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.

That's how it was, this is how it is

Research Background : Young people with negative experiences of mainstream education often display low levels of traditional literacy. These young people tend to display considerable cultural and social resources developed through their repeated experiences of adversity. Education research has a duty to provide these young people with opportunities to showcase, assess and translate their social and cultural resources into symbolic forms of capital. This creative work addresses the following research question. How can educators encourage disengaged youth to showcase their social and cultural capital through non-traditional literacy practices?----- Research Contribution : This DVD production of a music video affords the young participants opportunities to display their artistic, technical, social and cultural resources through a popular cultural format. In doing so it requires education institutions to assess alternative student outputs that demonstrate the skills these young people acquire as they re-engage in flexible learning environments. The new knowledge derived from this research centres on the retention and certification benefits for disengaged young people using popular culture and social enterprise as authentic learning activities.----- Research Significance : This research is significant because it aims to maximise the number of tangible outcomes related to a school-based arts project. The young participants gained technical, artistic, social and commercial skills during this project. The video sold at numerous youth festivals in SE QLD. It was distributed and downloaded via creative commons licences at the Australian Creative Resource Archive. It also contributed to their certified qualifications and acted as pilot research data for two competitively funded ARC grants (DP0209421 & LP0883643)

Sleeper [for laptop computer and live performer]

Sleeper is an 18'00" musical work for live performer and laptop computer which exists as both a live performance work and a recorded work for audio CD. The work has been presented at a range of international performance events and survey exhibitions. These include the 2003 International Computer Music Conference (Singapore) where it was selected for CD publication, Variable Resistance (San Francisco Museum of Modern Art, USA), and i.audio, a survey of experimental sound at the Performance Space, Sydney. The source sound materials are drawn from field recordings made in acoustically resonant spaces in the Australian urban environment, amplified and acoustic instruments, radio signals, and sound synthesis procedures. The processing techniques blur the boundaries between, and exploit, the perceptual ambiguities of de-contextualised and processed sound. The work thus challenges the arbitrary distinctions between sound, noise and music and attempts to reveal the inherent musicality in so-called non-musical materials via digitally re-processed location audio. Thematically the work investigates Paul Virilio’s theory that technology ‘collapses space’ via the relationship of technology to speed. Technically this is explored through the design of a music composition process that draws upon spatially and temporally dispersed sound materials treated using digital audio processing technologies. One of the contributions to knowledge in this work is a demonstration of how disparate materials may be employed within a compositional process to produce music through the establishment of musically meaningful morphological, spectral and pitch relationships. This is achieved through the design of novel digital audio processing networks and a software performance interface. The work explores, tests and extends the music perception theories of ‘reduced listening’ (Schaeffer, 1967) and ‘surrogacy’ (Smalley, 1997), by demonstrating how, through specific audio processing techniques, sounds may shifted away from ‘causal’ listening contexts towards abstract aesthetic listening contexts. In doing so, it demonstrates how various time and frequency domain processing techniques may be used to achieve this shift.

Attention and memory bias for body image and health related information using an Emotional Stroop task in a non-clinical sample

It has been proposed that body image disturbance is a form of cognitive bias wherein schemas for self-relevant information guide the selective processing of appearancerelated information in the environment. This threatening information receives disproportionately more attention and memory, as measured by an Emotional Stroop and incidental recall task. The aim of this thesis was to expand the literature on cognitive processing biases in non-clinical males and females by incorporating a number of significant methodological refinements. To achieve this aim, three phases of research were conducted. The initial two phases of research provided preliminary data to inform the development of the main study. Phase One was a qualitative exploration of body image concerns amongst males and females recruited through the general community and from a university. Seventeen participants (eight male; nine female) provided information on their body image and what factors they saw as positively and negatively impacting on their self evaluations. The importance of self esteem, mood, health and fitness, and recognition of the social ideal were identified as key themes. These themes were incorporated as psycho-social measures and Stroop word stimuli in subsequent phases of the research. Phase Two involved the selection and testing of stimuli to be used in the Emotional Stroop task. Six experimental categories of words were developed that reflected a broad range of health and body image concerns for males and females. These categories were high and low calorie food words, positive and negative appearance words, negative emotion words, and physical activity words. Phase Three addressed the central aim of the project by examining cognitive biases for body image information in empirically defined sub-groups. A National sample of males (N = 55) and females (N = 144), recruited from the general community and universities, completed an Emotional Stroop task, incidental memory test, and a collection of psycho-social questionnaires. Sub-groups of body image disturbance were sought using a cluster analysis, which identified three sub-groups in males (Normal, Dissatisfied, and Athletic) and four sub-groups in females (Normal, Health Conscious, Dissatisfied, and Symptomatic). No differences were noted between the groups in selective attention, although time taken to colour name the words was associated with some of the psycho-social variables. Memory biases found across the whole sample for negative emotion, low calorie food, and negative appearance words were interpreted as reflecting the current focus on health and stigma against being unattractive. Collectively these results have expanded our understanding of processing biases in the general community by demonstrating that the processing biases are found within non-clinical samples and that not all processing biases are associated with negative functionality

