A simple Bayesian decision-theoretic design for dose-finding trials

A flexible and simple Bayesian decision-theoretic design for dose-finding trials is proposed in this paper. In order to reduce the computational burden, we adopt a working model with conjugate priors, which is flexible to fit all monotonic dose-toxicity curves and produces analytic posterior distributions. We also discuss how to use a proper utility function to reflect the interest of the trial. Patients are allocated based on not only the utility function but also the chosen dose selection rule. The most popular dose selection rule is the one-step-look-ahead (OSLA), which selects the best-so-far dose. A more complicated rule, such as the two-step-look-ahead, is theoretically more efficient than the OSLA only when the required distributional assumptions are met, which is, however, often not the case in practice. We carried out extensive simulation studies to evaluate these two dose selection rules and found that OSLA was often more efficient than two-step-look-ahead under the proposed Bayesian structure. Moreover, our simulation results show that the proposed Bayesian method's performance is superior to several popular Bayesian methods and that the negative impact of prior misspecification can be managed in the design stage.

Structured model-following neuro-adaptive design for attitude maneuver of rigid bodies

A new structured model-following adaptive approach is presented in this paper to achieve large attitude maneuvers of rigid bodies. First, a nominal controller is designed using the dynamic inversion philosophy. Next, a neuro- adaptive design is proposed to augment the nominal design in order to assure robust performance in the presence of parameter inaccuracies as well as unknown constant external disturbances. The structured approach proposed in this paper (where kinematic and dynamic equations are handled separately), reduces the complexity of the controller structure. From simulation studies, this adaptive controller is found to be very effective in assuring robust performance.

Evolution in design of integral leg prosthesis leads to improved outcomes

Developments of surgical attachments for bone-anchored prostheses are slowly but surely winning over the initial disbelief in the orthopedic community. Clearly, this option is becoming accessible to a wide range of individuals with limb loss. Seminal studies have demonstrated that the pioneering procedure relying on screw-type fixation engenders major clinical benefits and acceptable safety. The surgical procedure for press-fit implants, such as the Integral-Leg-Prosthesis (ILP) has been described Dr Aschoff and his team. Some clinical benefits of press-fit implants have been also established. Here, his team is once again taking a leading role by sharing the progression over 15 years of the rate of deep infections for 69 individuals with transfemoral amputation fitted with three successive refined versions of the ILP. By definition, a double-blind randomized clinical trial to test the effect of different fixation’s design is difficult. Alternatively, Juhnke and colleagues are reporting the outcomes of action-research study for a cohort of participants. The first and foremost important outcome of this study is the confirmation that the current design of the IPL and rehabilitation program are altogether leading to an acceptable rate of deep infection and other adverse events (e.g., structural failure of implant, periprosthetic factures). This study is also providing a strong insight onto the effect of major phases in redesign of an implant on the risk of infection. This is an important reminder that the development of a successful osseointegrated implant is unlikely to be immediate but the results of a learning curve made of empirical and sequential changes led by a reflective clinical practice. Clearly, this study provided better understanding of the safety of the ILP surgical and rehabilitation procedure while establishing standards and benchmark data for future studies focusing on design and infection of press-fit implants. Complementary observations of relationship between infection and cofounders such as loading of the prosthesis and prosthetic components used would be beneficial.Further definitive evidences of the clinical benefits with the latest design would be valuable, although an increase in health related quality of life and functional outcomes are likely to be confirmed. Altogether, the authors are providing compelling evidence that bone-anchored attachments particularly those relying on press-fit implants are an established alternative to socket prostheses.

