A comparative analysis of risk stratification tools for emergency department patients with chest pain

Background: Appropriate disposition of emergency department (ED) patients with chest pain is dependent on clinical evaluation of risk. A number of chest pain risk stratification tools have been proposed. The aim of this study was to compare the predictive performance for major adverse cardiac events (MACE) using risk assessment tools from the National Heart Foundation of Australia (HFA), the Goldman risk score and the Thrombolysis in Myocardial Infarction risk score (TIMI RS). Methods: This prospective observational study evaluated ED patients aged ≥30 years with non-traumatic chest pain for which no definitive non-ischemic cause was found. Data collected included demographic and clinical information, investigation findings and occurrence of MACE by 30 days. The outcome of interest was the comparative predictive performance of the risk tools for MACE at 30 days, as analyzed by receiver operator curves (ROC). Results: Two hundred eighty-one patients were studied; the rate of MACE was 14.1%. Area under the curve (AUC) of the HFA, TIMI RS and Goldman tools for the endpoint of MACE was 0.54, 0.71 and 0.67, respectively, with the difference between the tools in predictive ability for MACE being highly significant [chi2 (3) = 67.21, N = 276, p < 0.0001]. Conclusion: The TIMI RS and Goldman tools performed better than the HFA in this undifferentiated ED chest pain population, but selection of cutoffs balancing sensitivity and specificity was problematic. There is an urgent need for validated risk stratification tools specific for the ED chest pain population.

Home and the embodiment of privacy

A home is an embodiment of human privacy, apart from providing shelter, security and several other functions. Achieving the desired level of privacy at home is very important in Muslim societies. Privacy is intended to protect the female members of the family from strangers, especially while entertaining guests at home. One way of controlling levels of exposure of the domestic domains to strangers is by controlling privacy levels. This research will investigate perceptions of privacy among Australian Muslims when entertaining guests at their homes. This research will also investigate the extent that modesty (achieved through both appearance and design) acts as the balancing factor in achieving a family’s desired levels of privacy while also affording them the capacity to be hospitable to guests. This research will use a qualitative approach to investigate Australian Muslim homes around Queensland, predominantly in the Brisbane area. A total number of 20 to 60 participants (10 to 30 males, 10 to 30 females) ranging from 25 to 55 years old will be interviewed. Ideally, participants will be those who have children or extended families (parents or siblings) living in the house. The data will be coded and analysed for the purpose of generating new knowledge for architects and designers when designing Muslim homes. It will also extend the current body of knowledge related to privacy mechanisms in housing designs, thereby benefitting architects and designers in the future.

The development of a carrying capacity assessment model for the Australian socio-environmental context

A key aim of this research was to highlight how society's understanding of constraints to the productive capacity of its resource base is vital to its long-term survival. This was achieved through the development of an online model, the Carrying Capacity Dashboard. The Dashboard was developed to estimate how much land Australian populations require for the production of their food, textiles, timber and liquid fuel. Findings reveal that Australia's estimated carrying capacity is currently over 40 million people but longer-term and more regional analyses suggest a much smaller number. Carrying capacity assessment also indicates that optimal resource security is to be found in balancing both small and large-scale self-sufficiency.

Performance-driven live migration of multiple virtual machines in datacenters

Live migration of multiple Virtual Machines (VMs) has become an indispensible management activity in datacenters for application performance, load balancing, server consolidation. While state-of-the-art live VM migration strategies focus on the improvement of the migration performance of a single VM, little attention has been given to the case of multiple VMs migration. Moreover, existing works on live VM migration ignore the inter-VM dependencies, and underlying network topology and its bandwidth. Different sequences of migration and different allocations of bandwidth result in different total migration times and total migration downtimes. This paper concentrates on developing a multiple VMs migration scheduling algorithm such that the performance of migration is maximized. We evaluate our proposed algorithm through simulation. The simulation results show that our proposed algorithm can migrate multiple VMs on any datacenter with minimum total migration time and total migration downtime.

On-line Demand Management of Low Voltage Residential Distribution Networks in Smart Grids

A novel intelligent online demand management system is discussed in this chapter for peak load management in low voltage residential distribution networks based on the smart grid concept. The discussed system also regulates the network voltage, balances the power in three phases and coordinates the energy storage within the network. This method uses low cost controllers, with two-way communication interfaces, installed in costumers’ premises and at distribution transformers to manage the peak load while maximizing customer satisfaction. A multi-objective decision making process is proposed to select the load(s) to be delayed or controlled. The efficacy of the proposed control system is verified by a MATLAB-based simulation which includes detailed modeling of residential loads and the network.

Research participation by people with intellectual disability and mental health issues : an examination of the processes of consent

Balancing the demands of research and ethics is always challenging and even more so when recruiting vulnerable groups. Within the context of current legislation and international human rights declarations, it is strongly advocated that research can and must be undertaken with all recipients of health care services. Research in the field of intellectual disability presents particular challenges in regard to consenting processes. This paper is a critical reflection and analysis of the complex processes undertaken and events that occurred in gaining informed consent from people with intellectual disability to participate in a study exploring their experiences of being an inpatient in mental health hospitals within Aotearoa/New Zealand. A framework based on capacity, information and voluntariness is presented with excerpts from the field provided to explore consenting processes. The practical implications of the processes utilised are then discussed in order to stimulate debate regarding clearer and enhanced methods of gaining informed consent from people with intellectual disability.

