The challenges of meeting the needs of children with Autism Spectrum Disorders (ASD) during out of hospital interactoins with Paramedics

This poster presents the results of a critical review of the literature on the intersection between paramedic practice with Autism Spectrum Disorder (ASD) and previews the clinical and communication challenges likely to be experienced with these patients. Paramedics in Australia provide 24/7 out-of-hospital care to the community. Although their core business is to provide emergency care, paramedics also provide care for vulnerable people as a consequence of the social, economic or domestic milieu. Little is known about the frequency of use of emergency out-of-hospital services by children with ASD and their families. Similarly, little is known about the attitudes and perceptions of paramedics to children with ASD and their emergency health care. However, individuals with ASD are likely to require paramedic services at some point across the life span and may be more frequent users of health services as a consequence of the challenges they face. The high rate of co-morbidities of people diagnosed with ASD is reported and includes seizure disorders, gastro-intestinal disorders, metabolic disorders, hormonal dysfunction, ear, nose and throat infections, hearing impairment, hypertension, allergies/anaphylaxis, immune disorders, migraine and diabetes, gross/fine motor skill dysfunction, premature birth, birth defects, obesity and mental illness. Individuals with ASD may frequently experience concurrent communication, behaviour and sensory challenges. Consequently, Paramedics can encounter difficulties gathering important patient information which may compromise sensitive care. These interactions occur often in high pressure and emotionally challenging environments, which add to the difficulties in communicating the treatment and transport needs of this population.

Out-of-pocket expenditures for hospital care in Iran : who is at risk of incurring catastrophic payments?

Since the beginning of 1980s, the Iranian health care system has undergone several reforms designed to increase accessibility of health services. Notwithstanding these reforms, out-of-pocket payments which create a barrier to access health services contribute almost half of total health are financing in Iran. This study aimed to provide a greater understanding about the inequality and determinants of the out-of-pocket expenditure (OOPE) and the related catastrophic expenditure (CE) for hospital services in Iran using a nationwide survey data, the 2003 Utilisation of Health Services Survey (UHSS). The concentration index and the Heckman selection model were used to assess inequality and factors associated with these expenditures. Inequality analysis suggests that the CE is concentrated among households in lower socioeconomic levels. The results of the Heckman selection model indicate that factors such as length of stay, admission to a hospital owned by private sector or Ministry of Health and Medical Education, and living in remote areas are positively associated with higher OOPE. Results of the ordered-probit selection model demonstrate that length of stay, lower household wealth index, and admission to a private hospital are major factors contributing to the increase in the probability of CE. Also, we find that households living in East Azarbaijan, Kordestan and Sistan and Balochestan face a higher level of CE. Based on our findings, the current employer-sponsored health insurance system does not offer equal protection against hospital expenditure in Iran. It seems that a single universal health insurance scheme that covers health services for all Iranian—regardless of their employment status—can better protect households from catastrophic health spending.

Design of coreless PCB transformers for power and signal isolation in a modular ADC system for power quality data acquisition

Available industrial energy meters offer high accuracy and reliability, but are typically expensive and low-bandwidth, making them poorly suited to multi-sensor data acquisition schemes and power quality analysis. An alternative measurement system is proposed in this paper that is highly modular, extensible and compact. To minimise cost, the device makes use of planar coreless PCB transformers to provide galvanic isolation for both power and data. Samples from multiple acquisition devices may be concentrated by a central processor before integration with existing host control systems. This paper focusses on the practical design and implementation of planar coreless PCB transformers to facilitate the module's isolated power, clock and data signal transfer. Calculations necessary to design coreless PCB transformers, and circuits designed for the transformer's practical application in the measurement module are presented. The designed transformer and each application circuit have been experimentally verified, with test data and conclusions made applicable to coreless PCB transformers in general.

Towards a consistent definition of a significant delta troponin with z-scores: A way out of chaos?

Aims: We assessed the diagnostic performance of z-scores to define a significant delta cardiac troponin (cTn) in a cohort of patients with well-defined clinical outcomes. Methods: We calculated z-scores, which are dependent on the analytical precision and biological variation, to report changes in cTn. We compared the diagnostic performances of a relative delta (%Δ), actual delta (Δ), and z-scores in 762 emergency department patients with symptoms of suspected acute coronary syndrome. cTn was measured with sensitive cTnI (Beckman Coulter), highly sensitive cTnI (Abbott), and highly sensitive cTnT (Roche) assays. Results: Receiver operating characteristic analysis showed no statistically significant differences in the areas under the curve (AUC) of z-scores and Δ with both superior compared to %Δ for all three assays (p<0.001). The AUCs of z-scores measured with the Abbott hs-cTnI (0.955) and Roche hs-cTnT (0.922) assays were comparable to Beckman Coulter cTnI (0.933) (p=0.272 and 0.640, respectively). The individualized Δ cut-off values that were required to emulate a z-score of 1.96 were: Beckman Coulter cTnI 30 ng/l, Abbott hs-cTnI 20 ng/l, and Roche hs-cTnT 7 ng/l. Conclusions: z-scores allow the use of a single cut-off value at all cTn levels, for both cTnI and cTnT and for sensitive and highly sensitive assays, with comparable diagnostic performances. This strategy of reporting significant changes as z-scores may obviate the need for the empirical development of assay-specific cut-off rules to define significant troponin changes.

