Humans, ‘things’ and space : costing hospital infection control interventions

Background: Previous attempts at costing infection control programmes have tended to focus on accounting costs rather than economic costs. For studies using economic costs, estimates tend to be quite crude and probably underestimate the true cost. One of the largest costs of any intervention is staff time, but this cost is difficult to quantify and has been largely ignored in previous attempts. Aim: To design and evaluate the costs of hospital-based infection control interventions or programmes. This article also discusses several issues to consider when costing interventions, and suggests strategies for overcoming these issues. Methods: Previous literature and techniques in both health economics and psychology are reviewed and synthesized. Findings: This article provides a set of generic, transferable costing guidelines. Key principles such as definition of study scope and focus on large costs, as well as pitfalls (e.g. overconfidence and uncertainty), are discussed. Conclusion: These new guidelines can be used by hospital staff and other researchers to cost their infection control programmes and interventions more accurately.

Improving statistical analysis of matched case-control studies

Matched case–control research designs can be useful because matching can increase power due to reduced variability between subjects. However, inappropriate statistical analysis of matched data could result in a change in the strength of association between the dependent and independent variables or a change in the significance of the findings. We sought to ascertain whether matched case–control studies published in the nursing literature utilized appropriate statistical analyses. Of 41 articles identified that met the inclusion criteria, 31 (76%) used an inappropriate statistical test for comparing data derived from case subjects and their matched controls. In response to this finding, we developed an algorithm to support decision-making regarding statistical tests for matched case–control studies.

Risk factors for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory : a matched case-control study

Background: Side effects of the medications used for procedural sedation and analgesia in the cardiac catheterisation laboratory are known to cause impaired respiratory function. Impaired respiratory function poses considerable risk to patient safety as it can lead to inadequate oxygenation. Having knowledge about the conditions that predict impaired respiratory function prior to the procedure would enable nurses to identify at-risk patients and selectively implement intensive respiratory monitoring. This would reduce the possibility of inadequate oxygenation occurring. Aim: To identify pre-procedure risk factors for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory. Design: Retrospective matched case–control. Methods: 21 cases of impaired respiratory function were identified and matched to 113 controls from a consecutive cohort of patients over 18 years of age. Conditional logistic regression was used to identify risk factors for impaired respiratory function. Results: With each additional indicator of acute illness, case patients were nearly two times more likely than their controls to experience impaired respiratory function (OR 1.78; 95% CI 1.19–2.67; p = 0.005). Indicators of acute illness included emergency admission, being transferred from a critical care unit for the procedure or requiring respiratory or haemodynamic support in the lead up to the procedure. Conclusion: Several factors that predict the likelihood of impaired respiratory function were identified. The results from this study could be used to inform prospective studies investigating the effectiveness of interventions for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory.

Aircraft collision avoidance using spherical visual predictive control and single point features

This paper presents practical vision-based collision avoidance for objects approximating a single point feature. Using a spherical camera model, a visual predictive control scheme guides the aircraft around the object along a conical spiral trajectory. Visibility, state and control constraints are considered explicitly in the controller design by combining image and vehicle dynamics in the process model, and solving the nonlinear optimization problem over the resulting state space. Importantly, range is not required. Instead, the principles of conical spiral motion are used to design an objective function that simultaneously guides the aircraft along the avoidance trajectory, whilst providing an indication of the appropriate point to stop the spiral behaviour. Our approach is aimed at providing a potential solution to the See and Avoid problem for unmanned aircraft and is demonstrated through a series.

Control of dc capacitor voltages in diode-clamped multilevel inverter using bidirectional buck-boost choppers

The dc capacitors voltage unbalancing is the main technical drawback of a diode-clamped multilevel inverter (DCMLI), with more than three levels. A voltage-balancing circuit based on buck–boost chopper connected to the dc link of DCMLI is a reliable and robust solution to this problem. This study presents four different schemes for controlling the chopper circuit to achieve the capacitor voltages equalisation. These can be broadly categorised as single-pulse, multi-pulse and hysteresis band current control schemes. The single-pulse scheme does not involve faster switching actions but need the chopper devices to be rated for higher current. The chopper devices current rating can be kept limited by using the multi-pulse scheme but it involves faster switching actions and slower response. The hysteresis band current control scheme offers faster dynamics, lower current rating of the chopper devices and can nullify the initial voltage imbalance as well. However, it involves much faster switching actions which may not be feasible for some of its applications. Therefore depending on the system requirements and ratings, one of these schemes may be used. The performance and validity of the proposed schemes are confirmed through both simulation and experimental investigations on a prototype five-level diode-clamped inverter.

