Emergency Health Services (EHS) : demand and service delivery models. [Monograph 2 : Queensland EHS users’ profile]

Emergency health is a critical component of Australia’s health system and one which is increasingly congested from growing demand and blocked access to inpatient beds. The Emergency Health Services Queensland (EHSQ) study aims to identify the factors driving increased demand for emergency health and to evaluate strategies which may safely reduce the future demand growth. This monograph addresses the characteristics of users of emergency health services with an aim to identify those that appear to contribute to demand growth. This study utilises data on patients treated by Emergency Departments (ED) and Queensland Ambulance Service (QAS) across Queensland. ED data was derived from the Emergency Department Information System (EDIS) for the period 2001-02 through to 2010-11. Ambulance data was extracted from the QAS’ Ambulance Information Management System (AIMS) and electronic Ambulance Report Form (eARF) for the period 2001-02 through to 2009-10. Due to discrepancies and comparability issues for ED data, this monograph compares data from the 2003-04 time period with 2010-11 data for 21 of the reporting EDs. Also a snapshot of users for the 2010-11 financial year for 31 reporting EDs is used to describe the characteristics of users and to compare those characteristics with population demographics. For QAS data, the 2002-03 and 2009-10 time periods were selected for detailed analyses to identify trends. • Demand for emergency health care services is increasing, representing both increased population and increased relative utilisation. Per capita demand for ED attention has increased by 2% per annum over the last decade and for ambulance attention by 3.7% per annum. • The growth in ED demand is prominent in more urgent triage categories with actual decline in less urgent patients. An estimated 55% of patients attend hospital EDs outside of normal working hours. There is no evidence that patients presenting out of hours are significantly different to those presenting within working hours; they have similar triage assessments and outcomes. • Patients suffering from injuries and poisoning comprise 28% of the ED workload (an increase of 65% in the study period), whilst declines of 32% in cardiovascular and circulatory conditions, and musculoskeletal problems have been observed. • 25.6% of patients attending EDs are admitted to hospital. 19% of admitted patients and 7% of patients who die in the ED are triage category 4 or 5 on arrival. • The average age of ED patients is 35.6 years. Demand has grown in all age groups and amongst both men and women. Men have higher utilisation rates for ED in all age groups. The only group where the growth rate in women has exceeded men is in the 20-29 age group; this growth is particularly in the injury and poisoning categories. • Considerable attention has been paid publicly to ED performance criteria. It is worth noting that 50% of all patients were treated within 33 minutes of arrival. • Patients from lower socioeconomic areas appear to have higher utilisation rates and the utilisation rate for indigenous people appears to exceed those of European and other backgrounds. The utilisation rates for immigrant people is generally less than that of Australian born however it has not been possible to eliminate the confounding impact of different age and socioeconomic profiles. • Demand for ambulance service is also increasing at a rate that exceeds population growth. Utilisation rates have increased by an average of 5% per annum in Queensland compared to 3.6% nationally, and the utilisation rate in Queensland is 27% higher than the national average. • The growth in ambulance utilisation has also been amongst the more urgent categories of dispatch and utilisation rates are higher in rural and regional areas than in the metropolitan area. The demand for ambulance increases with age but the growth in demand for ambulance service has been more prominent in younger age groups. These findings contribute significantly to an understanding of the growth in demand for emergency health. It shows that the growth is amongst patients in genuine need of emergency healthcare and public rhetoric that the congestion of emergency health services is due to inappropriate attendees is unable to be substantiated. The consistency of the growth in demand over the last decade reflects not only the changing demographics of the Australian population but also the changes in health status, standards of acute health care and other social factors. The growth is also amongst patients with acute injury and poisoning which is inconsistent with rates of chronic disease as a fundamental driver. We have also interviewed patients in regard to their decision making choices for acute health care and the factors that influence these decisions and this will be the subject of a third Monograph and publications.

