Pain expression in neonates:facial action and cry

Pain expression in neonates instigated by heel-lance for blood sampling purposes was systematically described using measures of facial expression and cry and compared across sleep/waking states and sex. From gate-control theory it was hypothesized that pain behavior would vary with the ongoing functional state of the infant, rather than solely reflecting tissue insult. Awake-alert but inactive infants responded with the most facial activity, consistent with current views that infants in this state are most receptive to environmental stimulation. Infants in quiet sleep showed the least facial reaction and the longest latency to cry. Fundamental frequency of cry was not related to sleep/waking state. This suggested that findings from the cry literature on qualities of pain cry as a reflection of nervous system 'stress', in unwell newborns, do not generalize directly to healthy infants as a function of state. Sex differences were apparent in speed of response, with boys showing shorter time to cry and to display facial action following heel-lance. The findings of facial action variation across sleep/waking state were interpreted as indicating that the biological and behavioral context of pain events affects behavioral expression, even at the earliest time developmentally, before the opportunity for learned response patterns occurs. Issues raised by the study include the importance of using measurement techniques which are independent of preconceived categories of affective response.

Introduction to Wireless Intrusion Detection Systems

The IDS (Intrusion Detection System) is a common means of protecting networked systems from attack or malicious misuse. The development and rollout of an IDS can take many different forms in terms of equipment, protocols, connectivity, cost and automation. This is particularly true of WIDS (Wireless Intrusion Detection Systems) which have many more opportunities and challenges associated with data transmission through an open, shared medium.
The operation of a WIDS is a multistep process from origination of an attack through to human readable evaluation. Attention to the performance of each of the processes in the chain from attack detection to evaluation is imperative if an optimum solution is to be sought. At present, research focuses very much on each discrete aspect of a WIDS with little consideration to the operation of the whole system. Taking a holistic view of the technology shows the interconnectivity and inter-dependence between stages, leading to improvements and novel research areas for investigation.
This chapter will outline the general structure of Wireless Intrusion Detection Systems and briefly describe the functions of each development stage, categorised into the following 6 areas:
• Threat Identification,
• Architecture,
• Data Collection,
• Intrusion Detection,
• Alert Correlation,
• Evaluation.
These topics will be considered in broad terms designed for those new to the area. Focus will be placed on ensuring the readers are aware of the impact of choices made at early stages in WIDS development on future stages.

Knowledge, innovation and emulation in the evolutionary thought of Bernard Mandeville

Of the early modern writers on the division of labour, Bernard Mandeville alone extended it to all aspects of human activity and emphasised its role in a cumulative process of evolution in which each generation modified and built on what had been achieved by earlier generations. This required exploration of the mechanisms through which new knowledge was developed as well as the means by which knowledge was transmitted between the generations. The present article examines Mandeville’s treatment of these mechanisms and explores their theoretical origins. It examines Mandeville’s understanding of the role of the division of labour in facilitating discovery and learning and the role of education and imitation in transmitting social knowledge. It shows that, for Mandeville, innovators were people of ordinary capacity who were alert to the opportunities and challenges of their environment. As a result of specialisation, they possessed tacit knowledge which was actualised in what they did rather than in theoretical propositions. Mandeville’s evolutionary thought influenced subsequent writers on political economy and evolutionary social thinkers. It may also have had some influence on Charles Darwin, though it is not, in itself, Darwinian. © The Author 2013. Published by Oxford University Press on behalf of the Cambridge Political Economy Society. All rights reserved.

USING ‘NUTRITIONAL NARRATIVE’ AND FOCUS GROUPS TO UNDERSTAND HOW NUTRITIONAL CARE CAN BETTER PRIORITISED FOR OLDER PEOPLE IN HOSPITAL SETTINGS

Introduction: Poor nutritional status among older people is well documented with 40% of older people reported as malnourished on hospital admission. Poor nutrition contributes to increased infection, poorer patient outcomes and death and longer hospital stays. In this study, we assessed the ‘nutrition narrative’ from older hospital patients together with nutrition knowledge among nursing and medical staff and students.
Methods: The study used a convenience sample of older people (30, mean age 82 years) in two large geographically separate city hospitals. Patients mentally alert and consenting, gave a recorded ‘nutrition narrative’ to get a sense of how they felt their nutritional needs were being met in hospital. Main themes were identified by grounded analysis framework. Focus groups were recruited from medical/nursing teachers and students to assess their working knowledge of nutrition and the nutritional needs of the older patient group.
Results: Analysis of the ‘nutrition narrative’ suggested several themes (i) staff should listen to patients' needs/wishes in discussion with themselves and family members (ii) staff should continue to encourage and progress a positive eating experience (iii) staff should monitor food eaten/or not eaten and increase regular monitoring of weight. The focus groups with medical and nursing students suggested a limited knowledge about nutritional care of older people and little understanding about roles or cross-talk about nutrition across the multidisciplinary groups.
Conclusions: The ‘nutrition narrative’ themes suggested that the nutritional experience of older people in hospital can and must be improved. Nursing and medical staff providing medical and nursing care need better basic knowledge of nutrition and nutritional assessment, an improved understanding of the roles of the various multidisciplinary staff and of hospital catering pathways. Care professionals need to prioritise patient nutrition much more highly and recognise nutritional care as integral to patient healing and recovery