Biophilic urbanism : harnessing natural elements to enhance the performance of constructed assets

Creating climate resilient, low-carbon urban environments and assets is a policy goal of many governments and city planners today, and an important issue for constructed asset owners. Stakeholders and decision makers in urban environments are also responding to growing evidence that cities need to increase their densities to reduce their footprint in the face of growing urban populations. Meanwhile, research is highlighting the importance of balancing such density with urban nature, to provide a range of health and wellbeing benefits to residents as well as to mitigate the environmental and economic impacts of heavily built up, impervious urban areas. Concurrently achieving this suite of objectives requires the coordination and cooperation of multiple stakeholder groups, with urban development and investment increasingly involving many private and public actors. Strategies are needed that can provide ‘win-win’ outcomes to benefit these multiple stakeholders, and provide immediate benefits while also addressing the emerging challenges of climate change, resource shortages and urban population growth. Within this context, ‘biophilic urbanism’ is emerging as an important design principle for buildings and urban areas. Through the use of a suite of natural design elements, biophilic urbanism has the potential to address multiple pressures related to climate change, increasing urban populations, finite resources and human’s inherent need for contact with nature. The principle directs the creation of urban environments that are conducive to life, delivering a range of benefits to stakeholders including building owners, occupiers and the surrounding community. This paper introduces the principle of biophilic urbanism and discusses opportunities for improved building occupant experience and performance of constructed assets, as well as addressing other sustainability objectives including climate change mitigation and adaptation. The paper presents an emerging process for considering biophilic design opportunities at different scales and highlights implications for the built environment industry. This process draws on findings of a study of leading cities internationally and learnings related to economic and policy considerations. This included literature review, two stakeholder workshops, and extensive industry consultation, funded by the Sustainable Built Environment National Research Centre through core project partners Western Australian Department of Finance, Parsons Brinckerhoff, Townsville City Council CitySolar Program, Green Roofs Australasia, and PlantUp.

Reflections on tomorrow’s menu : evidence for inpatient meal preferences at a large tertiary public hospital

There are limited studies that describe patient meal preferences in hospital; however this data is critical to develop menus that address satisfaction and nutrition whilst balancing resources. This quality study aimed to determine preferences for meals and snacks to inform a comprehensive menu revision in a large (929 bed) tertiary public hospital. The method was based on Vivanti et al. (2008) with data collected by two final year dietetic students. The first survey comprised 72 questions, achieved a response rate of 68% (n = 192), with the second more focused at 47 questions achieving a higher response rate of 93% (n = 212). Findings showed over half the patients reporting poor or less than normal appetite, 20% describing taste issues, over a third with a LOS >7 days, a third with a MST _ 2 and less than half eating only from the general menu. Soup then toast was most frequently reported as eaten at home when unwell, and whilst most reported not missing any foods when in hospital (25%), steak was most commonly missed. Hot breakfasts were desired by the majority (63%), with over half preferring toast (even if cold). In relation to snacks, nearly half (48%) wanted something more substantial than tea/coffee/biscuits, with sandwiches (54%) and soup (33%) being suggested. Sandwiches at the evening meal were not popular (6%). Difficulties with using cutlery and meal size selection were identified as issues. Findings from this study had high utility and supported a collaborative and evidenced based approach to a successful major menu change for the hospital.

Hypergraph-based modeling of ad-hoc business processes

Process models are usually depicted as directed graphs, with nodes representing activities and directed edges control flow. While structured processes with pre-defined control flow have been studied in detail, flexible processes including ad-hoc activities need further investigation. This paper presents flexible process graph, a novel approach to model processes in the context of dynamic environment and adaptive process participants’ behavior. The approach allows defining execution constraints, which are more restrictive than traditional ad-hoc processes and less restrictive than traditional control flow, thereby balancing structured control flow with unstructured ad-hoc activities. Flexible process graph focuses on what can be done to perform a process. Process participants’ routing decisions are based on the current process state. As a formal grounding, the approach uses hypergraphs, where each edge can associate any number of nodes. Hypergraphs are used to define execution semantics of processes formally. We provide a process scenario to motivate and illustrate the approach.

Legal rights during pandemics : federalism, rights and public health laws - a view from Australia

Pandemic influenza will cause significant social and economic disruption. Legal frameworks can play an important role in clarifying the rights and duties of individuals, communities and governments for times of crisis. In addressing legal frameworks, there is a need for jurisdictional clarity between different levels of government in responding to public health emergencies. Public health laws are also informed by our understandings of rights and responsibilities for individuals and communities, and the balancing of public health and public freedoms. Consideration of these issues is an essential part of planning for pandemic influenza.