Minding the gaps: Disability culture + cultural competence in interior design

Despite the increased attention to the relationship of disability and design, this area still suffers from terminological confusion, oversimplification and a positivist bias that continues to produce ableist space. Here, I am suggesting that space is not a fixed container or a pochéd plan that needs to be ‘altered’ in order to accommodate, but that space is a fundamental element of social life and that space continually reproduces the social and cultural relations of its production. This paper serves as a critical foundation for ongoing explorations into how disability culture is situated within interior design. A shift towards disability as culture is necessary to move our understanding of how to design for those with disabilities out of the objective realm (prescriptive codes and guidelines) and into a subjective realm (the lived experience and embodied know-how of those with disabilities). By framing disability around a cultural model rather than a medical model it allows for epistemological and pedagogical shifts in our ways of knowing in interior design. In defining culture as “a way of life” it is important to look at disability as both a diverse way of living and a diverse way of knowing. Most significant, is that the everyday expertise of people with disabilities is recognized as knowledge that can inform the field of interior design. The urgency for defining disability culture is essential to our understanding of cultural competence in interior design education and practice. The aim of this paper is to challenge our current understanding of how to design for those with disabilities and to shift our ways of knowing in interior design towards a deep understanding of the lived experience, embodied know-how and culture of those with disabilities. This paper will begin by analysing the different models of disability and how interior design education and practice has shifted to reflect these different models. Defining disability culture and all of its complexities is also an essential component of this paper. Finally, this paper will present best practices and case studies of how a cultural model of disability can shape interior environments and interior design pedagogy.

Design studio terrains: Mapping the learning landscapes of Australian architectural education

It has been nearly 25 years since the problems associated with passive learning in large undergraduate classes were first established by McDermott (1991). STEM education, for example North Carolina State University’s SCALE-UP project, has subsequently been influenced by some unique aspects of design studio education. While there are now many institutions applying SCALE-UP or similar approaches to enable lively interaction, enhanced learning, increased student engagement, and to teach many different content areas to classes of all sizes, nearly all of these have remained in the STEM fields (Beichner, 2008). Architectural education, although originally at the forefront of this field, has arguably been left behind. Architectural practice is undergoing significant change, globally. Access to new technology and the development of specialised architectural documentation software has scaffolded new building procurement methods and allowed consultant teams to work more collaboratively, efficiently and even across different time zones. Up until recently, the spatial arrangements, pedagogical approaches, and project work outcomes in the architectural design studio, have not been dissimilar to its inception. It is not possible to keep operating architectural design studios the same way that they have for the past two hundred years, with this new injection of high-end technology and personal mobile Wi-Fi enabled devices. Employing a grounded theory methodology, this study reviews the current provision of architectural design learning terrains across a range of tertiary institutions, in Australia. Some suggestions are provided for how these spaces could be modified to address the changing nature of the profession, and implications for how these changes may impact the design of future SCALE-UP type spaces outside of the discipline of architecture, are also explored.

Connecting the space between design and research: Explorations in participatory research supervision

In this article we offer a single case study using an action research method for gathering and analysing data offering insights valuable to both design and research supervision practice. We do not attempt to generalise from this single case, but offer it as an instance that can improve our understanding of research supervision practice. We question the conventional ‘dyadic’ models of research supervision and outline a more collaborative model, based on the signature pedagogy of architecture: the design studio. A novel approach to the supervision of creatively oriented post-graduate students is proposed, including new approaches to design methods and participatory supervision that draw on established design studio practices. This model collapses the distance between design and research activities. Our case study involving Research Masters student supervision in the discipline of Architecture, shows how ‘connected learning’ emerges from this approach. This type of learning builds strong elements of creativity and fun, which promote and enhance student engagement. The results of our action research suggests that students learn to research more easily in such an environment and supervisory practices are enhanced when we apply the techniques and characteristics of design studio pedagogy to the more conventional research pedagogies imported from the humanities. We believe that other creative disciplines can apply similar tactics to enrich both the creative practice of research and the supervision of HDR students.

A generic design environment for the rural industry knowledge acquisition

This paper describes a new knowledge acquisition method using a generic design environment where context-sensitive knowledge is used to build specific DSS for rural business. Although standard knowledge acquisition methods have been applied in rural business applications, uptake remains low and familiar weaknesses such as obsolescence and brittleness apply. We describe a decision support system (DSS) building environment where contextual factors relevant to the end users are directly taken into consideration. This "end user enabled design environment" (EUEDE) engages both domain experts in creating an expert knowledge base and business operators/end users (such as farmers) in using this knowledge for building their specific DSS. We document the knowledge organisation for the problem domain, namely a dairy industry application. This development involved a case-study research approach used to explore dairy operational knowledge. In this system end users can tailor their decision-making requirements using their own judgement to build specific DSSs. In a specific end user's farming context, each specific DSS provides expert suggestions to assist farmers in improving their farming practice. The paper also shows the environment's generic capability.

