Nurse-determined assessment of cardiac output. Comparing a non-invasive cardiac output device and pulmonary artery catheter: a prospective observational study.

Background The accurate measurement of Cardiac output (CO) is vital in guiding the treatment of critically ill patients. Invasive or minimally invasive measurement of CO is not without inherent risks to the patient. Skilled Intensive Care Unit (ICU) nursing staff are in an ideal position to assess changes in CO following therapeutic measures. The USCOM (Ultrasonic Cardiac Output Monitor) device is a non-invasive CO monitor whose clinical utility and ease of use requires testing. Objectives To compare cardiac output measurement using a non-invasive ultrasonic device (USCOM) operated by a non-echocardiograhically trained ICU Registered Nurse (RN), with the conventional pulmonary artery catheter (PAC) using both thermodilution and Fick methods. Design Prospective observational study. Setting and participants Between April 2006 and March 2007, we evaluated 30 spontaneously breathing patients requiring PAC for assessment of heart failure and/or pulmonary hypertension at a tertiary level cardiothoracic hospital. Methods SCOM CO was compared with thermodilution measurements via PAC and CO estimated using a modified Fick equation. This catheter was inserted by a medical officer, and all USCOM measurements by a senior ICU nurse. Mean values, bias and precision, and mean percentage difference between measures were determined to compare methods. The Intra-Class Correlation statistic was also used to assess agreement. The USCOM time to measure was recorded to assess the learning curve for USCOM use performed by an ICU RN and a line of best fit demonstrated to describe the operator learning curve. Results In 24 of 30 (80%) patients studied, CO measures were obtained. In 6 of 30 (20%) patients, an adequate USCOM signal was not achieved. The mean difference (±standard deviation) between USCOM and PAC, USCOM and Fick, and Fick and PAC CO were small, −0.34 ± 0.52 L/min, −0.33 ± 0.90 L/min and −0.25 ± 0.63 L/min respectively across a range of outputs from 2.6 L/min to 7.2 L/min. The percent limits of agreement (LOA) for all measures were −34.6% to 17.8% for USCOM and PAC, −49.8% to 34.1% for USCOM and Fick and −36.4% to 23.7% for PAC and Fick. Signal acquisition time reduced on average by 0.6 min per measure to less than 10 min at the end of the study. Conclusions In 80% of our cohort, USCOM, PAC and Fick measures of CO all showed clinically acceptable agreement and the learning curve for operation of the non-invasive USCOM device by an ICU RN was found to be satisfactorily short. Further work is required in patients receiving positive pressure ventilation.

Formative and summative assessment and the notion of constructive alignment

This paper discusses the different perceptions of first year accounting students about their tutorial activities and their engagements in assessment. As the literature suggests, unless participation in learning activities forms part of graded assessment, it is often difficult to engage students in these activities. Using an action research model, this paper reports the study of first year accounting students' responses to action-oriented learning tasks in tutorials. The paper focuses on the importance of aligning curriculum objectives, learning and teaching activities and assessment, i.e. the notion of constructive alignment. However, as the research findings indicate, without support at institutional level, applying constructive alignment to facilitate quality student learning outcomes is a difficult task. Thus, the impacts of policy constraints on curriculum issues are also discussed, focusing on the limitations faced by tutors and their lack of involvement in curriculum development.

International review of environmental assessment tools and databases

Existing widely known environmental assessment models, primarily those for Life Cycle Assessment of manufactured products and buildings, were reviewed to grasp their characteristics, since the past several years have seen a significant increase in interest and research activity in the development of building environmental assessment methods. Each method or tool was assessed under the headings of description, data requirement, end-use, assessment criteria (scale of assessment and scoring/ weighting system)and present status

The comprehensive Australian Study of entrepreneurial emergence (CAUSEE) high potential nascent entrepreneurs : some preliminary findings

