Referral patterns and proximity to palliative care inpatient services by level of socio-economic disadvantage : a national study using spatial analysis

Background: A range of health outcomes at a population level are related to differences in levels of social disadvantage. Understanding the impact of any such differences in palliative care is important. The aim of this study was to assess, by level of socio-economic disadvantage, referral patterns to specialist palliative care and proximity to inpatient services. Methods: All inpatient and community palliative care services nationally were geocoded (using postcode) to one nationally standardised measure of socio-economic deprivation – Socio-Economic Index for Areas (SEIFA; 2006 census data). Referral to palliative care services and characteristics of referrals were described through data collected routinely at clinical encounters. Inpatient location was measured from each person’s home postcode, and stratified by socio-economic disadvantage. Results: This study covered July – December 2009 with data from 10,064 patients. People from the highest SEIFA group (least disadvantaged) were significantly less likely to be referred to a specialist palliative care service, likely to be referred closer to death and to have more episodes of inpatient care for longer time. Physical proximity of a person’s home to inpatient care showed a gradient with increasing distance by decreasing levels of socio-economic advantage. Conclusion: These data suggest that a simple relationship of low socioeconomic status and poor access to a referral-based specialty such as palliative care does not exist. Different patterns of referral and hence different patterns of care emerge.

Bouncing back : homegrown. Curated exhibition of student work and design workshop

Bouncing Back Architecture Exhibition: This exhibition showcases interpretations of urban resiliency by 2nd and 4th Year undergraduate architecture students who explore the notion of Bouncing Back from the 2011 Queensland floods, in the context of contemporary Brisbane built environment. Design solutions have been expressed in a variety of forms including emergency shelters, flood-proof housing and a range of urban designs, some of which address extreme environmental conditions. Design Process Workshop | Architecture Workshop with Queensland Academy of Creative Industries Students: In collaboration with Homegrown Facilitator Natalie Wright, Lindy Osborne and Glenda Caldwell and some of their architecture students from the QUT School of Design, extended the university design studio experience to 18 Secondary School students, who brainstormed and designed emergency food distribution shelters for those affected by floods. Designs and models created in the workshop were subsequently included in the Bouncing Back Architecture Exhibition.

Optimal distribution network reinforcement considering load growth, line loss, and reliability

In this paper, a new comprehensive planning methodology is proposed for implementing distribution network reinforcement. The load growth, voltage profile, distribution line loss, and reliability are considered in this procedure. A time-segmentation technique is employed to reduce the computational load. Options considered range from supporting the load growth using the traditional approach of upgrading the conventional equipment in the distribution network, through to the use of dispatchable distributed generators (DDG). The objective function is composed of the construction cost, loss cost and reliability cost. As constraints, the bus voltages and the feeder currents should be maintained within the standard level. The DDG output power should not be less than a ratio of its rated power because of efficiency. A hybrid optimization method, called modified discrete particle swarm optimization, is employed to solve this nonlinear and discrete optimization problem. A comparison is performed between the optimized solution based on planning of capacitors along with tap-changing transformer and line upgrading and when DDGs are included in the optimization.

Validity and use of the UV index : Report from the UVI working group, Schloss Hohenkammer, Germany, 5-7 December 2011

The adequacy of the UV Index (UVI), a simple measure of ambient solar ultraviolet (UV) radiation, has been questioned on the basis of recent scientific data on the importance of vitamin D for human health, the mutagenic capacity of radiation in the UVA wavelength, and limitations in the behavioral impact of the UVI as a public awareness tool. A working group convened by ICNIRP and WHO met to assess whether modifications of the UVI were warranted and to discuss ways of improving its effectiveness as a guide to healthy sun-protective behavior. A UV Index greater than 3 was confirmed as indicating ambient UV levels at which harmful sun exposure and sunburns could occur and hence as the threshold for promoting preventive messages. There is currently insufficient evidence about the quantitative relationship of sun exposure, vitamin D, and human health to include vitamin D considerations in sun protection recommendations. The role of UVA in sunlight-induced dermal immunosuppression and DNA damage was acknowledged, but the contribution of UVA to skin carcinogenesis could not be quantified precisely. As ambient UVA and UVB levels mostly vary in parallel in real life situations, any minor modification of the UVI weighting function with respect to UVA-induced skin cancer would not be expected to have a significant impact on the UV Index. Though it has been shown that the UV Index can raise awareness of the risk of UV radiation to some extent, the UVI does not appear to change attitudes to sun protection or behavior in the way it is presently used. Changes in the UVI itself were not warranted based on these findings, but rather research testing health behavior models, including the roles of self-efficacy and self-affirmation in relation to intention to use sun protection among different susceptible groups, should be carried out to develop more successful strategies toward improving sun protection behavior. Health Phys. 103(3):301-306; 2012