Developing a best practice pathway to support improvements in Indigenous Australians' mental health and well-being: A qualitative study

Objective: There is a need to adapt pathways to care to promote access to mental health services for Indigenous people in Australia. This study explored Indigenous community and service provider perspectives of well-being and ways to promote access to care for Indigenous people at risk of depressive illness. Design: A participatory action research framework was used to inform the development of an agreed early intervention pathway; thematic analysis Setting: 2 remote communities in the Northern Territory. Participants: Using snowball and purposive sampling, 27 service providers and community members with knowledge of the local context and the diverse needs of those at risk of depression were interviewed. 30% of participants were Indigenous. The proposed pathway to care was adapted in response to participant feedback. Results: The study found that Indigenous mental health and well-being is perceived as multifaceted and strongly linked to cultural identity. It also confirms that there is broad support for promotion of a clear pathway to early intervention. Key identified components of this pathway were the health centre, visiting and community-based services, and local community resources including elders, cultural activities and families. Enablers to early intervention were reported. Significant barriers to the detection and treatment of those at risk of depression were identified, including insufficient resources, negative attitudes and stigma, and limited awareness of support options. Conclusions: Successful early intervention for wellbeing concerns requires improved understanding of Indigenous well-being perspectives and a systematic change in service delivery that promotes integration, flexibility and collaboration between services and the community, and recognises the importance of social determinants in health promotion and the healing process. Such changes require policy support, targeted training and education, and ongoing promotion.

Preservice early childhood teachers and designers partnering for change at The Lone Pine Koala Sanctuary: An interdisciplinary education and design for sustainability project

This presentation discusses and critiques a current case study of a project in which Early Childhood preservice teachers are working in partnership with Design students to develop principles and concepts for the design and construction of an early childhood centre. This centre, to be built on the grounds of the iconic Lone Pine Koala Sanctuary in Brisbane , focuses on Education for Sustainability (EfS), sustainable design and sustainable business. Interdisciplinary initiatives between QUT staff and students from two Faculties (Education and Creative Industries) have been situated in the real –world context of this project. This practical, authentic project has seen stakeholders take an interdisciplinary approach to sustainability, opening up new ways of thinking about early childhood centre design, particularly with respect to operation and function. Interdisciplinarity and a commitment to genuine partnerships have created intellectual spaces to re-think the potential of the disciplines to be interwoven so that future professionals from different fields might come together to learn from each other and to address the sustainability imperative. The case study documents and explores the possibilities that the Lone Pine project offers for academics and students from Early Childhood and Design to collaboratively inform the Sanctuary’s vision for the Centre. The research examines how students benefit from practical, real world, community-integrated learning; how academic staff across two disciplines are able to work collaboratively within a real-world context; and how external stakeholders experience and benefit from the partnership with university staff and students. Data were collected via a series of focus group and individual interviews designed to explore how the various stakeholders (staff, students, business partners) experienced their involvement in the interdisciplinary project. Inductive and deductive thematic analysis of these data suggest many benefits for participants as well as a number of challenges. Findings suggest that the project has provided students with ‘real world’ partnerships that reposition early childhood students’ identities from ‘novice’ to ‘professional’, where their knowledge, expertise and perspectives are simultaneously validated and challenged in their work with designers. These partnerships are enabling preservice teachers to practice a new model of early childhood leadership in sustainability, one that is vital for leading for change in an increasingly complex world. This presentation celebrates, critiques and problematises this project, exploring wider implications for other contexts in which university staff and students may seek to work across traditional boundaries, thus building partnerships for change.

Roles, responsibilities and scope of practice: describing the ‘state of play’ for infection control professionals in Australia and New Zealand

Background In the past decade the policy and practice context for infection control in Australia and New Zealand has changed, with infection control professionals (ICPs) now involved in the implementation of a large number of national strategies. Little is known about the current ICP workforce and what they do in their day-to-day positions. The aim of this study was to describe the ICP workforce in Australia and New Zealand with a focus on roles, responsibilities, and scope of practice. Methods A cross-sectional design using snowball recruitment was employed. ICPs completed an anonymous web-based survey with questions on demographics; qualifications held; level of experience; workplace characteristics; and roles and responsibilities. Chi-squared tests were used to determine if any factors were associated with how often activities were undertaken. Results A total of 300 ICPs from all Australian states and territories and New Zealand participated. Most ICPs were female (94%); 53% were aged over 50, and 93% were employed in registered nursing roles. Scope of practice was diverse: all ICPs indicated they undertook a large number and variety of activities as part of their roles. Some activities were undertaken on a less frequent basis by sole practitioners and ICPs in small teams. Conclusion This survey provides useful information on the current education, experience levels and scope of practice of ICPs in Australia and New Zealand. Work is now required to establish the best mechanisms to support and potentially streamline scope of practice, so that infection-control practice is optimised.

