Home-based support for palliative care families:challenges and recommendations

Providing adequate supportive services for the families of palliative care patients is a core principle of palliative care. Caring for a patient with terminal illness at home involves a considerable commitment on the part of family caregivers, and attention must be given to the caregiver's needs as well as those of the patient. Although a home death may be preferred by patients and promoted by healthcare agencies as a cost-effective option, it may be an ideal that is not often realised. Enhanced supportive care strategies can ameliorate the challenges facing families of palliative care patients cared for at home. All health professionals need to improve the standard of family-centred palliative care, and more evidence-based approaches are required.

Rule-Based Intrusion Detection System for SCADA Networks

Increased complexity and interconnectivity of Supervisory Control and Data Acquisition (SCADA) systems in Smart Grids potentially means greater susceptibility to malicious attackers. SCADA systems with legacy communication infrastructure have inherent cyber-security vulnerabilities as these systems were originally designed with little consideration of cyber threats. In order to improve cyber-security of SCADA networks, this paper presents a rule-based Intrusion Detection System (IDS) using a Deep Packet Inspection (DPI) method, which includes signature-based and model-based approaches tailored for SCADA systems. The proposed signature-based rules can accurately detect several known suspicious or malicious attacks. In addition, model-based detection is proposed as a complementary method to detect unknown attacks. Finally, proposed intrusion detection approaches for SCADA networks are implemented and verified using a ruled based method.

Intrusion Detection System for IEC 60870-5-104 Based SCADA Networks

Increased complexity and interconnectivity of Supervisory Control and Data Acquisition (SCADA) systems in Smart Grids potentially means greater susceptibility to malicious attackers. SCADA systems with legacy communication infrastructure have inherent cyber-security vulnerabilities as these systems were originally designed with little consideration of cyber threats. In order to improve cyber-security of SCADA networks, this paper presents a rule-based Intrusion Detection System (IDS) using a Deep Packet Inspection (DPI) method, which includes signature-based and model-based approaches tailored for SCADA systems. The proposed signature-based rules can accurately detect several known suspicious or malicious attacks. In addition, model-based detection is proposed as a complementary method to detect unknown attacks. Finally, proposed intrusion detection approaches for SCADA networks are implemented and verified via Snort rules.

A systematic review evaluating the impact of online or blended learning vs. face-to-face learning of clinical skills in undergraduate nurse education.

Aim: To determine whether the use of an online or blended learning paradigm has the potential to enhance the teaching of clinical skills in undergraduate nursing.

Background: The need to adequately support and develop students in clinical skills is now arguably more important than previously considered due to reductions in practice opportunities. Online and blended teaching methods are being developed to try and meet this requirement, but knowledge about their effectiveness in teaching clinical skills is limited.

Design: Mixed methods systematic review, which follows the Joanna Briggs Institute User guide version 5.

Data Sources: Computerized searches of five databases were undertaken for the period 1995-August 2013.

Review Methods: Critical appraisal and data extraction were undertaken using Joanna Briggs Institute tools for experimental/observational studies and interpretative and critical research. A narrative synthesis was used to report results.

Results: Nineteen published papers were identified. Seventeen papers reported on online approaches and only two papers reported on a blended approach. The synthesis of findings focused on the following four areas: performance/clinical skill, knowledge, self-efficacy/clinical confidence and user experience/satisfaction. The e-learning interventions used varied throughout all the studies.

Conclusion: The available evidence suggests that online learning for teaching clinical skills is no less effective than traditional means. Highlighted by this review is the lack of available evidence on the implementation of a blended learning approach to teaching clinical skills in undergraduate nurse education. Further research is required to assess the effectiveness of this teaching methodology.

What Are the Effects of Teaching Evidence-Based Health Care (EBHC)? Overview of Systematic Reviews

Background

An evidence-based approach to health care is recognized internationally as a key competency for healthcare practitioners. This overview systematically evaluated and organized evidence from systematic reviews on teaching evidence-based health care (EBHC).