Smart robust resources control in LV network to deal with voltage rise issue

Often voltage rise along low voltage (LV) networks limits their capacity to accommodate more renewable energy (RE) sources. This paper proposes a robust and effective approach to coordinate customers' resources and control voltage rise in LV networks, where photovoltaics (PVs) are considered as the RE sources. The proposed coordination algorithm includes both localized and distributed control strategies. The localized strategy determines the value of PV inverter active and reactive power, while the distributed strategy coordinates customers' energy storage units (ESUs). To verify the effectiveness of proposed approach, a typical residential LV network is used and simulated in the PSCAD-EMTC platform.

Universal active and reactive power control of electronically interfaced distributed generation sources in virtual power plants operating in gridconnected and islanding modes

The control paradigms of the distributed generation (DG) sources in the smart grid are realised by either utilising virtual power plant (VPP) or by employing MicroGrid structures. Both VPP and MicroGrid are presented with the problem of control of power flow between their comprising DG sources. This study depicts this issue for VPP and proposes a novel and improved universal active and reactive power flow controllers for three-phase pulse width modulated voltage source inverters (PWM-VSI) operating in the VPP environment. The proposed controller takes into account all cases of R-X relationship, thus allowing it to function in systems operating at high, medium (MV) and low-voltage (LV) levels. Also proposed control scheme for the first time in an inverter control takes into account the capacitance of the transmission line which is an important factor to accurately represent medium length transmission lines. This allows the proposed control scheme to be applied in VPP structures, where DG sources can operate at MV LV levels over a short/medium length transmission line. The authors also conducted small signal stability analysis of the proposed controller and compared it against the small signal study of the existing controllers.

Mediating conflict and control : practice challenges for nurses working in palliative care

A work-based professional development program was offered to a group of registered nurses working in palliative care. The goal of the program was to improve skills in psychosocial care (Yates et al., 1996). Participants were encouraged to reflect critically on their practice experience within a group setting. The focus of the group discussion and reflection were shared practice incidents. Each participant was given the opportunity to identify and describe an incident from their professional practice that presented a challenging issue within palliative nursing. This paper explores the themes of conflict and control, evident within the collection of fifteen practice incidents and discusses the nurses role as mediator. The concepts of patient advocacy and professional autonomy are challenged through the nurses experience of providing care within a hierarchical and bureaucratic health service. The outcome of reflection for the organization is most effective when shared experience and collective action (rather than individual practice) are the focus.

A multi-objective optimization approach for coordinating available transfer capability with risk control

In the electricity market environment, coordination of system reliability and economics of a power system is of great significance in determining the available transfer capability (ATC). In addition, the risks associated with uncertainties should be properly addressed in the ATC determination process for risk-benefit maximization. Against this background, it is necessary that the ATC be optimally allocated and utilized within relative security constraints. First of all, the non-sequential Monte Carlo stimulation is employed to derive the probability density distribution of ATC of designated areas incorporating uncertainty factors. Second, on the basis of that, a multi-objective optimization model is formulated to determine the multi-area ATC so as to maximize the risk-benefits. Then, the solution to the developed model is achieved by the fast non-dominated sorting (NSGA-II) algorithm, which could decrease the risk caused by uncertainties while coordinating the ATCs of different areas. Finally, the IEEE 118-bus test system is served for demonstrating the essential features of the developed model and employed algorithm.

A bondgraph approach to formation control using relative state measurements

In this paper we apply port-Hamiltonian theory with the bondgraph modelling approach to the problem of formation control using partial measurements of relative positions. We present a control design that drives a group of vehicles to a desired formation without requiring inter-vehicle communications or global position and velocity measurements to be available. Our generic approach is applicable to any form of relative measurement between vehicles, but we specifically consider the important cases of relative bearings and relative distances. In the case of bearings, our theory closely relates to the field of image-based visual servo (IBVS) control. We present simulation results to support the developed theory.