Advanced practice: A survey of current perspectives of Australian pharmacists

Background An Advanced Pharmacy Practice Framework for Australia (the ‘APPF’) was published in October 2012. Further to the release of the APPF, the Advanced Pharmacy Practice Framework Steering Committee planned to develop an advanced practice recognition model for Australian pharmacists. Aim To gauge the perspectives of the pharmacy profession relating to advanced practice, via an online survey, in order to inform the design of the model. Method A survey was developed and administered to Australian pharmacists through SurveyMonkey . The survey content was based on findings from a review of national and international initiatives for recognition of advanced practice in pharmacy and other health disciplines, including medicine and nursing. Results The results of the survey showed that a high proportion of respondents considered they were already working at, or working towards achieving, an advanced level of practice. The responses relating to the assessment methods showed a clear preference for ‘submission of a professional portfolio’. A ‘written examination’ had a low level of support and in relation to an ‘oral examination by a panel’ there was a marked preference for a panel of multidisciplinary health professionals over a panel of pharmacists. Conclusion The survey outcomes will inform the development of an advanced pharmacy practice recognition model for Australian pharmacists, particularly in relation to the assessment methods. Survey outcomes also demonstrated that there is scope to further enhance the application of the APPF in the development and recognition of advanced practitioners, and to build greater awareness of the breadth of competencies encompassed by ‘advanced practice’.

Pre-service early childhood teachers and designers partnering for change at The Lone Pine Koala Sanctuary: An interdisciplinary education and design for sustainability project

This presentation discusses and critiques a current case study of a project in which Early Childhood preservice teachers are working in partnership with Design students to develop principles and concepts for the design and construction of an early childhood centre. This centre, to be built on the grounds of the iconic Lone Pine Koala Sanctuary in Brisbane , focuses on Education for Sustainability (EfS), sustainable design and sustainable business. Interdisciplinary initiatives between QUT staff and students from two Faculties (Education and Creative Industries) have been situated in the real –world context of this project. This practical, authentic project has seen stakeholders take an interdisciplinary approach to sustainability, opening up new ways of thinking about early childhood centre design, particularly with respect to operation and function. Interdisciplinarity and a commitment to genuine partnerships have created intellectual spaces to re-think the potential of the disciplines to be interwoven so that future professionals from different fields might come together to learn from each other and to address the sustainability imperative. The case study documents and explores the possibilities that the Lone Pine project offers for academics and students from Early Childhood and Design to collaboratively inform the Sanctuary’s vision for the Centre. The research examines how students benefit from practical, real world, community-integrated learning; how academic staff across two disciplines are able to work collaboratively within a real-world context; and how external stakeholders experience and benefit from the partnership with university staff and students. Data were collected via a series of focus group and individual interviews designed to explore how the various stakeholders (staff, students, business partners) experienced their involvement in the interdisciplinary project. Inductive and deductive thematic analysis of these data suggest many benefits for participants as well as a number of challenges. Findings suggest that the project has provided students with ‘real world’ partnerships that reposition early childhood students’ identities from ‘novice’ to ‘professional’, where their knowledge, expertise and perspectives are simultaneously validated and challenged in their work with designers. These partnerships are enabling preservice teachers to practice a new model of early childhood leadership in sustainability, one that is vital for leading for change in an increasingly complex world. This presentation celebrates, critiques and problematises this project, exploring wider implications for other contexts in which university staff and students may seek to work across traditional boundaries, thus building partnerships for change.

Rockhampton's Resilient Future Design Charrette

The QUT Centre for Subtropical Design conducted a design-led interdisciplinary collaborative workshop (charrette) to develop some initial ideas for how innovation in research and practice can be applied to the complex problem of resilient future-focussed urban renewal in Rockhampton’s flood-prone suburbs and core grid. Three creative teams explored a range of scenarios for Rockhampton’s resilience in built form over the longer term. A large number of sketches, drawings and text were produced over two days. This report identifies themes, principles and strategies which emerged from the charrette. Each group proposed multiple guiding principles that fell into three strategic approaches: defend (through construction of a levee); adapt (by designing with flood in mind); retreat (a long term view to relocate populations in flood-prone areas). All three groups identified the importance of design that accommodates art, heritage, recreation, sustainability and tourism, and proposed these as principles to guide future strategies that mediate between Rockhampton’s broader ecological landscape and urban living to accommodate more affordable housing options, demonstrate sustainability and be climate responsive to predicted increased extreme weather events including flooding. The charrette outcomes pave the way to investigate wider issues and solutions to Rockhampton’s resilient future, beyond a levee as an isolated structure.