Methods/Findings

We searched for systematic reviews evaluating interventions for teaching EBHC to health professionals compared to no intervention or different strategies. Outcomes covered EBHC knowledge, skills, attitudes, practices and health outcomes. Comprehensive searches were conducted in April 2013. Two reviewers independently selected eligible reviews, extracted data and evaluated methodological quality. We included 16 systematic reviews, published between 1993 and 2013. There was considerable overlap across reviews. We found that 171 source studies included in the reviews related to 81 separate studies, of which 37 are in more than one review. Studies used various methodologies to evaluate educational interventions of varying content, format and duration in undergraduates, interns, residents and practicing health professionals. The evidence in the reviews showed that multifaceted, clinically integrated interventions, with assessment, led to improvements in knowledge, skills and attitudes. Interventions improved critical appraisal skills and integration of results into decisions, and improved knowledge, skills, attitudes and behaviour amongst practicing health professionals. Considering single interventions, EBHC knowledge and attitude were similar for lecture-based versus online teaching. Journal clubs appeared to increase clinical epidemiology and biostatistics knowledge and reading behavior, but not appraisal skills. EBHC courses improved appraisal skills and knowledge. Amongst practicing health professionals, interactive online courses with guided critical appraisal showed significant increase in knowledge and appraisal skills. A short workshop using problem-based approaches, compared to no intervention, increased knowledge but not appraisal skills.

Conclusions

EBHC teaching and learning strategies should focus on implementing multifaceted, clinically integrated approaches with assessment. Future rigorous research should evaluate minimum components for multifaceted interventions, assessment of medium to long-term outcomes, and implementation of these interventions.

Realizing Accelerated Cost-Effective Distributed RAID

The exponential growth in user and application data entails new means for providing fault tolerance and protection against data loss. High Performance Com- puting (HPC) storage systems, which are at the forefront of handling the data del- uge, typically employ hardware RAID at the backend. However, such solutions are costly, do not ensure end-to-end data integrity, and can become a bottleneck during data reconstruction. In this paper, we design an innovative solution to achieve a flex- ible, fault-tolerant, and high-performance RAID-6 solution for a parallel file system (PFS). Our system utilizes low-cost, strategically placed GPUs — both on the client and server sides — to accelerate parity computation. In contrast to hardware-based approaches, we provide full control over the size, length and location of a RAID array on a per file basis, end-to-end data integrity checking, and parallelization of RAID array reconstruction. We have deployed our system in conjunction with the widely-used Lustre PFS, and show that our approach is feasible and imposes ac- ceptable overhead.

Application examples of performance-based specification and quality control

This chapter presents an overview on several performance-based approaches for concrete durability specification and conformity assessment of the as-built structure.

Solubility parameter based screening methods for early stage formulation development of itraconazole amorphous solid dispersions

Objectives: This article uses conventional and newly extended solubility parameter (δ) methods to identify polymeric materials capable of forming amorphous dispersions with itraconazole (itz). Methods: Combinations of itz and Soluplus, Eudragit E PO (EPO), Kollidon 17PF (17PF) or Kollidon VA64 (VA64) were prepared as amorphous solid dispersions using quench cooling and hot melt extrusion. Storage stability was evaluated under a range of conditions using differential scanning calorimetry and powder X-ray diffraction. Key findings: The rank order of itz miscibility with polymers using both conventional and novel δ-based approaches was 17PF > VA64 > Soluplus > EPO, and the application of the Flory–Huggins lattice model to itz–excipient binary systems corroborated the findings. The solid-state characterisation analyses of the formulations manufactured by melt extrusion correlated well with pre-formulation screening. Long-term storage studies showed that the physical stability of 17PF/vitamin E TPGS–itz was poor compared with Soluplus and VA64 formulations, and for EPO/itz systems variation in stability may be observed depending on the preparation method. Conclusion: Results have demonstrated that although δ-based screening may be useful in predicting the initial state of amorphous solid dispersions, assessment of the physical behaviour of the formulations at relevant temperatures may be more appropriate for the successful development of commercially acceptable amorphous drug products.

Risk, Recovery and Capacity: Competing or Complementary Approaches to Mental Health Social Work

Mental health social workers have a central role in providing support to people with mental health problems and in the use of coercion aimed at dealing with risk. Mental health services have traditionally focused on monitoring symptoms and ascertaining the risks people may present to themselves and/or others. This well-intentioned but negative focus on deficits has contributed to stigma, discrimination and exclusion experienced by service users. Emerging understandings of risk also suggest that our inability to accurately predict the future makes risk a problematic foundation for compulsory intervention. It is therefore argued that alternative approaches are needed to make issues of power and inequality transparent. This article focuses on two areas of practice: the use of recovery based approaches, which promote supported decision making and inclusion; and the assessment of a person’s ability to make decisions, their mental capacity, as a less discriminatory gateway criterion than risk for compulsory intervention.