Suspected giant cell arteritis:A study of referrals for temporal artery biopsy

Background: The purpose of this study is to describe the nature of cases undergoing temporal artery biopsy (TAB) for suspected giant cell arteritis (GCA). Methods: A retrospective review of case notes was undertaken for all patients on whom ophthalmologists had performed TAB in 2 teaching hospitals between 1995 and 2001. Presenting symptoms, referring specialty, TAB result, treatment, and discharge diagnosis were recorded. Results: Ophthalmologists performed TAB on 110 patients for suspected GCA. A variety of specialties referred patients to ophthalmology for TAB; presenting symptoms varied with referral source. Of the 110 TABs, 21 (19%) were reported as positive for GCA, 84 (76%) were negative, and 5 (4.5%) were reported as inadequate. The symptoms most commonly associated with a positive TAB were visual disturbance (15/21) and headache (15/21).The odds ratios for having a positive TAB result rather than a negative result were 1.0 for the presence of headache, 4.1 for visual disturbance, and 6.7 for jaw claudication. Interpretation: Physicians were faced with a different population of GCA suspects than ophthalmologists. While physicians should be alert to the significance of visual symptoms or jaw claudication, ophthalmologists should be ready to facilitate prompt TABs when appropriate. TAB should be performed promptly and an adequate length of artery taken for biopsy. An argument can be made that TAB is not needed in cases of suspected GCA. However, a positive result provides firm justification for the use of steroids. We feel that TAB has a useful role and we make reference to methods to maximize its usefulness.

Lightweight Risk Management in Agile projects

Risk management in software engineering has become a recognized project management practice but it seems that not all companies are systematically applying it. At the same time, agile methods have become popular, partly because proponents claim that agile methods implicitly reduce risks due
to, for example, more frequent and earlier feedback, shorter periods of development time and easier prediction of cost. Therefore, there is a need to investigate how risk management can be usable in iterative and evolutionary software development processes. This paper investigates the gathering of empirical data on risk management from the project environment and presents
a novel approach to manage risk in agile projects. Our approach is based on a prototype tool, Agile Risk Tool (ART). This tool reduces human effort in risk management by using software agents to identify, assess and monitor risk, based on input and data collected from the project environment and by applying
some designated rules. As validation, groups of student project data were used to provide evidence of the efficacy of this approach. We demonstrate the approach and the feasibility of using a lightweight risk management tool to alert, assess and monitor risk with reduced human effort.

The Work of Sisyphus: Squaring the Circle of Roma Recognition

Most special issues on Roma minorities want to alert readers to the devastating consequences of racist public attitudes and misdirected public policy. Here we don't shy away from such issues, but we also want to challenge our own scholarship and ask some fundamental questions about how we, as academics, are approaching such research. In this introduction the context of the special issue is explored, both in terms of the historic backdrop of an expanding European Union and the academic theoretical framework of minority integration. Major critical questioning – such as broader questions around migration, race and ethnicity discourses – are still lacking when it comes to research on or with Roma minorities. Our main aim is to move debates on from continually describing who Roma people are and what they are doing, to questioning: who defines who is Roma, when and why? What happens in policy-making, research, everyday interactions? This approach sees an understanding of recognition, representations and power dynamics as fundamental to understanding the positionings of minorities who can also be marginalised or feel disenfranchised. This introduction to the special issue highlights the importance of deeply conceptualising issues around minority integration alongside empirical knowledge of how Roma identities become implicated in and through different modalities of mobilisation. Contributions to this special issue speak to debates in minority politics and identity studies along with migration and race/ethnicity discourses. This indicates that the experiences of, and discourses surrounding Roma minorities reflect the fundamental concerns of social science research about identity, ethnicity, cohesion and change.

STOPP/START criteria for potentially inappropriate prescribing in older people: version 2

PURPOSE: screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria were first published in 2008. Due to an expanding therapeutics evidence base, updating of the criteria was required.

METHODS: we reviewed the 2008 STOPP/START criteria to add new evidence-based criteria and remove any obsolete criteria. A thorough literature review was performed to reassess the evidence base of the 2008 criteria and the proposed new criteria. Nineteen experts from 13 European countries reviewed a new draft of STOPP & START criteria including proposed new criteria. These experts were also asked to propose additional criteria they considered important to include in the revised STOPP & START criteria and to highlight any criteria from the 2008 list they considered less important or lacking an evidence base. The revised list of criteria was then validated using the Delphi consensus methodology.

