Delirium knowledge and recognition : a randomized controlled trial of a web-based educational intervention for acute care nurses

Delirium is a significant problem for older hospitalized people and is associated with poor outcomes. It is poorly recognized and evidence suggests that a major reason is lack of education. Nurses, who are educated about delirium, can play a significant role in improving delirium recognition. This study evaluated the impact of a delirium specific educational website. A cluster randomized controlled trial, with a pretest/post-test time series design, was conducted to measure delirium knowledge (DK) and delirium recognition (DR) over three time-points. Statistically significant differences were found between the intervention and non-intervention group. The intervention groups' DK scores were higher and the change over time results were statistically significant [T3 and T1 (t=3.78 p=<0.001) and T2 and T1 baseline (t=5.83 p=<0.001)]. Statistically significant improvements were also seen for DR when comparing T2 and T1 results (t=2.56 p=0.011) between both groups but not for changes in DR scores between T3 and T1 (t=1.80 p=0.074). Participants rated the website highly on the visual, functional and content elements. This study supports the concept that web-based delirium learning is an effective and satisfying method of information delivery for registered nurses. Future research is required to investigate clinical outcomes as a result of this web-based education.

Teaching Teachers for the Future (TTF) Project TPACK Survey : summary of the key findings

This paper presents a summary of the key findings of the TTF TPACK Survey developed and administered for the Teaching the Teachers for the Future (TTF) Project implemented in 2011. The TTF Project, funded by an Australian Government ICT Innovation Fund grant, involved all 39 Australian Higher Education Institutions which provide initial teacher education. TTF data collections were undertaken at the end of Semester 1 (T1) and at the end of Semester 2 (T2) in 2011. A total of 12881 participants completed the first survey (T1) and 5809 participants completed the second survey (T2). Groups of like-named items from the T1 survey were subject to a battery of complementary data analysis techniques. The psychometric properties of the four scales: Confidence - teacher items; Usefulness - teacher items; Confidence - student items; Usefulness- student items, were confirmed both at T1 and T2. Among the key findings summarised, at the national level, the scale: Confidence to use ICT as a teacher showed measurable growth across the whole scale from T1 to T2, and the scale: Confidence to facilitate student use of ICT also showed measurable growth across the whole scale from T1 to T2. Additional key TTF TPACK Survey findings are summarised.

Diode-clamped three-level inverter-based battery/supercapacitor direct integration scheme for renewable energy systems

This paper describes a diode-clamped three-level inverter-based battery/supercapacitor direct integration scheme for renewable energy systems. The study is carried out for three different cases. In the first case, one of the two dc-link capacitors of the inverter is replaced by a battery bank and the other by a supercapacitor bank. In the second case, dc-link capacitors are replaced by two battery banks. In the third case, ordinary dc-link capacitors are replaced by two supercapacitor banks. The first system is supposed to mitigate both long-term and short-term power fluctuations while the last two systems are intended for smoothening long-term and short-term power fluctuations, respectively. These topologies eliminate the need for interfacing dc-dc converters and thus considerably improve the overall system efficiency. The major issue in aforementioned systems is the unavoidable imbalance in dc-link voltages. An analysis on the effects of unbalance and a space vector modulation method, which can produce undistorted current even in the presence of such unbalances, are presented in this paper. Furthermore, small vector selection-based power sharing and state of charge balancing techniques are proposed. Experimental results, obtained from a laboratory prototype, are presented to verify the efficacy of the proposed modulation and control techniques.