Identifying advanced practice: A national survey of a nursing workforce

Background The size and flexibility of the nursing workforce has positioned nursing as central to the goals of health service improvement. Nursing's response to meeting these goals has resulted in proliferation of advanced practice nursing with a confusing array of practice profiles, titles and roles. Whilst numerous models and definitions of advanced practice nursing have been developed there is scant published research of significant scope that supports these models. Consequently there is an ongoing call in the literature for clarity and stability in nomenclature, and confusion in the health industry on how to optimise the utility of advanced practice nursing. Objectives To identify and delineate advanced practice from other levels of nursing practice through examination of a national nursing workforce. Design A cross-sectional electronic survey of nurses using the validated Advanced Practice Role Delineation tool based on the Strong Model of Advanced Practice. Participants Study participants were registered nurses employed in a clinical service environment across all states and territories of Australia. Methods A sample of 5662 registered nurses participated in the study. Domain means for each participant were calculated then means for nursing position titles were calculated. Position titles were grouped by delineation and were compared with one-way analysis of variance on domain means. The alpha for all tests was set at 0.05. Significant effects were examined with Scheffe post hoc comparisons to control for Type 1 error. Results The survey tool was able to identify position titles where nurses were practicing at an advanced level and to delineate this cohort from other levels of nursing practice, including nurse practitioner. The results show that nurses who practice at an advanced level are characterised by high mean scores across all Domains of the Strong Model of Advanced Practice. The mean scores of advanced practice nurses were significantly different from nurse practitioners in the Direct Care Domain and significantly different from other levels of nurse across all domains. Conclusions The study results show that the nurse practitioner, advanced practice nurse and foundation level registered nurse have different patterns of practice and the Advanced Practice Role Delineation tool has the capacity to clearly delineate and define advanced practice nursing. These findings make a significant contribution to the international debate and show that the profession can now identify what is and what is not advanced practice in nursing.

On probability-based inference under data missing by design

Whether a statistician wants to complement a probability model for observed data with a prior distribution and carry out fully probabilistic inference, or base the inference only on the likelihood function, may be a fundamental question in theory, but in practice it may well be of less importance if the likelihood contains much more information than the prior. Maximum likelihood inference can be justified as a Gaussian approximation at the posterior mode, using flat priors. However, in situations where parametric assumptions in standard statistical models would be too rigid, more flexible model formulation, combined with fully probabilistic inference, can be achieved using hierarchical Bayesian parametrization. This work includes five articles, all of which apply probability modeling under various problems involving incomplete observation. Three of the papers apply maximum likelihood estimation and two of them hierarchical Bayesian modeling. Because maximum likelihood may be presented as a special case of Bayesian inference, but not the other way round, in the introductory part of this work we present a framework for probability-based inference using only Bayesian concepts. We also re-derive some results presented in the original articles using the toolbox equipped herein, to show that they are also justifiable under this more general framework. Here the assumption of exchangeability and de Finetti's representation theorem are applied repeatedly for justifying the use of standard parametric probability models with conditionally independent likelihood contributions. It is argued that this same reasoning can be applied also under sampling from a finite population. The main emphasis here is in probability-based inference under incomplete observation due to study design. This is illustrated using a generic two-phase cohort sampling design as an example. The alternative approaches presented for analysis of such a design are full likelihood, which utilizes all observed information, and conditional likelihood, which is restricted to a completely observed set, conditioning on the rule that generated that set. Conditional likelihood inference is also applied for a joint analysis of prevalence and incidence data, a situation subject to both left censoring and left truncation. Other topics covered are model uncertainty and causal inference using posterior predictive distributions. We formulate a non-parametric monotonic regression model for one or more covariates and a Bayesian estimation procedure, and apply the model in the context of optimal sequential treatment regimes, demonstrating that inference based on posterior predictive distributions is feasible also in this case.