RESULTS: the expert panel agreed a final list of 114 criteria after two Delphi validation rounds, i.e. 80 STOPP criteria and 34 START criteria. This represents an overall 31% increase in STOPP/START criteria compared with version 1. Several new STOPP categories were created in version 2, namely antiplatelet/anticoagulant drugs, drugs affecting, or affected by, renal function and drugs that increase anticholinergic burden; new START categories include urogenital system drugs, analgesics and vaccines.

CONCLUSION: STOPP/START version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people. These criteria are based on an up-to-date literature review and consensus validation among a European panel of experts.

International inter-school competition to encourage children to walk to school: a mixed methods feasibility study.

Background: Active travel to school can be an important contributor to the total physical activity of children but levels have declined and more novel approaches are required to stimulate this as an habitual behaviour. The aim of this mixed methods study was to investigate the feasibility of an international walk to school competition supported by novel swipecard technology to increase children's walking to/from school. Methods: Children aged 9-13 years old participated in an international walk to school competition to win points for themselves, their school and their country over a 4-week period. Walks to and from school were recorded using swipecard technology and a bespoke website. For each point earned by participants, 1 pence (£0.01) was donated to the charity of the school's choice. The primary outcome was number of walks to/from school objectively recorded using the swipecard tracking system over the intervention period. Other measures included attitudes towards walking collected at baseline and week 4 (post-intervention). A qualitative sub-study involving focus groups with children, parents and teachers provided further insight. Results: A total of 3817 children (mean age 11.5±SD 0.7) from 12 schools in three cities (London and Reading, England and Vancouver, Canada) took part in the intervention, representing a 95% intervention participation rate. Results show a gradual decline in the average number of children walking to and from school over the 4-week period (week 1 mean 29%±SD2.5; week 2 mean 18%±SD3.6; week 3 mean 14%±SD4.0; week 4 mean 12%±SD1.1). Post intervention, 97% of children felt that walking to school helped them stay healthy, feel happy (81%) and stay alert in class (76%). These results are supported by qualitative findings from children, parents and teachers. Key areas for improvement include the need to incorporate strategies for maintenance of behaviour change into the intervention and also to adopt novel methods of data collection to increase follow-up rates. Conclusions: This mixed methods study suggests that an international walk to school competition using innovative technology can be feasibly implemented and offers a novel way of engaging schools and motivating children to walk to school.

To be inside someone else's dream: On Music for Sleeping & Waking Minds

Music for Sleeping & Waking Minds (2011-2012) is a new,overnight work in which four performers fall asleep while wearing custom designed EEG sensors which monitor their brainwave activity. The data gathered from the EEG sensors is applied in real time to different audio and image signal processing functions, resulting in continuously evolving multichannel sound environment and visual projection. This material serves as an audiovisual description of the individual and collective neuro physiological state of the ensemble. Audiences are invited to experience the work in different states of attention: while alert and asleep, resting and awakening.

A survey of location inference techniques on Twitter

The increasing popularity of the social networking service, Twitter, has made it more involved in day-to-day communications, strengthening social relationships and information dissemination. Conversations on Twitter are now being explored as indicators within early warning systems to alert of imminent natural disasters such earthquakes and aid prompt emergency responses to crime. Producers are privileged to have limitless access to market perception from consumer comments on social media and microblogs. Targeted advertising can be made more effective based on user profile information such as demography, interests and location. While these applications have proven beneficial, the ability to effectively infer the location of Twitter users has even more immense value. However, accurately identifying where a message originated from or author’s location remains a challenge thus essentially driving research in that regard. In this paper, we survey a range of techniques applied to infer the location of Twitter users from inception to state-of-the-art. We find significant improvements over time in the granularity levels and better accuracy with results driven by refinements to algorithms and inclusion of more spatial features.

A co-operative formation-based collision avoidance approach for a group of autonomous vehicles (Special Issue on Adaptive Control and Signal Processing in Marine System)

This paper employs a unique decentralised cooperative control method to realise a formation-based collision avoidance strategy for a group of autonomous vehicles. In this approach, the vehicles' role in the formation and their alert and danger areas are first defined, and the formation-based intra-group and external collision avoidance methods are then proposed to translate the collision avoidance problem into the formation stability problem. The extension–decomposition–aggregation formation control method is next employed to stabilise the original and modified formations, whilst manoeuvring, and subsequently solve their collision avoidance problem indirectly. Simulation study verifies the feasibility and effectiveness of the intra-group and external collision avoidance strategy. It is demonstrated that both formation control and collision avoidance problems can be simultaneously solved if the stability of the expanded formation including external obstacles can be satisfied.

