex network is simulated in real time simulator (RTS) while the PNUT is connected to the Voltage Source Converter (VSC) based power amplifier. Two way interaction between the simulator and amplifier is performed using analog to digital (A/D) and digital to analog (D/A) converters. The power amplifier amplifies the current or voltage signal of simulator to the power level and establishes the power level interaction between RTS and PNUT. In the first part of this thesis, design and control of a VSC based power amplifier that can amplify a broadband voltage signal is presented. A new Hybrid Discontinuous Control method is proposed for the amplifier. This amplifier can be used for several power systems applications. In the first part of the thesis, use of this amplifier in DSTATCOM and UPS applications are presented. In the later part of this thesis the solution of network in the loop testing with the help of this amplifier is reported. The experimental setup for PNIL testing is built in the laboratory of Queensland University of Technology and the feasibility of PNIL testing has been evaluated using the experimental studies. In the last section of this thesis a universal load with power regenerative capability is designed. This universal load is used to test the DG system using PNIL concepts. This thesis is composed of published/submitted papers that form the chapters in this dissertation. Each paper has been published or submitted during the period of candidature. Chapter 1 integrates all the papers to provide a coherent view of wide bandwidth switching amplifier and its used in different power systems applications specially for the solution of power systems testing using PNIL.

A naturally shaped silicone ventricle evaluated in a mock circulation loop : a preliminary study

Mock circulation loops are used to evaluate the performance of cardiac assist devices prior to animal and clinical testing. A compressible, translucent silicone ventricle chamber that mimics the exact size, shape and motion of a failing heart is desired to assist in flow visualization studies around inflow cannulae during VAD support. The aim of this study was therefore to design and construct a naturally shaped flexible left ventricle and evaluate its performance in a mock circulation loop. The ventricle shape was constructed by the use of CT images taken from a patient experiencing cardiomyopathic heart failure and used to create a 3D image and subsequent mould to produce a silicone ventricle. Different cardiac conditions were successfully simulated to validate the ventricle performance, including rest, left heart failure and VAD support.

Final report : enabling team collaboration with pervasive and mobile computing

This is the final report of research project 2002-057-C: Enabling Team Collaboration with Pervasive and Mobile Computing. The research project was carried out by the Australian Cooperative Research Centre for Construction Innovation and has two streams that consider the use of pervasive computing technologies in two different contexts. The first context was the on-site deployment of mobile computing devices, where as the second context was the use and development of intelligent rooms based on sensed environments and new human-computer interfaces (HCI) for collaboration in the design office. The two streams present a model of team collaboration that relies on continues communication to people and information to reduce information leakage. This report consists of five sections: (1) Introduction; (2) Research Project Background; (3) Project Implementation; (4) Case Studies and Outcomes; and (5) Conclusion and Recommendation. Introduction in Section 1 presents a brief description of the research project including general research objectives and structure. Section 2 introduces the background of the research and detailed information regarding project participants, objectives and significance, and also research methodology. Review of all research activities such as literature review and case studies are summarised in Project Implementation in Section 3. Following this, in Section 4 the report then focuses on analysing the case studies and presents their outcomes. Conclusion and recommendation of the research project are summarised in Section 5. Other information to support the content of the report such as research project schedule is provided in Appendices. The purpose of the final project report is to provide industry partners with detailed information on the project activities and methodology such as the implementation of pervasive computing technologies in the real contexts. The report summarises the outcomes of the case studies and provides necessary recommendation to industry partners of using new technologies to support better project collaboration.

The effect of social support derived from World of Warcraft on negative psychological symptoms

Previous research examining players of Massively-Multiplayer Online Games (MMOGs) suggests that players form meaningful relationships with each other. Other research indicates that people may derive social support from online sources and this social support has been associated with greater wellbeing. This study used an online survey of players (N = 206) of the MMOG “World of Warcraft” (WoW) to examine if social support can be derived from MMOGs, and to examine its relationship with negative psychological symptoms. Players of WoW were found to derive social support from playing and a positive relationship was found between game engagement and levels of in-game social support. Higher levels of in-game social support were associated with fewer negative psychological symptoms, although this effect was not maintained after accounting for social support derived from the offline sources. Additionally, a small subsample of players (N = 21) were identified that played for between 44 and 82 hours per week (M = 63.33). These players had significantly lower levels of offline social support and higher levels of negative symptoms compared to the rest of the sample. This study provides evidence that social support can be derived from MMOGs and the associated potential to promote well being, but also highlights the potential harm from spending excessive hours playing.

Sustainable transport and the impact on the built environment : Future trends and directions

We love the automobile and the independence that it gives us. We are more mobile than we have ever been before in recorded history. In Australia 80% of journeys are by private motor vehicle. But it is becoming increasingly obvious that this era has a very limited lifespan. Fuel prices have skyrocketed recently with no end in sight. In spite of massive amounts of road construction, our cities are becoming increasingly congested. We desperately need to address climate change and the automobile is a major contributor. Carbon trading schemes will put even more upward pressure on fuel prices. At some point in the near future, most of us will need to reconsider our automobile usage whether we like it or not. The time to plan for the future is now. But what will happen to our mobility when access to cheap and available petroleum becomes a thing of the past? Will we start driving electric/hydrogen/ethanol vehicles? Or will we flock to public transport? Will our public transport systems cope with a massive increase in demand? Will thousands of people take to alternatives such as bicycles? If so, where do we put them? How do we change our roads to cope? How do we change our buildings to suit? Will we need recharging stations in our car park for example? Some countries are less reliant on the car than others e.g. Holland and Germany. How can the rest of the world learn from them? This paper discusses many of the likely outcomes of the inevitable shift away from society’s reliance on petroleum and examines the expected impact on the built environment. It also looks at ways in which the built environment can be planned to help ease the transition to a fossil free world. 1.