Interstellar titanium-oxides in interplanetary dust

Interstellar gas abundances (Clayton et al., 1986) suggest that titanium may be bound up in dust and indeed, excess titanium in carbonaceous chondrites is attributed to mixing of interstellar and Solar System materials (Morton, 1974). Fine-grained chondritic interplanetary dust particles (lOPs) of cometary origin are relatively pristine early Solar System materials (Mackinnon and Rietmeijer, 1987; Rietmeijer, 1987) and show chemical and mineralogical signatures related to a pre-solar or nebular origin. For example, large OtH ratios suggest a presolar or interstellar dust component in some chondritic lOPs(Mackinnon and Rietmeijer, 1987). Ti/Si ratios (normalized to bulk CI) in lOPs and carbonaceous chondrite matrices exceed solar abundances but are similar to dust from comet Halley (Jessberger et al., 1987). The Ti-distribution in chondritic lOPs shows major, small-scale « 0.1 urn) variations (Flynn et al., 1978) consistent with heterogeneously distributed Ti-bearingphases. Analytical electron microscope (AEM) studies, in fact, have identified platey grains of Ti-metal, Ti407 and Ti s09 in two different lOPs (Mackinnon and Rietmeijer, 1987). The occurrence of Ti407 was related in situ low-temperature aqueous alteration and therefore implied the presence of BaTi03 (Rietmeijer and Mackinnon, 1984). Yet, the presence ofTis09 in an lOp which shows no evidence of aqueous alteration (Rietmeijer.and McKay, 1986) requires a different interpretation. The distribution of Ti-oxides in chondritic lOPs were investigated with ultra-microtomed thin sections of fluffy chondri tic lOP U2011*B (lSC allocation U2011C2) using a lEOL 2000FX AEM operating at an accelerating voltage of 200kV and with an attached Tracor Northern TN5500 energy dispersive spectrometer.

Varieties of collaboration: The case of an Australian retail union

Much has been written about varieties of collaboration and the interplay between conflict and collaboration in industrial relations. This paper explores the preconditions, processes and outcomes associated with the collaborative strategies of an Australian retail trade union: the Shop, Distributive and Allied Employees' Association. The data were collected from an extensive series of interviews with officials and organisers within the union across all Australian states. We find that despite taking a servicing approach, and indeed never aggressively organising members, the union has managed to achieve a range of outcomes that exceed retail employment conditions in other countries. We argue that this is partly a result of the Australian legislative framework, which is inherently pluralist and supportive of collective bargaining. This environment, whereby unions are not forced to fight to represent members, can be conducive to collaborative employment relations, particularly in industries where the parties do not adopt an adversarialist stance.

An analytical method for assessing stage-specific drug activity in Plasmodium vivax malaria : implications for ex vivo drug susceptibility testing

The emergence of highly chloroquine (CQ) resistant P. vivax in Southeast Asia has created an urgent need for an improved understanding of the mechanisms of drug resistance in these parasites, the development of robust tools for defining the spread of resistance, and the discovery of new antimalarial agents. The ex vivo Schizont Maturation Test (SMT), originally developed for the study of P. falciparum, has been modified for P. vivax. We retrospectively analysed the results from 760 parasite isolates assessed by the modified SMT to investigate the relationship between parasite growth dynamics and parasite susceptibility to antimalarial drugs. Previous observations of the stage-specific activity of CQ against P. vivax were confirmed, and shown to have profound consequences for interpretation of the assay. Using a nonlinear model we show increased duration of the assay and a higher proportion of ring stages in the initial blood sample were associated with decreased effective concentration (EC50) values of CQ, and identify a threshold where these associations no longer hold. Thus, starting composition of parasites in the SMT and duration of the assay can have a profound effect on the calculated EC50 for CQ. Our findings indicate that EC50 values from assays with a duration less than 34 hours do not truly reflect the sensitivity of the parasite to CQ, nor an assay where the proportion of ring stage parasites at the start of the assay does not exceed 66%. Application of this threshold modelling approach suggests that similar issues may occur for susceptibility testing of amodiaquine and mefloquine. The statistical methodology which has been developed also provides a novel means of detecting stage-specific drug activity for new antimalarials.

Craving : a research update [Editorial to a special issue]

Craving has long been associated with addictive disorders. It has received much attention over the last two decades, partly through the advent of pharmacotherapies that attempt to address it (Jonson, 2008; Yahyavi-Firouz-Abadi & See, 2009). More recently, craving for substances has attained increased prominence, with the inclusion of “Craving or a strong desire or urge” in the draft of DSM-5 (APA, 2012). Studies generally support craving as occurring on a single diagnostic dimension alongside existing dependence criteria (Hasin, et al., 2012; Keyes, et al., 2011). Some (e.g. Keyes, et al., 2011) demonstrate that the addition of craving to DSM-IV alcohol abuse and alcohol dependence criteria contributes novel variance in predicting severity, and improves discrimination above that offered by existing DSM-IV criteria. Within the current volume, the paper by Agrawal et al. confirms that craving strongly loads on a single dimension that also incorporates DSM-IV alcohol dependence criteria. Craving was a relatively severe symptom: It was least often endorsed, and did not exceed 50% endorsement until 6 of the remaining 7 criteria were present...