Segmental torso masses in adolescent idiopathic scoliosis

Background Adolescent Idiopathic Scoliosis is the most common type of spinal deformity whose aetiology remains unclear. Studies suggest that gravitational forces in the standing position play an important role in scoliosis progression, therefore anthropometric data are required to develop biomechanical models of the deformity. Few studies have analysed the trunk by vertebral level and none have performed investigations of the scoliotic trunk. The aim of this study was to determine the centroid, thickness, volume and estimated mass, for sections of the trunk in Adolescent Idiopathic Scoliosis patients. Methods Existing low-dose Computed Tomography scans were used to estimate vertebral level-by-level torso masses for 20 female Adolescent Idiopathic Scoliosis patients. ImageJ processing software was used to analyse the Computed Tomography images and enable estimation of the segmental torso mass corresponding to each vertebral level. Findings The patients’ mean age was 15.0 (SD 2.7) years with mean major Cobb Angle of 52° (SD 5.9) and mean patient weight of 58.2 (SD 11.6) kg. The magnitude of torso segment mass corresponding to each vertebral level increased by 150% from 0.6kg at T1 to 1.5kg at L5. Similarly, the segmental thickness corresponding to each vertebral level from T1-L5 increased inferiorly from a mean 18.5 (SD 2.2) mm at T1 to 32.8 (SD 3.4) mm at L5. The mean total trunk mass, as a percentage of total body mass, was 27.8 (SD 0.5) % which was close to values reported in previous literature. Interpretation This study provides new anthropometric reference data on segmental (vertebral level-by-level) torso mass in Adolescent Idiopathic Scoliosis patients, useful for biomechanical models of scoliosis progression and treatment.

Segmental torso masses and joint torques produced by gravity in the adolescent scoliotic spine

Introduction Calculating segmental torso masses in Adolescent Idiopathic Scoliosis (AIS) patients allows the gravitational loading on the scoliotic spine during relaxed standing to be estimated. Methods Low dose CT data was used to calculate vertebral level-by-level torso masses and spinal joint torques for 20 female AIS patients (mean age 15.0 ± 2.7 years, mean Cobb angle 53 ± 7.1°). ImageJ software (v1.45 NIH USA) was used to threshold the T1 to L5 CT images and calculate the segmental torso volume and mass for each vertebral level. Masses for the head, neck and arms were taken from published data. Intervertebral joint torques in the coronal and sagittal planes at each vertebral level were found from the position of the centroid of the segment masses relative to the joint centres (assumed to be at the centre of the intervertebral disc. The joint torque at each level was found by summing torque contributions for all segments above that joint. Results Segmental torso mass increased from 0.6kg at T1 to 1.5kg at L5. The coronal plane joint torques due to gravity were 5-7Nm at the apex of the curve; sagittal torques were 3-5.4Nm. Conclusion CT scans were in the supine position and curve magnitudes are known to be smaller than those in standing. Hence, this study has shown that gravity produces joint torques potentially of higher than 7Nm in the coronal plane and 5Nm in the sagittal plane during relaxed standing in scoliosis patients. The magnitude of these torques may help to explain the mechanics of AIS progression and the mechanics of bracing. This new data on torso segmental mass in AIS patients will assist biomechanical models of scoliosis.

Topological design and modulation strategy for buck-boost three-level inverters

To date, designed topologies for DC-AC inversion with both voltage-buck and boost capabilities are mainly focused on two-level circuitries with extensions to three-level possibilities left nearly unexplored. Contributing to this area of research, this paper presents the design of a number of viable buck-boost three-level inverters that can also support bidirectional power conversion. The proposed front-end circuitry is developed from the Cuk-derived buck-boost two-level inverter, and by using the "alternative phase opposition disposition" (APOD) modulation scheme, the buck-boost three-level inverters can perform distinct five-level line voltage and three-level phase voltage switching by simply controlling the active switches located in the designed voltage boost section of the circuits. As a cost saving option, one active switch can further be removed from the voltage-boost section of the circuits by simply re-routing the gating commands of the remaining switches without influencing the ac output voltage amplitude. To verify the validity of the proposed inverters, Matlab/PLECS simulations were performed before a laboratory prototype was implemented for experimental testing.

Topological design and modulation strategy for buck-boost three-level inverters

To date, designed topologies for DC-AC inversion with both voltage buck and boost capabilities are mainly focused on two-level circuitries with extensions to three-level possibilities left nearly unexplored. Contributing to this area of research, this paper presents the design of a number of viable buck-boost three-level inverters that can also support bidirectional power conversion. The proposed front-end circuitry is developed from the Cuk-derived buck-boost two-level inverter, and by using the ldquoalternative phase opposition dispositionrdquo modulation scheme, the buck-boost three-level inverters can perform distinct five-level line voltage and three-level phase voltage switching by simply controlling the active switches located in the designed voltage boost section of the circuits. As a cost saving option, one active switch can further be removed from the voltage boost section of the circuits by simply rerouting the gating commands of the remaining switches without influencing the AC output voltage amplitude. To verify the validity of the proposed inverters, MATLAB/PLECS simulations were performed before a laboratory prototype was implemented for experimental testing.