The challenge of defining guanxi : a review

Guanxi has become a common term in the wider business environment and has attracted the increasing attention of researchers. Despite this, a consistent understanding of the concept continues to prove elusive. We review the extant business literature to highlight the major inconsistencies in the way guanxi is currently conceptualized: the breadth, linguistic-cultural depth, temporality, and level of analysis. We conclude with a clearer conceptualization of guanxi which separates the core elements from antecedents and consequences of guanxi. Furthermore, we compare and contrast guanxi with western correlates such as social networks and social capitals to further consolidate our understanding of guanxi.

Magnetic convection heat transfer in an open ended enclosure filled with paramagnetic fluids

Numerical simulations of thermomagnetic convection of paramagnetic fluids placed in a micro-gravity condition (g nearly 0) and under a uniform vertical gradient magnetic field in an open ended square enclosure with ramp heating temperature condition applied on a vertical wall is investigated in this study. In presence of the strong magnetic gradient field thermal convection of the paramagnetic fluid might take place even in a zero-gravity environment as a direct consequence of temperature differences occurring within the fluid. The thermal boundary layer develops adjacent to the hot wall as soon as the ramp temperature condition is applied on it. There are two scenario that can be observed based on the ramp heating time. The steady state of the thermal boundary layer can be reached before the ramp time is finished or vice versa. If the ramp time is larger than the quasi-steady time then the thermal boundary layer is in a quasi-steady mode with convection balancing conduction after the quasi-steady time. Further increase of the heat input simply accelerates the flow to maintain the proper thermal balance. Finally, the boundary layer becomes completely steady state when the ramp time is finished. Effects of magnetic Rayleigh number, Prandtl number and paramagnetic fluid parameter on the flow pattern and heat transfer are presented.

Assessing capacity in the context of testamentary, enduring power of attorney, and advance care directive documents in Australia

Balancing the competing interests of autonomy and protection of individuals is an escalating challenge confronting an ageing Australian population. Legal and medical professionals are increasingly being asked to determine whether individuals are legally capable to make their own testamentary, financial and/or personal/health care decisions. Diseases such as dementia impact upon cognition which necessitates collaboration between the legal and medical professions to satisfactorily assess the effect of such mentally disabling conditions upon legal competency. Terminological and methodological differences exist between the two professions when assessing capacity in this context which subsequently create miscommunication and misunderstanding. Consequently, it is not necessarily a simple solution for a legal professional to seek the opinion of a medical practitioner. Exacerbating the situation is the fact that no consistent and transparent capacity assessment paradigm currently exists in Australia. Assessments are instead being undertaken on an ad hoc basis dependent upon the skill set of the legal and/or medical professionals involved. A qualitative study seeking the views of legal and medical professionals who practise in this area has been conducted. This incorporated a review of the relevant literature and surveys which informed the semi-structured interviews conducted with 10 legal and 20 medical practitioners. Practitioners were asked whether there is a standard approach to assessment and whether national guidelines would assist. The general consensus was that uniform guidelines would be advantageous. The research also canvassed practitioner views as to the state of the relationship between the professions when assessing capacity. Three promising practices have emerged from this research: first, is the need for the development of national guidelines and supporting principles to satisfactorily assess capacity; second, is the possibility of strengthening the relationship between legal and medical professionals to assist in the satisfactory assessment of legal capacity; and third, the need for increased community education.

Diode-clamped three-level inverter-based battery/supercapacitor direct integration scheme for renewable energy systems

This paper describes a diode-clamped three-level inverter-based battery/supercapacitor direct integration scheme for renewable energy systems. The study is carried out for three different cases. In the first case, one of the two dc-link capacitors of the inverter is replaced by a battery bank and the other by a supercapacitor bank. In the second case, dc-link capacitors are replaced by two battery banks. In the third case, ordinary dc-link capacitors are replaced by two supercapacitor banks. The first system is supposed to mitigate both long-term and short-term power fluctuations while the last two systems are intended for smoothening long-term and short-term power fluctuations, respectively. These topologies eliminate the need for interfacing dc-dc converters and thus considerably improve the overall system efficiency. The major issue in aforementioned systems is the unavoidable imbalance in dc-link voltages. An analysis on the effects of unbalance and a space vector modulation method, which can produce undistorted current even in the presence of such unbalances, are presented in this paper. Furthermore, small vector selection-based power sharing and state of charge balancing techniques are proposed. Experimental results, obtained from a laboratory prototype, are presented to verify the efficacy of the proposed modulation and control techniques.

Non-linear model predictive control for UAVs with slung/swung load

Suspended loads on UAVs can provide significant benefits to several applications in agriculture, law enforcement and construction. The load impact on the underlying system dynamics should not be neglected as significant feedback forces may be induced on the vehicle during certain flight manoeuvres. Much research has focused on standard multi-rotor position and attitude control with and without a slung load. However, predictive control schemes, such as Nonlinear Model Predictive Control (NMPC), have not yet been fully explored. To this end, we present software and flight system architecture to test controller for safe and precise operation of multi-rotors with heavy slung load in three dimensions.