A bound on the maximum strong order of stochastic Runge-Kutta methods for stochastic ordinary differential equations

In Burrage and Burrage [1] it was shown that by introducing a very general formulation for stochastic Runge-Kutta methods, the previous strong order barrier of order one could be broken without having to use higher derivative terms. In particular, methods of strong order 1.5 were developed in which a Stratonovich integral of order one and one of order two were present in the formulation. In this present paper, general order results are proven about the maximum attainable strong order of these stochastic Runge-Kutta methods (SRKs) in terms of the order of the Stratonovich integrals appearing in the Runge-Kutta formulation. In particular, it will be shown that if an s-stage SRK contains Stratonovich integrals up to order p then the strong order of the SRK cannot exceed min{(p + 1)/2, (s - 1)/2), p greater than or equal to 2, s greater than or equal to 3 or 1 if p = 1.

Dynamic performance characteristics of an innovative Hybrid Composite Floor Plate System under human-induced loads

This study explored the dynamic performance of an innovative Hybrid Composite Floor Plate System (HCFPS), composed of Polyurethane (PU) core, outer layers of Glass–fibre Reinforced Cement (GRC) and steel laminates at tensile regions, using experimental testing and Finite Element (FE) modelling. Experimental testing included heel impact and walking tests for 3200 mm span HCFPS panels. FE models of the HCFPS were developed using the FE program ABAQUS and validated with experimental results. HCFPS is a light-weight high frequency floor system with excellent damping ratio of 5% (bare floor) due to the central PU core. Parametric studies were conducted using the validated FE models to investigate the dynamic response of the HCFPS and to identify characteristics that influence acceleration response under human induced vibration in service. This vibration performance was compared with recommended acceptable perceptibility limits. The findings of this study show that HCFPS can be used in residential and office buildings as a light-weight floor system, which does not exceed the perceptible thresholds due to human induced vibrations.

In situ SANS study of the surface and pore filling adsorption of subcritical and supercritical CO2 in porous silica as a function of pore size

We applied small-angle neutron scattering (SANS) and ultra small-angle neutron scattering (USANS) to monitor evolution of the CO2 adsorption in porous silica as a function of CO2 pressure and temperature in pores of different sizes. The range of pressures (0 < P < 345 bar) and temperatures (T=18 OC, 35 OC and 60 OC) corresponded to subcritical, near critical and supercritical conditions of bulk fluid. We observed that the adsorption behavior of CO2 is fundamentally different in large and small pores with the sizes D > 100 Å and D < 30 Å, respectively. Scattering data from large pores indicate formation of a dense adsorbed film of CO2 on pore walls with the liquid-like density (ρCO2)ads≈0.8 g/cm3. The adsorbed film coexists with unadsorbed fluid in the inner pore volume. The density of unadsorbed fluid in large pores is temperature and pressure dependent: it is initially lower than (ρCO2)ads and gradually approaches it with pressure. In small pores compressed CO2 gas completely fills the pore volume. At the lowest pressures of the order of 10 bar and T=18 OC, the fluid density in smallest pores available in the matrix with D ~ 10 Å exceeds bulk fluid density by a factor of ~ 8. As pressure increases, progressively larger pores become filled with the condensed CO2. Fluid densification is only observed in pores with sizes less than ~ 25 – 30 Å. As the density of the invading fluid reaches (ρCO2)bulk~ 0.8 g/cm3, pores of all sizes become uniformly filled with CO2 and the confinement effects disappear. At higher densities the fluid in small pores appears to follow the equation of state of bulk CO2 although there is an indication that the fluid density in the inner volume of large pores may exceed the density of the adsorbed layer. The equivalent internal pressure (Pint) in the smallest pores exceeds the external pressure (Pext) by a factor of ~ 5 for both sub- and supercritical CO2. Pint gradually approaches Pext as D → 25 – 30 Å and is independent of temperature in the studied range of 18 OC ≤ T ≤ 60 OC. The obtained results demonstrate certain similarity as well as differences between adsorption of subcritical and supercritical CO2 in disordered porous silica. High pressure small angle scattering experiments open new opportunities for in situ studies of the fluid adsorption in porous media of interest to CO2 sequestration, energy storage, and heterogeneous catalysis.

Vision-based place recognition : how low can you go?