A realistic evaluation of track and trigger systems and acute care training for early recognition and treatment of deteriorating ward-based patients: research protocol.

Aim The aim of the study is to evaluate factors that enable or constrain the implementation and service delivery of early warnings systems or acute care training in practice. Background To date there is limited evidence to support the effectiveness of acute care initiatives (early warning systems, acute care training, outreach) in reducing the number of adverse events (cardiac arrest, death, unanticipated Intensive Care admission) through increased recognition and management of deteriorating ward based patients in hospital [1-3]. The reasons posited are that previous research primarily focused on measuring patient outcomes following the implementation of an intervention or programme without considering the social factors (the organisation, the people, external influences) which may have affected the process of implementation and hence measured end-points. Further research which considers the social processes is required in order to understand why a programme works, or does not work, in particular circumstances [4]. Method The design is a multiple case study approach of four general wards in two acute hospitals where Early Warning Systems (EWS) and Acute Life-threatening Events Recognition and Treatment (ALERT) course have been implemented. Various methods are being used to collect data about individual capacities, interpersonal relationships and institutional balance and infrastructures in order to understand the intended and unintended process outcomes of implementing EWS and ALERT in practice. This information will be gathered from individual and focus group interviews with key participants (ALERT facilitators, nursing and medical ALERT instructors, ward managers, doctors, ward nurses and health care assistants from each hospital); non-participant observation of ward organisation and structure; audit of patients' EWS charts and audit of the medical notes of patients who deteriorated during the study period to ascertain whether ALERT principles were followed. Discussion & progress to date This study commenced in January 2007. Ethical approval has been granted and data collection is ongoing with interviews being conducted with key stakeholders. The findings from this study will provide evidence for policy-makers to make informed decisions regarding the direction for strategic and service planning of acute care services to improve the level of care provided to acutely ill patients in hospital. References 1. Esmonde L, McDonnell A, Ball C, Waskett C, Morgan R, Rashidain A et al. Investigating the effectiveness of Critical Care Outreach Services: A systematic review. Intensive Care Medicine 2006; 32: 1713-1721 2. McGaughey J, Alderdice F, Fowler R, Kapila A, Mayhew A, Moutray M. Outreach and Early Warning Systems for the prevention of Intensive Care admission and death of critically ill patients on general hospital wards. Cochrane Database of Systematic Reviews 2007, Issue 3. www.thecochranelibrary.com 3. Winters BD, Pham JC, Hunt EA, Guallar E, Berenholtz S, Pronovost PJ (2007) Rapid Response Systems: A systematic review. Critical Care Medicine 2007; 35 (5): 1238-43 4. Pawson R and Tilley N. Realistic Evaluation. London; Sage: 1997

A realistic evaluation of Early Warning Systems and acute care training in Northern Ireland: findings and recommendations

Statement of purpose The purpose of this concurrent session is to present the main findings and recommendations from a five year study evaluating the implementation of Early Warning Systems (EWS) and the Acute Life-threatening Events: Recognition and Treatment (ALERT) course in Northern Ireland. The presentation will provide delegates with an understanding of those factors that enable and constrain successful implementation of EWS and ALERT in practice in order to provide an impetus for change. Methods The research design was a multiple case study approach of four wards in two hospitals in Northern Ireland. It followed the principles of realist evaluation research which allowed empirical data to be gathered to test and refine RRS programme theory [1]. The stages included identifying the programme theories underpinning EWS and ALERT, generating hypotheses, gathering empirical evidence and refining the programme theories. This approach used a variety of mixed methods including individual and focus group interviews, observation and documentary analysis of EWS compliance data and ALERT training records. A within and across case comparison facilitated the development of mid-range theories from the research evidence. Results The official RRS theories developed from the realist synthesis were critically evaluated and compared with the study findings to develop a mid-range theory to explain what works, for whom in what circumstances. The findings of what works suggests that clinical experience, established working relationships, flexible implementation of protocols, ongoing experiential learning, empowerment and pre-emptive management are key to the success of EWS and ALERT implementation. Each concept is presented as ‘context, mechanism and outcome configurations’ to provide an understanding of how the context impacts on individual reasoning or behaviour to produce certain outcomes. Conclusion These findings highlight the combination of factors that can improve the implementation and sustainability of EWS and ALERT and in light of this evidence several recommendations are made to provide policymakers with guidance and direction for future policy development. References: 1. Pawson R and Tilley N. (1997) Realistic Evaluation. Sage Publications; London Type of submission: Concurrent session Source of funding: Sandra Ryan Fellowship funded by the School of Nursing & Midwifery, Queen’s University of Belfast