A novel fluorescence-based assay for the rapid detection and quantification of cellular deoxyribonucleoside triphosphates

Current methods for measuring deoxyribonucleoside triphosphates (dNTPs) employ reagent and labor-intensive assays utilizing radioisotopes in DNA polymerase-based assays and/or chromatography-based approaches. We have developed a rapid and sensitive 96-well fluorescence-based assay to quantify cellular dNTPs utilizing a standard real-time PCR thermocycler. This assay relies on the principle that incorporation of a limiting dNTP is required for primer-extension and Taq polymerase-mediated 5-3' exonuclease hydrolysis of a dual-quenched fluorophore-labeled probe resulting in fluorescence. The concentration of limiting dNTP is directly proportional to the fluorescence generated. The assay demonstrated excellent linearity (R(2) > 0.99) and can be modified to detect between ∼0.5 and 100 pmol of dNTP. The limits of detection (LOD) and quantification (LOQ) for all dNTPs were defined as <0.77 and <1.3 pmol, respectively. The intra-assay and inter-assay variation coefficients were determined to be <4.6% and <10%, respectively with an accuracy of 100 ± 15% for all dNTPs. The assay quantified intracellular dNTPs with similar results obtained from a validated LC-MS/MS approach and successfully measured quantitative differences in dNTP pools in human cancer cells treated with inhibitors of thymidylate metabolism. This assay has important application in research that investigates the influence of pathological conditions or pharmacological agents on dNTP biosynthesis and regulation.

A Parametric Study of a Drive by Bridge Inspection System Based on the Morlet Wavelet

Many of the bridges currently in use worldwide are approaching the end of their design lives. However, rehabilitating and extending the lives of these structures raises important safety issues. There is also a need for increased monitoring which has considerable cost implications for bridge management systems. Existing structural health monitoring (SHM) techniques include vibration-based approaches which typically involve direct instrumentation of the bridge and are important as they can indicate the deterioration of the bridge condition. However, they can be labour intensive and expensive. In the past decade, alternative indirect vibration-based approaches which utilise the response of a vehicle passing over a bridge have been developed. This paper investigates such an approach; a low-cost approach for the monitoring of bridge structures which consists of the use of a vehicle fitted with accelerometers on its axles. The approach aims to detect damage in the bridge while obviating the need for direct instrumentation of the bridge. Here, the effectiveness of the approach in detecting damage in a bridge is investigated using a simplified vehicle-bridge interaction (VBI) model in theoretical simulations and a scaled VBI model in a laboratory experiment. In order to identify the existence and location of damage, the vehicle accelerations are recorded and processed using a continuous Morlet wavelet transform and a damage index is established. A parametric study is carried out to investigate the effect of parameters such as the bridge span length, vehicle speed, vehicle mass, damage level and road surface roughness on the accuracy of results.

Identificação de utilizadores seniores em televisão interativa (iTV) : uma matriz de decisão tecnológica