Combinatorial design of key distribution mechanisms for wireless sensor networks

Key distribution is one of the most challenging security issues in wireless sensor networks where sensor nodes are randomly scattered over a hostile territory. In such a sensor deployment scenario, there will be no prior knowledge of post deployment configuration. For security solutions requiring pairwise keys, it is impossible to decide how to distribute key pairs to sensor nodes before the deployment. Existing approaches to this problem are to assign more than one key, namely a key-chain, to each node. Key-chains are randomly drawn from a key-pool. Either two neighboring nodes have a key in common in their key-chains, or there is a path, called key-path, among these two nodes where each pair of neighboring nodes on this path has a key in common. Problem in such a solution is to decide on the key-chain size and key-pool size so that every pair of nodes can establish a session key directly or through a path with high probability. The size of the key-path is the key factor for the efficiency of the design. This paper presents novel, deterministic and hybrid approaches based on Combinatorial Design for key distribution. In particular, several block design techniques are considered for generating the key-chains and the key-pools.

Expander graph based key distribution mechanisms in wireless sensor networks

Secure communications between large number of sensor nodes that are randomly scattered over a hostile territory, necessitate efficient key distribution schemes. However, due to limited resources at sensor nodes such schemes cannot be based on post deployment computations. Instead, pairwise (symmetric) keys are required to be pre-distributed by assigning a list of keys, (a.k.a. key-chain), to each sensor node. If a pair of nodes does not have a common key after deployment then they must find a key-path with secured links. The objective is to minimize the keychain size while (i) maximizing pairwise key sharing probability and resilience, and (ii) minimizing average key-path length. This paper presents a deterministic key distribution scheme based on Expander Graphs. It shows how to map the parameters (e.g., degree, expansion, and diameter) of a Ramanujan Expander Graph to the desired properties of a key distribution scheme for a physical network topology.

Smart demand side management of low-voltage distribution networks using multi-objective decision making

A novel intelligent online demand side management system is proposed for peak load management in low-voltage distribution networks. This method uses low-cost controllers with low-bandwidth two-way communication installed in custumers’ premises and at distribution transformers to manage the peak load while maximising customer satisfaction. A multi-objective decision making process is proposed to select the load(s) to be delayed or controlled. The efficacy of the proposed control system is verified by simulation of three different feeder types.

Ventilation distribution in rats : Part I - The effect of gas composition as measured with electrical impedance tomography

The measurement of ventilation distribution is currently performed using inhaled tracer gases for multiple breath inhalation studies or imaging techniques to quantify spatial gas distribution. Most tracer gases used for these studies have properties different from that of air. The effect of gas density on regional ventilation distribution has not been studied. This study aimed to measure the effect of gas density on regional ventilation distribution. Methods Ventilation distribution was measured in seven rats using electrical impedance tomography (EIT) in supine, prone, left and right lateral positions while being mechanically ventilated with either air, heliox (30% oxygen, 70% helium) or sulfur hexafluoride (20% SF6, 20% oxygen, 60% air). The effect of gas density on regional ventilation distribution was assessed. Results Gas density did not impact on regional ventilation distribution. The non-dependent lung was better ventilated in all four body positions. Gas density had no further impact on regional filling characteristics. The filling characteristics followed an anatomical pattern with the anterior and left lung showing a greater impedance change during the initial phase of the inspiration. Conclusion It was shown that gas density did not impact on convection dependent ventilation distribution in rats measured with EIT.

Key distribution mechanisms for wireless sensor networks : a survey

Advances in technology introduce new application areas for sensor networks. Foreseeable wide deployment of mission critical sensor networks creates concerns on security issues. Security of large scale densely deployed and infrastructure less wireless networks of resource limited sensor nodes requires efficient key distribution and management mechanisms. We consider distributed and hierarchical wireless sensor networks where unicast, multicast and broadcast type of communications can take place. We evaluate deterministic, probabilistic and hybrid type of key pre-distribution and dynamic key generation algorithms for distributing pair-wise, group-wise and network-wise keys.

Combinatorial design of key distribution mechanisms for wireless sensor networks

Key distribution is one of the most challenging security issues in wireless sensor networks where sensor nodes are randomly scattered over a hostile territory. In such a sensor deployment scenario, there will be no prior knowledge of post deployment configuration. For security solutions requiring pair wise keys, it is impossible to decide how to distribute key pairs to sensor nodes before the deployment. Existing approaches to this problem are to assign more than one key, namely a key-chain, to each node. Key-chains are randomly drawn from a key-pool. Either two neighbouring nodes have a key in common in their key-chains, or there is a path, called key-path, among these two nodes where each pair of neighbouring nodes on this path has a key in common. Problem in such a solution is to decide on the key-chain size and key-pool size so that every pair of nodes can establish a session key directly or through a path with high probability. The size of the key-path is the key factor for the efficiency of the design. This paper presents novel, deterministic and hybrid approaches based on Combinatorial Design for key distribution. In particular, several block design techniques are considered for generating the key-chains and the key-pools. Comparison to probabilistic schemes shows that our combinatorial approach produces better connectivity with smaller key-chain sizes.