Gravity-induced coronal plane joint moments in the adolescent scoliotic spine

INTRODUCTION Calculating segmental (vertebral level-by-level) torso masses in Adolescent Idiopathic Scoliosis (AIS) patients allows the gravitational loading on the scoliotic spine during relaxed standing to be estimated. METHODS Existing low dose CT scans were used to calculate vertebral level-by-level torso masses and joint moments occurring in the spine for a group of female AIS patients with right-sided thoracic curves. Image processing software, ImageJ (v1.45 NIH USA) was used to reconstruct the torso segments and subsequently measure the torso volume and mass corresponding to each vertebral level. Body segment masses for the head, neck and arms were taken from published anthropometric data. Intervertebral joint moments at each vertebral level were found by summing each of the torso segment masses above the required joint and multiplying it by the perpendicular distance to the centre of the disc. RESULTS AND DISCUSSION Twenty patients were included in this study with a mean age of 15.0±2.7 years and a mean Cobb angle 52±5.9°. The mean total trunk mass, as a percentage of total body mass, was 27.8 (SD 0.5) %. Mean segmental torso mass increased inferiorly from 0.6kg at T1 to 1.5kg at L5. The coronal plane joint moments during relaxed standing were typically 5-7Nm at the apex of the curve (Figure 1), with the highest apex joint of 7Nm. CT scans were performed in the supine position and curve magnitudes are known to be 7-10° smaller than those measured in standing [1]. Therefore joint moments produced by gravity will be greater than those calculated here. CONCLUSIONS Coronal plane joint moments as high as 7Nm can occur during relaxed standing in scoliosis patients, which may help to explain the mechanics of AIS progression. The body mass distributions calculated in this study can be used to estimate joint moments derived using other imaging modalities such as MRI and subsequently determine if a relationship exists between joint moments and progressive vertebral deformity.

An improved gate driver for power MOSFETs using a cascode configuration

To overcome the limitations of existing gate drive topologies an improved gate drive concept is proposed to provide fast, controlled switching of power MOSFETs. The proposed topology exploits the cascode configuration with the inclusion of an active gate clamp to ensure that the driven MOSFET may be turned off under all load conditions. Key operating principles and advantages of the proposed gate drive topology are discussed. Characteristic waveforms are investigated via simulation and experimentation for the cascode driver in an inductive switching application at 375V and 10A. Experimental waveforms compared well with simulations with long gate charging delays (including the Miller plateau) being eliminated from the gate voltage waveform.

Rectifier systems for variable speed wind generation : a review

The drive towards high efficiency wind energy conversion systems has resulted in almost all the modern wind turbines to operate in the variable speed mode which inevitably requires back-to-back power electronic converters to decouple generator dynamics from the grid. The aim of this paper is to present an analysis on suitable topologies for the generator-side converter (rectifier) of the back-to-back converter arrangement. Performance of the two most popular rectifier systems, namely, the passive diode bridge rectifier and the active six-switch two-level rectifier are taken as two extremes to evaluate other topologies presented in this paper. The other rectifier systems considered in this study include combinations of a diode bridge rectifier and electronic reactance(s), a combination of a rectifier and a dc-dc converter and a half controlled rectifier. Diode-clamped and capacitor-clamped three-level active rectifier topologies and their possible switch reductions are also discussed in relation to the requirements of modern high power wind energy conversion systems (WECSs). Simulation results are presented to support conclusion derived from this analysis.

A modular matrix converter for transformer-less PMSG wind generation systems

An offshore wind turbine usually has the grid step-up transformer integrated in the nacelle. This increases mechanical loading of the tower. In that context, a transformer-less, high voltage, highly-reliable and compact converter system for nacelle installation would be an attractive solution for large offshore wind turbines. This paper, therefore, presents a transformer-less grid integration topology for PMSG based large wind turbine generator systems using modular matrix converters. Each matrix converter module is fed from three generator coils of the PMSG which are phase shifted by 120°. Outputs of matrix converter modules are connected in series to increase the output voltage and thus eliminate the need of a coupling step-up transformer. Moreover, dc-link capacitors found in conventional back-to-back converter topologies are eliminated in the proposed system. Proper multilevel output voltage generation and power sharing between converter modules are achieved through an advanced switching strategy. Simulation results are presented to validate the proposed modular matrix converter system, modulation method and control techniques.