Principal Topic The Comprehensive Australian Study of Entrepreneurial Emergence (CAUSEE) represents the first Australian study to employ and extend the longitudinal and large scale systematic research developed for the Panel Study of Entrepreneurial Dynamics (PSED) in the US (Gartner, Shaver, Carter and Reynolds, 2004; Reynolds, 2007). This research approach addresses several shortcomings of other data sets including under coverage; selection bias; memory decay and hindsight bias, and lack of time separation between the assessment of causes and their assumed effects (Johnson et al 2006; Davidsson 2006). However, a remaining problem is that any a random sample of start-ups will be dominated by low potential, imitative ventures. In recognition of this issue CAUSEE supplemented PSED-type random samples with theoretically representative samples of the 'high potential' emerging ventures employing a unique methodology using novel multiple screening criteria. We define new ''high-potential'' ventures as new entrepreneurial innovative ventures with high aspirations and potential for growth. This distinguishes them from those ''lifestyle'' imitative businesses that start small and remain intentionally small (Timmons, 1986). CAUSEE is providing the opportunity to explore, for the first time, if process and outcomes of high potentials differ from those of traditional lifestyle firms. This will allows us to compare process and outcome attributes of the random sample with the high potential over sample of new firms and young firms. The attributes in which we will examine potential differences will include source of funding, and internationalisation. This is interesting both in terms of helping to explain why different outcomes occur but also in terms of assistance to future policymaking, given that high growth potential firms are increasingly becoming the focus of government intervention in economic development policies around the world. The first wave of data of a four year longitudinal study has been collected using these samples, allowing us to also provide some initial analysis on which to continue further research. The aim of this paper therefore is to present some selected preliminary results from the first wave of the data collection, with comparisons of high potential with lifestyle firms. We expect to see owing to greater resource requirements and higher risk profiles, more use of venture capital and angel investment, and more internationalisation activity to assist in recouping investment and to overcome Australia's smaller economic markets Methodology/Key Propositions In order to develop the samples of 'high potential' in the NF and YF categories a set of qualification criteria were developed. Specifically, to qualify, firms as nascent or young high potentials, we used multiple, partly compensating screening criteria related to the human capital and aspirations of the founders as well as the novelty of the venture idea, and venture high technology. A variety of techniques were also employed to develop a multi level dataset of sources to develop leads and firm details. A dataset was generated from a variety of websites including major stakeholders including the Federal and State Governments, Australian Chamber of Commerce, University Commercialisation Offices, Patent and Trademark Attorneys, Government Awards and Industry Awards in Entrepreneurship and Innovation, Industry lead associations, Venture Capital Association, Innovation directories including Australian Technology Showcase, Business and Entrepreneurs Magazines including BRW and Anthill. In total, over 480 industry, association, government and award sources were generated in this process. Of these, 74 discrete sources generated high potentials that fufilled the criteria. 1116 firms were contacted as high potential cases. 331 cases agreed to participate in the screener, with 279 firms (134 nascents, and 140 young firms) successfully passing the high potential criteria. 222 Firms (108 Nascents and 113 Young firms) completed the full interview. For the general sample CAUSEE conducts screening phone interviews with a very large number of adult members of households randomly selected through random digit dialing using screening questions which determine whether respondents qualify as 'nascent entrepreneurs'. CAUSEE additionally targets 'young firms' those that commenced trading from 2004 or later. This process yielded 977 Nascent Firms (3.4%) and 1,011 Young Firms (3.6%). These were directed to the full length interview (40-60 minutes) either directly following the screener or later by appointment. The full length interviews were completed by 594 NF and 514 YF cases. These are the cases we will use in the comparative analysis in this report. Results and Implications The results for this paper are based on Wave one of the survey which has been completed and the data obtained. It is expected that the findings will assist in beginning to develop an understanding of high potential nascent and young firms in Australia, how they differ from the larger lifestyle entrepreneur group that makes up the vast majority of the new firms created each year, and the elements that may contribute to turning high potential growth status into high growth realities. The results have implications for Government in the design of better conditions for the creation of new business, firms who assist high potentials in developing better advice programs in line with a better understanding of their needs and requirements, individuals who may be considering becoming entrepreneurs in high potential arenas and existing entrepreneurs make better decisions.