Attitudinal, normative, and control beliefs underlying people’s curbside household waste recycling decisions

This study examined the beliefs underlying people’s decision-making, from a theory of planned behaviour (TPB) framework, in the prediction of curbside household waste recycling. Community members in Brisbane, Australia (N = 148) completed a questionnaire assessing the belief based TPB measures of attitudinal beliefs (costs and benefits), normative beliefs (important referents), and control beliefs (barriers) in relation to engaging in curbside household waste recycling for a 2-week period. Two weeks later, participants completed self report measures of recycling behaviour for the previous fortnight. The results revealed that the attitudinal, normative, and control beliefs for people who performed higher and lower levels of recycling differed significantly. A regression analysis identified both normative and control beliefs as the main determinants of recycling behaviour. For normative beliefs, high level recyclers perceived more approval from referents such as partners, friends, and neighbours to recycle all eligible materials. In addition, the strong results for control beliefs indicated that barriers such as forgetfulness, lack of time, and laziness were rated as more likely to hamper optimal recycling performance for low level recyclers. These findings provide important applied information about beliefs to target in the development of future community recycling campaigns.

Development and use of risk adjusted statistical process control tools for the monitoring and improvement of clinical outcomes in interventional cardiology

This thesis explored the development of statistical methods to support the monitoring and improvement in quality of treatment delivered to patients undergoing coronary angioplasty procedures. To achieve this goal, a suite of outcome measures was identified to characterise performance of the service, statistical tools were developed to monitor the various indicators and measures to strengthen governance processes were implemented and validated. Although this work focused on pursuit of these aims in the context of a an angioplasty service located at a single clinical site, development of the tools and techniques was undertaken mindful of the potential application to other clinical specialties and a wider, potentially national, scope.

Analysis of 3 common polymorphisms in the KCNK18 gene in an Australian migraine case-control cohort

Migraine is a common neurological disorder characterised by temporary disabling attacks of severe head pain and associated disturbances. There is significant evidence to suggest a genetic aetiology to the disease however few causal mutations have been conclusively linked to the migraine subtypes Migraine with (MA) or without Aura (MO). The Potassium Channel, Subfamily K, member 18 (KCNK18) gene, coding the potassium channel TRESK, is the first gene in which a rare mutation resulting in a non-functional truncated protein has been identified and causally linked to MA in a multigenerational family. In this study, three common polymorphisms in the KCNK18 gene were analysed for genetic variation in an Australian case-control migraine population consisting of 340 migraine cases and 345 controls. No association was observed for the polymorphisms examined with the migraine phenotype or with any haplotypes across the gene. Therefore even though the KCNK18 gene is the only gene to be causally linked to MA our studies indicate that common genetic variation in the gene is not a contributor to MA.

Association of a GRIA3 gene polymorphism with migraine in an Australian case-control cohort

BACKGROUND: The excitatory neurotransmitter glutamate has been implicated in both the hyperexcitability required for cortical spreading depression as well as activation of the trigeminovascular system required for the allodynia associated with migraine. Polymorphisms in the glutamate receptor ionotropic amino-3-hydroxy-5-methyl-4-isoxazole-propionin acid 1 (GRIA1) and GRIA3 genes that code for 2 of 4 subunits of the glutamate receptor have been previously associated with migraine in an Italian population. In addition, the GRIA3 gene is coded within a previously identified migraine susceptibility locus at Xq24. This study investigated the previously associated polymorphisms in both genes in an Australian case-control population. METHODS: Variants in GRIA1 and GRIA3 were genotyped in 472 unrelated migraine cases and matched controls, and data were analyzed for association. RESULTS: Analysis showed no association between migraine and the GRIA1 gene. However, association was observed with the GRIA3 single nucleotide polymorphism (SNP) rs3761555 (P = .008). CONCLUSION: The results of this study confirmed the previous report of association at the rs3761555 SNP within the migraine with aura subgroup of migraineurs. However, the study identified association with the inverse allele suggesting that rs3761555 may not be the causative SNP but is more likely in linkage disequilibrium with another causal variant in both populations. This study supports the plethora of evidence suggesting that glutamate dysfunction may contribute to migraine susceptibility, warranting further investigation of the glutamatergic system and particularly of the GRIA3 gene.

Digitally-implemented naturally sampled PWM suitable for multilevel converter control

For dynamic closed loop control of a multilevel converter with a low pulse number (ratio of switching frequency to synthesized fundamental), natural sampled pulse-width modulation (PWM) is the best form of modulation. Natural sampling does not introduce distortion or a delayed response to the modulating signal. However previous natural sampled PWM implementations have generally been analog. For a modular multilevel converter, a digital implementation has advantages of accuracy and flexibility. Re-sampled uniform PWM is a novel digital modulation technique which approaches the performance of natural PWM. Both hardware and software implementations for a five level multilevel converter phase are presented, demonstrating the improvement over uniform PWM.