Desde que surgiu há mais de 50 anos, a televisão sofreu muitas transformações, tanto ao nível tecnológico (por exemplo com a passagem da emissão a preto/branco para cor, o som analógico para digital, a difusão digital) como a nível da sua influência nas sociedades. Entre outros fatores de ordem tecnológica, a consolidação da Internet com o seu elevado nível de personalização, da experiência de utilização, e a sua enorme quantidade de conteúdos disponíveis, catapultou a televisão no sentido de esta se tornar mais interativa. Assim, o telespectador passou a poder usufruir de uma experiência televisiva que pode, por um lado, ser mais participativa, sendo-lhe possível, por exemplo, alvitrar sobre a qualidade de um programa enquanto assiste à sua exibição, e, por outro, ser mais personalizada, possibilitando-lhe, por exemplo, receber conteúdos automaticamente adequados ao seu perfil e contexto. No entanto, esta experiência mais participativa e personalizável carece de uma identificação, idealmente automática e não intrusiva, de quem pode beneficiar da mesma – o telespectador. Contudo, e apesar de significativos avanços na área da televisão interativa, tanto ao nível da infraestrutura de suporte como ao nível dos serviços disponibilizados, a identificação dos utilizadores é, ainda, uma área de estudo com muitos aspetos por compreender. Os seniores, em particular, são grandes consumidores de televisão e representam uma fatia muito considerável das pessoas que podem beneficiar das potencialidades disponibilizadas pela interatividade presente em muitos serviços atuais. Um número crescente destes serviços são desenhados com o objetivo de promoverem um envelhecimento ativo e um concreto apoio à vida, pelo que os seniores podem beneficiar, em vários aspetos do seu quotidiano, se os utilizarem. Nesta faixa etária, a identificação de utilizadores tem, como elemento potenciador da experiência de utilização, um papel especialmente importante ao nível de um aproveitamento personalizado e dirigido destes serviços. No entanto, atendendo às diferentes combinações de características físicas, sensoriais, cognitivas e, mesmo, de literacia digital que tipificam os seniores, perspetivou-se existir uma dependência do perfil do utilizador na seleção do método de identificação mais adequado, os quais podem ser baseados, por exemplo, num leitor de impressões digitais, instalado no telecomando; na leitura de uma wearable tag ou de um cartão RFiD; no reconhecimento da face e, eventualmente, na voz do utilizador. Assim, a inerente investigação desenrolou-se em várias fases, no sentido de permitir alicerçar a construção de uma matriz de decisão tecnológica que, em função do perfil de utilizador, selecione o sistema de identificação mais adequado. O procedimento metodológico inerente à construção desta matriz de decisão, passou por um longo processo envolvendo utilizadores reais, que se iniciou com a realização de entrevistas exploratórias com o objetivo de permitir conhecer melhor os seniores e a forma como estes encaram a tecnologia e, mais concretamente, a televisão interativa. Foi depois implementado um protótipo de alta-fidelidade, completamente funcional, para a realização de testes com o objetivo de perceber qual a preferência relativamente a um subconjunto de tecnologias de identificação. Estes testes, uma vez que não permitiram testar todas as tecnologias em estudo, revelaram-se inconclusivos, porém permitiram reforçar a necessidade de identificar e caracterizar os referidos aspetos do perfil do utilizador que podem interferir na sua preferência relativamente ao sistema de identificação. As características identificadas constituíram-se como os parâmetros de entrada da matriz, sendo que para preencher as respetivas células realizaramse testes de aceitação, com um conjunto de seniores, tendo por base um protótipo, wizard of oz, especificamente implementado para permitir experienciar todas as tecnologias em estudo. Estes testes foram precedidos pela avaliação das capacidades funcionais dos participantes, nos diversos parâmetros definidos. Este texto relata, assim, todo o processo de investigação que foi conduzido, terminando com uma descrição de exemplos de utilização da matriz de decisão implementada e com a identificação de potenciais caminhos de desenvolvimento deste trabalho.

SocialLDA:Scalable Topic Modeling in Social Networks

Thesis (Master's)--University of Washington, 2012

On the development of an automatic voice pleasantness classification and intensity estimation system

In the last few years, the number of systems and devices that use voice based interaction has grown significantly. For a continued use of these systems, the interface must be reliable and pleasant in order to provide an optimal user experience. However there are currently very few studies that try to evaluate how pleasant is a voice from a perceptual point of view when the final application is a speech based interface. In this paper we present an objective definition for voice pleasantness based on the composition of a representative feature subset and a new automatic voice pleasantness classification and intensity estimation system. Our study is based on a database composed by European Portuguese female voices but the methodology can be extended to male voices or to other languages. In the objective performance evaluation the system achieved a 9.1% error rate for voice pleasantness classification and a 15.7% error rate for voice pleasantness intensity estimation.

TRAILER project overview: tagging, recognition and acknowledgment of informal learning experiences

The evolution of new technology and its increasing use, have for some years been making the existence of informal learning more and more transparent, especially among young and older adults in both Higher Education and workplace contexts. However, the nature of formal and non-formal, course-based, approaches to learning has made it hard to accommodate these informal processes satisfactorily, and although technology bring us near to the solution, it has not yet achieved. TRAILER project aims to address this problem by developing a tool for the management of competences and skills acquired through informal learning experiences, both from the perspective of the user and the institution or company. This paper describes the research and development main lines of this project.