Final report : tasks 1 and 4: eco-efficiency assessment of building refurbishment

The main objective was to compare the environmental impacts of a building undergoing refurbishment both before and after the refurbishment and to assist in the design of the refurbishment with what is learned.

Final report : feasibility study linking best value procurement assessment to outcome performance indicators

This feasibility study was established to investigate the application of the concept of ‘best value’ in construction procurement in Australia. In the case of ‘best value’ in the business enterprise, ‘best value’ is that which returns greatest value to the business enterprise’s shareholders. However, in the case of the public sector, ‘best value’ is more complex. For that reason, this research project focuses mainly on public sector construction project procurement.

Report : enabling team collaboration with pervasive and mobile computing : cost benefit analysis methodology

Construction is an information intensive industry in which the accuracy and timeliness of information is paramount. It observed that the main communication issue in construction is to provide a method to exchange data between the site operation, the site office and the head office. The information needs under consideration are time critical to assist in maintaining or improving the efficiency at the jobsite. Without appropriate computing support this may increase the difficulty of problem solving. Many researchers focus their research on the usage of mobile computing devices in the construction industry and they believe that mobile computers have the potential to solve some construction problems that leads to reduce overall productivity. However, to date very limited observation has been conducted in terms of the deployment of mobile computers for construction workers on-site. By providing field workers with accurate, reliable and timely information at the location where it is needed, it will support the effectiveness and efficiency at the job site. Bringing a new technology into construction industry is not only need a better understanding of the application, but also need a proper preparation of the allocation of the resources such as people, and investment. With this in mind, an accurate analysis is needed to provide clearly idea of the overall costs and benefits of the new technology. A cost benefit analysis is a method of evaluating the relative merits of a proposed investment project in order to achieve efficient allocation of resources. It is a way of identifying, portraying and assessing the factors which need to be considered in making rational economic choices. In principle, a cost benefit analysis is a rigorous, quantitative and data-intensive procedure, which requires identification all potential effects, categorisation of these effects as costs and benefits, quantitative estimation of the extent of each cost and benefit associated with an action, translation of these into a common metric such as dollars, discounting of future costs and benefits into the terms of a given year, and summary of all cost and benefit to see which is greater. Even though many cost benefit analysis methodologies are available for a general assessment, there is no specific methodology can be applied for analysing the cost and benefit of the application of mobile computing devices in the construction site. Hence, the proposed methodology in this document is predominantly adapted from Baker et al. (2000), Department of Finance (1995), and Office of Investment Management (2005). The methodology is divided into four main stages and then detailed into ten steps. The methodology is provided for the CRC CI 2002-057-C Project: Enabling Team Collaboration with Pervasive and Mobile Computing and can be seen in detail in Section 3.

Determinants of pre-hospital care non-usage for patients with emergency care needs [including commentary by Snooks H.]

Objective-To establish the demographic, health status and insurance determinants of pre-hospital ambulance non-usage for patients with emergency medical needs. Methods-Triage category, date of birth, sex, marital status, country of origin, method and time of arrival, ambulance insurance status, diagnosis, and disposal were collected for all patients who presented over a four month period (n=10 229) to the emergency department of a major provincial hospital. Data for patients with urgent (n=678) or critical care needs (n=332) who did not use pre-hospital care were analysed using Poisson regression. Results-Only a small percentage (6.6%) of the total sample were triaged as having urgent medical needs or critical care needs (3.2%). Predictors of usage for those with urgent care needs included age greater than 65 years (prevalence ratio (PR)=0.54; 95% confidence interval (CI)= 0.35 to 0.83), being admitted to intensive care or transferred to another hospital (PR=0.62; 95% CI=0.44 to 0.89) or ward (PR=0.72; 95% CI=0.56 to 0.93) and ambulance insurance status (PR=0.67; 95% CI=052 to 0.86). Sex, marital status, time of day and country of origin were not predictive of usage and non-usage. Predictors of usage for those with critical care needs included age 65 years or greater (PR=0.45; 95% CI=0.25 to 0.81) and a diagnosis of trauma (PR=0.49; 95% CI=0.26 to 0.92). A non-English speaking background was predictive of non-usage (PR=1.98; 95% CI=1.06 to 3.70). Sex, marital status, time of day, triage and ambulance insurance status were not predictive of non-usage. Conclusions-Socioeconomic and medical factors variously influence ambulance usage depending on the severity or urgency of the medical condition. Ambulance insurance status was less of an influence as severity of condition increased suggesting that, at a critical level of urgency, patients without insurance are willing to pay for a pre-hospital ambulance service.