Consequences of extensional tectonics on volcanic eruption style, compositions and source regions : new insights from the southern Sierra Madre Occidental and Gulf of California regions, western Mexico

Understanding the link between tectonic-driven extensional faulting and volcanism is crucial from a hazard perspective in active volcanic environments, while ancient volcanic successions provide records on how volcanic eruption styles, compositions, magnitudes and frequencies can change in response to extension timing, distribution and intensity. This study draws on intimate relationships of volcanism and extension preserved in the Sierra Madre Occidental (SMO) and Gulf of California (GoC) regions of western Mexico. Here, a major Oligocene rhyolitic ignimbrite “flare-up” (>300,000 km3) switched to a dominantly bimodal and mixed effusive-explosive volcanic phase in the Early Miocene (~100,000 km3), associated with distributed extension and opening of numerous grabens. Rhyolitic dome fields were emplaced along graben edges and at intersections of cross-graben and graben-parallel structures during early stages of graben development. Concomitant with this change in rhyolite eruption style was a change in crustal source as revealed by zircon chronochemistry with rapid rates of rhyolite magma generation due to remelting of mid- to upper crustal, highly differentiated igneous rocks emplaced during earlier SMO magmatism. Extension became more focused ~18 Ma resulting in volcanic activity being localised along the site of GoC opening. This localised volcanism (known as the Comondú “arc”) was dominantly effusive and andesite-dacite in composition. This compositional change resulted from increased mixing of basaltic and rhyolitic magmas rather than fluid flux melting of the mantle wedge above the subducting Guadalupe Plate. A poor understanding of space-time relationships of volcanism and extension has thus led to incorrect past tectonic interpretations of Comondú-age volcanism.

Stress distribution of CFRP strengthened steel hollow sections under tension

Carbon fibre reinforced polymer (CFRP) sheets have many outstanding properties such as high strength, high elastic modulus, light weight and good durability which are made them a suitable alternative for steel in strengthening work. This paper describe the ultimate load carrying capacity of steel hollow sections at effective bond length in terms of its cross sectional area and the stress distribution within bond region for different layers CFRP. It was found that depending on their size and orientation of uni- directional CFRP layers, the ultimate tensile load was different. Along with these tests, non linear finite element analysis was also performed to validate the ultimate load carrying capacity depending on their cross sections. The predicted ultimate loads from FE analysis are found very close to the laboratory test results. The validated model has been used to determine the stress distribution at bond joint for different orientation of CFRP. This research shows the effect of stress distribution and suitable wrapping layer to be used for the strengthening of steel hollow sections in tension.

The decline in activities of daily living at discharge (DADLD) index : stratifying patients at lower and higher risk

Background: Decreased ability to perform Activities of Daily Living (ADLs) during hospitalisation has negative consequences for patients and health service delivery. Objective: To develop an Index to stratify patients at lower and higher risk of a significant decline in ability to perform ADLs at discharge. Design: Prospective two cohort study comprising a derivation (n=389; mean age 82.3 years; SD� 7.1) and a validation cohort (n=153; mean age 81.5 years; SD� 6.1). Patients and setting: General medical patients aged = 70 years admitted to three university-affiliated acute care hospitals in Brisbane, Australia. Measurement and main results: The short ADL Scale was used to identify a significant decline in ability to perform ADLs from premorbid to discharge. In the derivation cohort, 77 patients (19.8%) experienced a significant decline. Four significant factors were identified for patients independent at baseline: 'requiring moderate assistance to being totally dependent on others with bathing'; 'difficulty understanding others (frequently or all the time)'; 'requiring moderate assistance to being totally dependent on others with performing housework'; a 'history of experiencing at least one fall in the previous 90 days prior to hospital admission' in addition to 'independent at baseline', which was protective against decline at discharge. 'Difficulty understanding others (frequently or all the time)' and 'requiring moderate assistance to being totally dependent on others with performing housework' were also predictors for patients dependent in ADLs at baseline. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of the DADLD dichotomised risk scores were: 83.1% (95% CI 72.8; 90.7); 60.5% (95% CI 54.8; 65.9); 34.2% (95% CI 27.5; 41.5); 93.5% (95% CI 89.2; 96.5). In the validation cohort, 47 patients (30.7%) experienced a significant decline. Sensitivity, specificity, PPV and NPV of the DADLD were: 78.7% (95% CI 64.3; 89.3); 69.8% (95% CI 60.1, 78.3); 53.6% (95% CI 41.2; 65.7); 88.1% (95% CI 79.2; 94.1). Conclusions: The DADLD Index is a useful tool for identifying patients at higher risk of decline in ability to perform ADLs at discharge.