Black Diggers: Out of the trenches at the Brisbane Festival (Theatre review)

The performance space in which Wesley Enoch’s play Black Diggers is being performed at the Brisbane Festival is a large black box. It features a raised stage in the middle which proves versatile for battlegrounds at home and abroad – and later as ground for discriminatory encounters experienced by Aboriginal returned ex-servicemen. The fire-filled 44-gallon drum off to the side creates another space of encounter; there are few other props. Now and then, dates and other details are whitewashed on the black walls...

A place carved out by time

A travel story about South Dakota. "Time travel is much easier in life than in the movies. Driving out of Rapid City in South Dakota, you cover 500,000 years in the first hour. That journey brings you to the Badlands, a vast natural excavation site that has been created by water and wind. At the same time, you’re deposited into the deep past..."--publisher website

Feeling left out? The mediating role of perceived rejection on workgroup mistreatment and affective, behavioral, and organizational outcomes and the moderating role of organizational norms

This two-study paper examines the detrimental impact of workgroup mistreatment and the mediating role of perceived rejection. In Study 1, perceived rejection emerged as a mediator between workgroup mistreatment and depression, organization-based self-esteem, organizational deviance, and organizational citizenship behaviors. In Study 2, the role of organizational norms was examined. Employees who experienced supportive organizational norms reported lower levels of perceived rejection, depression and turnover intentions, and higher levels of organization-based self-esteem and job satisfaction. Employees in the supportive norms condition reported that they were more likely to seek reconciliation after experiencing mistreatment than those who experienced low support. Perceived rejection also emerged as a mediator. Results, practical implications, and future research directions are discussed.

Development of a cost-effective and flexible vibration DAQ system for long-term continuous structural health monitoring

In the structural health monitoring (SHM) field, long-term continuous vibration-based monitoring is becoming increasingly popular as this could keep track of the health status of structures during their service lives. However, implementing such a system is not always feasible due to on-going conflicts between budget constraints and the need of sophisticated systems to monitor real-world structures under their demanding in-service conditions. To address this problem, this paper presents a comprehensive development of a cost-effective and flexible vibration DAQ system for long-term continuous SHM of a newly constructed institutional complex with a special focus on the main building. First, selections of sensor type and sensor positions are scrutinized to overcome adversities such as low-frequency and low-level vibration measurements. In order to economically tackle the sparse measurement problem, a cost-optimized Ethernet-based peripheral DAQ model is first adopted to form the system skeleton. A combination of a high-resolution timing coordination method based on the TCP/IP command communication medium and a periodic system resynchronization strategy is then proposed to synchronize data from multiple distributed DAQ units. The results of both experimental evaluations and experimental–numerical verifications show that the proposed DAQ system in general and the data synchronization solution in particular work well and they can provide a promising cost-effective and flexible alternative for use in real-world SHM projects. Finally, the paper demonstrates simple but effective ways to make use of the developed monitoring system for long-term continuous structural health evaluation as well as to use the instrumented building herein as a multi-purpose benchmark structure for studying not only practical SHM problems but also synchronization related issues.

Fractional models in space for diffusive processes in heterogeneous media with applications in cell motility and electrical signal propagation

This work addresses fundamental issues in the mathematical modelling of the diffusive motion of particles in biological and physiological settings. New mathematical results are proved and implemented in computer models for the colonisation of the embryonic gut by neural cells and the propagation of electrical waves in the heart, offering new insights into the relationships between structure and function. In particular, the thesis focuses on the use of non-local differential operators of non-integer order to capture the main features of diffusion processes occurring in complex spatial structures characterised by high levels of heterogeneity.

MATLAB/Simulink simulation and C2000 code generation model for a grid-interactive 3-phase 4-wire inverter

This work is a MATLAB/Simulink model of a controller for a three-phase, four-wire, grid-interactive inverter. The model provides capacity for simulating the performance of power electroinic hardware, as well as code generation for an embedded controller. The implemented hardware topology is a three-leg bridge with a neutral connection to the centre-tap of the DC bus. An LQR-based current controller and MAF-based phase detector are implemented. The model is configured for code generation for a Texas Instruments TMS320F28335 Digital Signal Processor (DSP).