Synthesis of orchestrators from service choreographies

Interaction topologies in service-oriented systems are usually classified into two styles: choreographies and orchestrations. In a choreography, services interact in a peer-to-peer manner and no service plays a privileged role. In contrast, interactions in an orchestration occur between one particular service, the orchestrator, and a number of subordinated services. Each of these topologies has its trade-offs. This paper considers the problem of migrating a service-oriented system from a choreography style to an orchestration style. Specifically, the paper presents a tool chain for synthesising orchestrators from choreographies. Choreographies are initially represented as communicating state machines. Based on this representation, an algorithm is presented that synthesises the behaviour of an orchestrator, which is also represented as a state machine. Concurrent regions are then identified in the synthesised state machine to obtain a more compact representation in the form of a Petri net. Finally, it is shown how the resulting Petri nets can be transformed into notations supported by commercial tools, such as the Business Process Modelling Notation (BPMN).

The dynamics of cellular automata on 2-manifolds is affected by topology

In this paper, we demonstrate that the distribution of Wolfram classes within a cellular automata rule space in the triangular tessellation is not consistent across different topological general. Using a statistical mechanics approach, cellular automata dynamical classes were approximated for cellular automata defined on genus-0, genus-1 and genus-2 2-manifolds. A distribution-free equality test for empirical distributions was applied to identify cases in which Wolfram classes were distributed differently across topologies. This result implies that global structure and local dynamics contribute to the long term evolution of cellular automata.

On the effect of topology on cellular automata rule spaces

This thesis presents an empirical study of the effects of topology on cellular automata rule spaces. The classical definition of a cellular automaton is restricted to that of a regular lattice, often with periodic boundary conditions. This definition is extended to allow for arbitrary topologies. The dynamics of cellular automata within the triangular tessellation were analysed when transformed to 2-manifolds of topological genus 0, genus 1 and genus 2. Cellular automata dynamics were analysed from a statistical mechanics perspective. The sample sizes required to obtain accurate entropy calculations were determined by an entropy error analysis which observed the error in the computed entropy against increasing sample sizes. Each cellular automata rule space was sampled repeatedly and the selected cellular automata were simulated over many thousands of trials for each topology. This resulted in an entropy distribution for each rule space. The computed entropy distributions are indicative of the cellular automata dynamical class distribution. Through the comparison of these dynamical class distributions using the E-statistic, it was identified that such topological changes cause these distributions to alter. This is a significant result which implies that both global structure and local dynamics play a important role in defining long term behaviour of cellular automata.

Relevance of the deletion polymorphisms of the glutathione S-transferases GSTT1 and GSTM1 in pharmacology and toxicology

Although cytosolic glutathione S-transferase (GST) enzymes occupy a key position in biological detoxification processes, two of the most relevant human isoenzymes, GSTT1-1 and GSTM1-1, are genetically deleted (non-functional alleles GSTT1*0 and GSTM1*0) in a high percentage of the human population, with major ethnic differences. The structures of the GSTT and GSTM gene areas explain the underlying genetic processes. GSTT1-1 is highly conserved during evolution and plays a major role in phase-II biotransformation of a number of drugs and industrial chemicals, e.g. cytostatic drugs, hydrocarbons and halogenated hydrocarbons. GSTM1-1 is particularly relevant in the deactivation of carcinogenic intermediates of polycyclic aromatic hydrocarbons. Several lines of evidence suggest that hGSTT1-1 and/or hGSTM1-1 play a role in the deactivation of reactive oxygen species that are likely to be involved in cellular processes of inflammation, ageing and degenerative diseases. There is cumulating evidence that combinations of the GSTM1*0 state with other genetic traits affecting the metabolism of carcinogens (CYP1A1, GSTP1) may predispose the aero-digestive tract and lung, especially in smokers, to a higher risk of cancer. The GSTM1*0 status appears also associated with a modest increase in the risk of bladder cancer, consistent with a GSTM1 interaction with carcinogenic tobacco smoke constituents. Both human GST deletions, although largely counterbalanced by overlapping substrate affinities within the GST superfamily, have consequences when the organism comes into contact with distinct man-made chemicals. This appears relevant in industrial toxicology and in drug metabolism.