Addressing the needs of struggling literacy learners

Think back to your teaching experiences over the past four years. Were there a number of children or adolescents in your classes who seemed to have learning difficulties? What area of their learning seemed to be of greatest concern for these students? Did most of these struggling learners have difficulty with reading? Was expressing their thoughts in writing also a challenge? Did some of these students also have difficulty in listening to and following directions? And did some of these students seem hesitant when asked to speak to the class?

Risk assessment in life-cycle costing for road asset management

Queensland Department of Main Roads, Australia, spends approximately A$ 1 billion annually for road infrastructure asset management. To effectively manage road infrastructure, firstly road agencies not only need to optimise the expenditure for data collection, but at the same time, not jeopardise the reliability in using the optimised data to predict maintenance and rehabilitation costs. Secondly, road agencies need to accurately predict the deterioration rates of infrastructures to reflect local conditions so that the budget estimates could be accurately estimated. And finally, the prediction of budgets for maintenance and rehabilitation must provide a certain degree of reliability. This paper presents the results of case studies in using the probability-based method for an integrated approach (i.e. assessing optimal costs of pavement strength data collection; calibrating deterioration prediction models that suit local condition and assessing risk-adjusted budget estimates for road maintenance and rehabilitation for assessing life-cycle budget estimates). The probability concept is opening the path to having the means to predict life-cycle maintenance and rehabilitation budget estimates that have a known probability of success (e.g. produce budget estimates for a project life-cycle cost with 5% probability of exceeding). The paper also presents a conceptual decision-making framework in the form of risk mapping in which the life-cycle budget/cost investment could be considered in conjunction with social, environmental and political issues.

A national building products inventory

Australia has no nationally accepted building products life cycle inventory (LCI) database for use in building Ecologically Sustainable Development (ESD) assessment (BEA) tools. More information about the sustainability of the supply chain is limited by industry’s lack of real capacity to deliver objective information on process and product environmental impact. Recognition of these deficits emerged during compilation of a National LCI database to inform LCADesign, a prototype 3 dimensional object oriented computer aided design (3-D CAD) commercial building design tool. Development of this Australian LCI represents 24 staff years of effort here since 1995. Further development of LCADesign extensions is proposed as being essential to support key applications demanded from a more holistic theoretical framework calling for modules of new building and construction industry tools. A proposed tool, conceptually called LCADetails, is to serve the building product industries own needs as well as that of commercial building design amongst other industries’ prospective needs. In this paper, a proposition is examined that the existing national LCI database should be further expanded to serve Australian building product industries’ needs as well as to provide details for its client-base from a web based portal containing a module of practical supply and procurement applications. Along with improved supply chain assessment services, this proposed portal is envisaged to facilitate industry environmental life cycle improvement assessment and support decision-making to provide accredited data for operational reporting capabilities, load-based reasoning as well as BEA applications. This paper provides an overview of developments to date, including a novel 3-D CAD information and communications technology (ICT) platform for more holistic integration of existing tools for true cost assessment. Further conceptualisation of future prospects, based on a new holistic life cycle assessment framework LCADevelop, considering stakeholder relationships and their need for a range of complementary tools leveraging automated function off such ICT platforms to inform dimensionally defined operations for such as automotive, civil, transport and industrial applications are also explored.