Quantification of functional hand grip using electromyography and inertial sensor-derived accelerations: Clinical implications

Background Assessing hand injury is of great interest given the level of involvement of the hand with the environment. Knowing different assessment systems and their limitations generates new perspectives. The integration of digital systems (accelerometry and electromyography) as a tool to supplement functional assessment allows the clinician to know more about the motor component and its relation to movement. Therefore, the purpose of this study was the kinematic and electromyography analysis during functional hand movements. Method Ten subjects carried out six functional movements (terminal pinch, termino-lateral pinch, tripod pinch, power grip, extension grip and ball grip). Muscle activity (hand and forearm) was measured in real time using electromyograms, acquired with the Mega ME 6000, whilst acceleration was measured using the AcceleGlove. Results Electrical activity and acceleration variables were recorded simultaneously during the carrying out of the functional movements. The acceleration outcome variables were the modular vectors of each finger of the hand and the palm. In the electromyography, the main variables were normalized by the mean and by the maximum muscle activity of the thenar region, hypothenar, first interosseous dorsal, wrist flexors, carpal flexors and wrist extensors. Conclusions Knowing muscle behavior allows the clinician to take a more direct approach in the treatment. Based on the results, the tripod grip shows greater kinetic activity and the middle finger is the most relevant in this regard. Ball grip involves most muscle activity, with the thenar region playing a fundamental role in hand activity. Clinical relevance Relating muscle activation, movements, individual load and displacement offers the possibility to proceed with rehabilitation by individual component.

Active aging: Exploration into self-ratings of "being active," out-of-home physical activity, and participation among older Australian adults living in four different settings

We examined whether self-ratings of “being active” among older people living in four different settings (major city high and lower density suburbs, a regional city, and a rural area) were associated with out-of-home participation and outdoor physical activity. A mixed-methods approach (survey, travel diary, and GPS tracking over a one-week period) was used to gather data from 48 individuals aged over 55 years. Self-ratings of “being active” were found to be positively correlated with the number of days older people spent time away from home but unrelated to time traveled by active means (walking and biking). No significant differences in active travel were found between the four study locations, despite differences in their respective built environments.The findings suggest that additional strategies to the creation of “age-friendly” environments are needed if older people are to increase their levels of outdoor physical activity. “Active aging” promotion campaigns may need to explicitly identify the benefits of walking outdoors to ambulatory older people as a means of maintaining their overall health, functional ability, and participation within society in the long-term and also encourage the development of community-based programs in order to facilitate regular walking for this group.

A LIN inspired optical bus for signal isolation in multilevel or modular power electronic converters

Proposed in this paper is a low-cost, half-duplex optical communication bus for control signal isolation in modular or multilevel power electronic converters. The concept is inspired by the Local Interconnect Network (LIN) serial network protocol as used in the automotive industry. The proposed communications bus utilises readily available optical transceivers and is suitable for use with low-cost microcontrollers for distributed control of multilevel converters. As a signal isolation concept, the proposed optical bus enables very high cell count modular multilevel cascaded converters (MMCCs) for high-bandwidth, high-voltage and high-power applications. Prototype hardware is developed and the optical bus concept is validated experimentally in a 33-level MMCC converter operating at 120 Vrms and 60 Hz.

Dataset-invariant covariance normalization for out-domain PLDA speaker verification

In this paper we introduce a novel domain-invariant covariance normalization (DICN) technique to relocate both in-domain and out-domain i-vectors into a third dataset-invariant space, providing an improvement for out-domain PLDA speaker verification with a very small number of unlabelled in-domain adaptation i-vectors. By capturing the dataset variance from a global mean using both development out-domain i-vectors and limited unlabelled in-domain i-vectors, we could obtain domain- invariant representations of PLDA training data. The DICN- compensated out-domain PLDA system is shown to perform as well as in-domain PLDA training with as few as 500 unlabelled in-domain i-vectors for NIST-2010 SRE and 2000 unlabelled in-domain i-vectors for NIST-2008 SRE, and considerable relative improvement over both out-domain and in-domain PLDA development if more are available.

A cluster-voting approach for speaker diarization and linking of Australian broadcast news recordings

We present a clustering-only approach to the problem of speaker diarization to eliminate the need for the commonly employed and computationally expensive Viterbi segmentation and realignment stage. We use multiple linear segmentations of a recording and carry out complete-linkage clustering within each segmentation scenario to obtain a set of clustering decisions for each case. We then collect all clustering decisions, across all cases, to compute a pairwise vote between the segments and conduct complete-linkage clustering to cluster them at a resolution equal to the minimum segment length used in the linear segmentations. We use our proposed cluster-voting approach to carry out speaker diarization and linking across the SAIVT-BNEWS corpus of Australian broadcast news data. We compare our technique to an equivalent baseline system with Viterbi realignment and show that our approach can outperform the baseline technique with respect to the diarization error rate (DER) and attribution error rate (AER).