In this paper we use the algorithm SeqSLAM to address the question, how little and what quality of visual information is needed to localize along a familiar route? We conduct a comprehensive investigation of place recognition performance on seven datasets while varying image resolution (primarily 1 to 512 pixel images), pixel bit depth, field of view, motion blur, image compression and matching sequence length. Results confirm that place recognition using single images or short image sequences is poor, but improves to match or exceed current benchmarks as the matching sequence length increases. We then present place recognition results from two experiments where low-quality imagery is directly caused by sensor limitations; in one, place recognition is achieved along an unlit mountain road by using noisy, long-exposure blurred images, and in the other, two single pixel light sensors are used to localize in an indoor environment. We also show failure modes caused by pose variance and sequence aliasing, and discuss ways in which they may be overcome. By showing how place recognition along a route is feasible even with severely degraded image sequences, we hope to provoke a re-examination of how we develop and test future localization and mapping systems.

Review : "Heat islands : understanding and mitigating heat in urban areas" by Lisa Gartland. Reviewed by Tony Matthews.

Heat islands are a significant problem in urban spaces worldwide. The phenomenon occurs when air and surface temperatures in urban areas significantly exceed those experienced in nearby rural areas. There are two main causes of heat islands. The first is the use of highly absorptive construction materials in buildings and infrastructure, which soak up heat and radiate it back into the immediate surroundings. These materials, including but not limited to concrete, steel, asphalt and stone, are usually impermeable and so do not embody moisture that could dissipate some of the absorbed heat. The second cause relates to urban form, where the canyon-like configurations of buildings and streets channel and trap heat from the sun. In both cases, an absence of greenery and other soft landscaping can compound the problem by lowering capacity for cooling through shading and evotranspiration. Incidences of heat islands increase as urban areas swell in size and cover more land area, making the phenomenon an unwelcome side effect of global trends towards increased urbanisation. Heat islands create serious problems, including increased energy demand for cooling, declining air quality and heat stress for people and animals. In very severe cases, heat islands can compound the effects of high urban temperatures, leading to increased human mortality...

Excursion guidance criteria to guide control of peak emission and exposure to airborne engineered particles

The overall aim of our research was to characterize airborne particles from selected nanotechnology processes and to utilize the data to develop and test quantitative particle concentration-based criteria that can be used to trigger an assessment of particle emission controls. We investigated particle number concentration (PNC), particle mass (PM) concentration, count median diameter (CMD), alveolar deposited surface area, elemental composition, and morphology from sampling of aerosols arising from six nanotechnology processes. These included fibrous and non-fibrous particles, including carbon nanotubes (CNTs). We adopted standard occupational hygiene principles in relation to controlling peak emission and exposures, as outlined by both Safe Work Australia, (1) and the American Conference of Governmental Industrial Hygienists (ACGIH®). (2) The results from the study were used to analyses peak and 30-minute averaged particle number and mass concentration values measured during the operation of the nanotechnology processes. Analysis of peak (highest value recorded) and 30-minute averaged particle number and mass concentration values revealed: Peak PNC20–1000 nm emitted from the nanotechnology processes were up to three orders of magnitude greater than the local background particle concentration (LBPC). Peak PNC300–3000 nm was up to an order of magnitude greater, and PM2.5 concentrations up to four orders of magnitude greater. For three of these nanotechnology processes, the 30-minute average particle number and mass concentrations were also significantly different from the LBPC (p-value < 0.001). We propose emission or exposure controls may need to be implemented or modified, or further assessment of the controls be undertaken, if concentrations exceed three times the LBPC, which is also used as the local particle reference value, for more than a total of 30 minutes during a workday, and/or if a single short-term measurement exceeds five times the local particle reference value. The use of these quantitative criteria, which we are terming the universal excursion guidance criteria, will account for the typical variation in LBPC and inaccuracy of instruments, while precautionary enough to highlight peaks in particle concentration likely to be associated with particle emission from the nanotechnology process. Recommendations on when to utilize local excursion guidance criteria are also provided.

Illustrating outcomes for Australian nascent and young firm entrepreneurial activity

This paper examines the outcomes of nascent and young entrepreneurial firms in Australia. Findings of interest in this paper include: • After three years similar proportions of nascent firms reach an operational state (31 per cent), i.e. sales regularly exceed costs, compared with those that have terminated (35 per cent), and those who are still trying to achieve venture creation (34 per cent). This outcome closely mirrors the outcomes in the US PSED study. • The young firm sample shows that these new ventures remain more robust to firm closure. The vast majority of young firms (78 per cent) continue to be active in the market the last time they participated in CAUSEE. • The annual termination rate for young firms is 9 per cent at most, and 14 per cent cumulatively, while cumulatively only 8 per cent of young firms experience a drop-off in activity to be considered as having uncertain status. • The average number of employees in Nascent Firms is one person, the average number of Young Firm employees increases from two at first sampling to three after three years. • While the founders of exiting Nascent Firms are more likely to return to their old job upon termination of their business, Young Firm founders move on to new jobs. Regardless the majority of exiting firm founders rate their experience as positive and are prepared to attempt business creation in the future.