Integrating eco-efficiency assessment of commercial buildings into the design process : LCADesign

The ability to assess a commercial building for its impact on the environment at the earliest stage of design is a goal which is achievable by integrating several approaches into a single procedure directly from the 3D CAD representation. Such an approach enables building design professionals to make informed decisions on the environmental impact of building and its alternatives during the design development stage instead of at the post-design stage where options become limited. The indicators of interest are those which relate to consumption of resources and energy, contributions to pollution of air, water and soil, and impacts on the health and wellbeing of people in the built environment as a result of constructing and operating buildings. 3D object-oriented CAD files contain a wealth of building information which can be interrogated for details required for analysis of the performance of a design. The quantities of all components in the building can be automatically obtained from the 3D CAD objects and their constituent materials identified to calculate a complete list of the amounts of all building products such as concrete, steel, timber, plastic etc. When this information is combined with a life cycle inventory database, key internationally recognised environmental indicators can be estimated. Such a fully integrated tool known as LCADesign has been created for automated ecoefficiency assessment of commercial buildings direct from 3D CAD. This paper outlines the key features of LCADesign and its application to environmental assessment of commercial buildings.

LCADesign : an integrated approach to automatic eco-efficiency assessment of commercial buildings

Buildings consume resources and energy, contribute to pollution of our air, water and soil, impact the health and well-being of populations and constitute an important part of the built environment in which we live. The ability to assess their design with a view to reducing that impact automatically from their 3D CAD representations enables building design professionals to make informed decisions on the environmental impact of building structures. Contemporary 3D object-oriented CAD files contain a wealth of building information. LCADesign has been designed as a fully integrated approach for automated eco-efficiency assessment of commercial buildings direct from 3D CAD. LCADesign accesses the 3D CAD detail through Industry Foundation Classes (IFCs) - the international standard file format for defining architectural and constructional CAD graphic data as 3D real-world objects - to permit construction professionals to interrogate these intelligent drawing objects for analysis of the performance of a design. The automated take-off provides quantities of all building components whose specific production processes, logistics and raw material inputs, where necessary, are identified to calculate a complete list of quantities for all products such as concrete, steel, timber, plastic etc and combines this information with the life cycle inventory database, to estimate key internationally recognised environmental indicators such as CML, EPS and Eco-indicator 99. This paper outlines the key modules of LCADesign and their role in delivering an automated eco-efficiency assessment for commercial buildings.

Authentic and conventional assessment in Singapore schools : an empirical study of teacher assignments and student work

This is an empirical examination of the quality of teacher assignments and student work in Singapore schools. Using a theoretical framework based on principles of authentic assessment and intellectual quality, two sets of criteria and scoring rubrics were developed for the training of expert teachers to judge the quality of assignments and student work. Following rigorous training, the inter-rater reliability of expert teacher scoring was high. Samples of teacher assignments and student work were collected in English, social studies, mathematics, and science subject areas from a random stratified sample of 30 elementary schools and 29 high schools. For both grade levels, there were significant differences for the authentic intellectual quality of teachers’ assignments by subject area. Likewise, the differences of authentic intellectual quality for student work were significant and varied by subject area. Subject area effect was large. The correlations between the quality of teachers’ assignment tasks and student work were strong and significant at both grade levels. Where teachers set more intellectually demanding tasks, students were more likely to generate work or artefacts judged to be of higher quality. The findings suggest that teacher professional development in authentic intellectual assessment task design can contribute to the improvement of student learning and performance. It is argued that this will be a key requisite of educational systems like Singapore that are seeking to expand pedagogy and student outcomes beyond a focus on factual and rote knowledge.

Characterising creativity : a holistic methodology for the assessment of creative works

This paper reports on the early stages of a design experiment in educational assessment that challenges the dichotomous legacy evident in many assessment activities. Combining social networking technologies with the sociology of education the paper proposes that assessment activities are best understood as a negotiable field of exchange. In this design experiment students, peers and experts engage in explicit, "front-end" assessment (Wyatt-Smith, 2008) to translate holistic judgments into institutional, and potentiality economic capital without adhering to long lists of pre-set criteria. This approach invites participants to use social networking technologies to judge creative works using scatter graphs, keywords and tag clouds. In doing so assessors will refine their evaluative expertise and negotiate the characteristics of creative works from which criteria will emerge (Sadler, 2008). The real-time advantages of web-based technologies will aggregate, externalise and democratise this transparent method of assessment for most, if not all, creative works that can be represented in a digital format.