Increase in particle number emissions from motor vehicles due to interruption of steady traffic flow

We assess the increase in particle number emissions from motor vehicles driving at steady speed when forced to stop and accelerate from rest. Considering the example of a signalized pedestrian crossing on a two-way single-lane urban road, we use a complex line source method to calculate the total emissions produced by a specific number and mix of light petrol cars and diesel passenger buses and show that the total emissions during a red light is significantly higher than during the time when the light remains green. Replacing two cars with one bus increased the emissions by over an order of magnitude. Considering these large differences, we conclude that the importance attached to particle number emissions in traffic management policies be reassessed in the future.

Growing demand for emergency health services in Queensland, Australia

Introduction: The demand for emergency health services (EHS), both in the prehospital (ambulance) and hospital (emergency departments) settings, is growing rapidly in Australia. Broader health system changes have reduced available health infrastructure, particularly hospital beds, resulting in reduced access to and congestion of the EHS as demonstrated by longer waiting times and ambulance “ramping”. Ambulance ramping occurring when patients have a prolonged wait on the emergency vehicle due to the unavailability of hospital beds. This presentation will outline the trends in EHS demand in Queensland compared with the rest of Australia and factors that appear to be contributing to the growth in demand. Methods: Secondary analysis was conducted using data from publicly available sources. Data from the Queensland Ambulance Service and Queensland Health Emergency Department Information System (EDIS) also were analyzed. Results: The demand for ambulance services and emergency departments has been increasing at 8% and 4% per year over the last decade, respectively; while accessible hospital beds have reduced by almost 10% contributing to the emergency department congestion and possibly contributing to the prehospital demand. While the increase in the proportion of the elderly population seems to explain a great deal of the demand for EHS, other factors also influence this growth including patient characteristics, institutional and societal factors, economic, EHS arrangements, and clinical factors. Conclusions: Overcrowding of facilities that provide EHS are causing considerable community concern. This overcrowding is caused by the growing demand and reduced access. The causes of this growing demand are complex, and require further detailed analysis in order to quantify and qualify these causes in order to provide a resilient foundation of evidence for future policy direction.

The role of self-efficacy in dental patients’ brushing and flossing: Testing an extended Health Belief Model

Objective: In an effort to examine the decreasing oral health trend of Australian dental patients, the Health Belief Model (HBM) was utilised to understand the beliefs underlying brushing and flossing self-care. The HBM states that perception of severity and susceptibility to inaction and an estimate of the barriers and benefits of behavioural performance influences people’s health behaviours. Self-efficacy, confidence in one’s ability to perform oral self-care, was also examined. Methods: In dental waiting rooms, a community sample (N = 92) of dental patients completed a questionnaire assessing HBM variables and self-efficacy, as well as their performance of the oral hygiene behaviours of brushing and flossing. Results: Partial support only was found for the HBM with barriers emerging as the sole HBM factor influencing brushing and flossing behaviours. Self-efficacy significantly predicted both oral hygiene behaviours also. Conclusion: Support was found for the control factors, specifically a consideration of barriers and self-efficacy, in the context of understanding dental patients’ oral hygiene decisions. Practice implications: Dental professionals should encourage patients’ self-confidence to brush and floss at recommended levels and discuss strategies that combat barriers to performance, rather than emphasising the risks of inaction or the benefits of oral self-care.

Low-fat oxidation may be a factor in obesity among men with schizophrenia

Objective: Obesity associated with atypical antipsychotic medications is an important clinical issue for people with schizophrenia. The purpose of this project was to determine whether there were any differences in resting energy expenditure (REE) and respiratory quotient (RQ) between men with schizophrenia and controls. Method: Thirty-one men with schizophrenia were individually matched for age and relative body weight with healthy, sedentary controls. Deuterium dilution was used to determine total body water and subsequently fat-free mass (FFM). Indirect calorimetry using a Deltatrac metabolic cart was used to determine REE and RQ. Results: When corrected for FFM, there was no significant difference in REE between the groups. However, fasting RQ was significantly higher in the men with schizophrenia than the controls. Conclusion: Men with schizophrenia oxidised proportionally less fat and more carbohydrate under resting conditions than healthy controls. These differences in substrate utilisation at rest may be an important consideration in obesity in this clinical group.

Three-dimensional reconstruction of an ancient Egyptian mummy

A complete series of cross-sectional computed tomography (CT) scans were obtained of a mummy of an Egyptian priestess, Tjenmutengebtiu, (Jeni), who lived in the twenty-second Dynasty (c. 945-715 BC). The purpose of this joint British Museum and St. Thomas’ Hospital project was effectively to ‘unwrap’ a mummy using cross-sectional X-rays. Jeni is encased in a beautifully decorated anthropomorphic cartonnage coffin. The head and neck were scanned with 2mm slices, the teeth with 1mm slices and the rest of the body with 4 mm slices, a 512 x 512 matrix was used. The 2D CT images, and 3D surface reconstruction’s, demonstrate many features of the embalming techniques and funerary customs of the XXII Dynasty. The presence of cloth protruding from the nasal cavities into the otherwise empty cranial cavity indicates that the brain was extracted via the nose. The remains of the heart can be seen as well as four organ packs corresponding to the mummified and repackaged lungs, intestines, stomach and liver. Each of the organ packs encloses a wax figurine representing one of the four sons of Horus. The teeth are in very good condition with little signs of wear, which, considering the gritty diet of the Egyptians, indicates that Jeni must have been very young when she died. A young age of death is also suggested by analysis of the shape of the molar teeth. The body is generally in very good condition demonstrating the consummate skill of the twenty-second Dynasty embalmers.