Continuous production of Bi-2212 thick film on silver tape

Bi-2212 thick film on silver tapes are seen as a simple and low cost alternative to high temperature superconducting wires produced by the Powder In Thbe (PIT) technique, particularly in react and wind applications. A rig for the continuous production of Bi-2212 tapes for use in react and wind component manufacture has been developed and commissioned. The rig consists of several sections, each fully automatic, for task specific duties in the production of HTS tape. The major sections are: tape coating, sintering and annealing. High temperature superconducting tapes with engineering critical current densities of 10 kA/cm2 (77 K, self field), and lengths of up to 100 m have been produced using the rig. Properties of the finished tape are discussed and results are presented for current density versus bend radius and applied strain. Depending on tape content and thickness, irreversible strain tirrm varies between 0.04 and 0.1 %. Cyclic bending tests when applied strain does not exceed Eirrm showed negligible reduction in J c along the length of the tape.

Video analytics for the detection of near-miss incidents on approach to railway level crossings

Recent modelling of socio-economic costs by the Australian railway industry in 2010 has estimated the cost of level crossing accidents to exceed AU$116 million annually. To better understand causal factors that contribute to these accidents, the Cooperative Research Centre for Rail Innovation is running a project entitled Baseline Level Crossing Video. The project aims to improve the recording of level crossing safety data by developing an intelligent system capable of detecting near-miss incidents and capturing quantitative data around these incidents. To detect near-miss events at railway level crossings a video analytics module is being developed to analyse video footage obtained from forward-facing cameras installed on trains. This paper presents a vision base approach for the detection of these near-miss events. The video analytics module is comprised of object detectors and a rail detection algorithm, allowing the distance between a detected object and the rail to be determined. An existing publicly available Histograms of Oriented Gradients (HOG) based object detector algorithm is used to detect various types of vehicles in each video frame. As vehicles are usually seen from a sideway view from the cabin’s perspective, the results of the vehicle detector are verified using an algorithm that can detect the wheels of each detected vehicle. Rail detection is facilitated using a projective transformation of the video, such that the forward-facing view becomes a bird’s eye view. Line Segment Detector is employed as the feature extractor and a sliding window approach is developed to track a pair of rails. Localisation of the vehicles is done by projecting the results of the vehicle and rail detectors on the ground plane allowing the distance between the vehicle and rail to be calculated. The resultant vehicle positions and distance are logged to a database for further analysis. We present preliminary results regarding the performance of a prototype video analytics module on a data set of videos containing more than 30 different railway level crossings. The video data is captured from a journey of a train that has passed through these level crossings.

Long non coding RNAs (lncRNAs) are dysregulated in Malignant Pleural Mesothelioma (MPM)

Malignant Pleural Mesothelioma (MPM) is an aggressive cancer that is often diagnosed at an advanced stage and is characterized by a long latency period (20-40 years between initial exposure and diagnosis) and prior exposure to asbestos. Currently accurate diagnosis of MPM is difficult due to the lack of sensitive biomarkers and despite minor improvements in treatment, median survival rates do not exceed 12 months. Accumulating evidence suggests that aberrant expression of long non-coding RNAs (lncRNAs) play an important functional role in cancer biology. LncRNAs are a class of recently discovered non-protein coding RNAs >200 nucleotides in length with a role in regulating transcription. Here we used NCode long noncoding microarrays to identify differentially expressed lncRNAs potentially involved in MPM pathogenesis. High priority candidate lncRNAs were selected on the basis of statistical (P<0.05) and biological significance (>3-fold difference). Expression levels of 9 candidate lncRNAs were technically validated using RT-qPCR, and biologically validated in three independent test sets: (1) 57 archived MPM tissues obtained from extrapleural pneumonectomy patients, (2) 15 cryopreserved MPM and 3 benign pleura, and (3) an extended panel of 10 MPM cell lines. RT-qPCR analysis demonstrated consistent up-regulation of these lncRNAs in independent datasets. ROC curve analysis showed that two candidates were able to separate benign pleura and MPM with high sensitivity and specificity, and were associated with nodal metastases and survival following induction chemotherapy. These results suggest that lncRNAs have potential to serve as biomarkers in MPM.