Non-adversarial advocates and gatekeepers : lawyers, FDR practitioners and co-operative post-separation parenting

The compulsory dispute resolution requirements in family law parenting cases create new roles and obligations for both lawyers and family dispute resolution (FDR) practitioners. This article will discuss how the legislative provisions impact on both sets of professionals in practice. It will also highlight the increased non-adversarial role of lawyers and a new role for FDR practitioners as “gatekeepers” to family courts in cases requiring FDR certificates.

A review of non-traditional occupational therapy practice placement education : a focus on role-emerging and project placements

Practice placement education has been recognised as an integral and critical component of the training of occupational therapy students. Although there is an extensive body of literature on clinical education and traditional practice placement education models, there has been limited research on alternative placements.-------- This paper reviews the literature on various practice placement education models and presents a contemporary view on how it is currently delivered. The literature is examined with a particular focus on the increasing range of practice placement education opportunities, such as project and role-emerging placements. The drivers for non-traditional practice placement education include shortages of traditional placement options, health reform and changing work practices, potential for role development and influence on practice choice. The benefits and challenges of non-traditional practice placement education are discussed, including supervision issues, student evaluation, professional and personal development and the opportunity to practise clinical skills.--------- Further research is recommended to investigate occupational therapy graduates' perceptions of role-emerging and project placements in order to identify the benefits or otherwise of these placements and to contribute to the limited body of knowledge of emerging education opportunities.

Operation and control of a microgrid containing inertial and non-inertial micro sources

In this paper, a new power sharing control method for a microgrid with several distributed generation units is proposed. The presence of both inertial and noninertial sources with different power ratings, maximum power point tracking, and various types of loads pose a great challenge for the power sharing and system stability. The conventional droop control method is modified to achieve the desired power sharing ensuring system stability in a highly resistive network. A transformation matrix is formed to derive equivalent real and reactive power output of the converter and equivalent feedback gain matrix for the modified droop equation. The proposed control strategy, aimed for the prototype microgrid planned at Queensland University of Technology, is validated through extensive simulation results using PSCAD/EMTDC software.

Is there a future for non-motorized public transport in Asia?

Non-motorized public transport (NMPT), especially three-wheeler cycle rickshaws, has a long history in East Asia; and has long been a major transport planning issue. Policy measures to restrict or eliminate NMPT have already been implemented in many developing cities with mixed success. However given the economic, social and cultural significance of NMPT, its environmental benefits, and the magnitude of its role in sustaining the mobility needs of citizens, it is timely to reconsider the future role of NMPT. Rather than pursuing policies to eliminate NMPT, a better approach may be to integrate motorized and non-motorized vehicles as complementary rather than competitive forces. With this backdrop and given the international significance of the problem, this paper examines the current role and significance of NMPT using Dhaka as a case study, and sets a research agenda for the future of NMPT in a sustainable transport system.

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.

From Prosumer to Produser: Understanding User-Led Content Creation

Alvin Toffler’s image of the prosumer (1970, 1980, 1990) continues to influence in a significant way our understanding of the user-led, collaborative processes of content creation which are today labelled “social media” or “Web 2.0”. A closer look at Toffler’s own description of his prosumer model reveals, however, that it remains firmly grounded in the mass media age: the prosumer is clearly not the self-motivated creative originator and developer of new content which can today be observed in projects ranging from open source software through Wikipedia to Second Life, but simply a particularly well-informed, and therefore both particularly critical and particularly active, consumer. The highly specialised, high end consumers which exist in areas such as hi-fi or car culture are far more representative of the ideal prosumer than the participants in non-commercial (or as yet non-commercial) collaborative projects. And to expect Toffler’s 1970s model of the prosumer to describe these 21st-century phenomena was always an unrealistic expectation, of course. To describe the creative and collaborative participation which today characterises user-led projects such as Wikipedia, terms such as ‘production’ and ‘consumption’ are no longer particularly useful – even in laboured constructions such as ‘commons-based peer-production’ (Benkler 2006) or ‘p2p production’ (Bauwens 2005). In the user communities participating in such forms of content creation, roles as consumers and users have long begun to be inextricably interwoven with those as producer and creator: users are always already also able to be producers of the shared information collection, regardless of whether they are aware of that fact – they have taken on a new, hybrid role which may be best described as that of a produser (Bruns 2008). Projects which build on such produsage can be found in areas from open source software development through citizen journalism to Wikipedia, and beyond this also in multi-user online computer games, filesharing, and even in communities collaborating on the design of material goods. While addressing a range of different challenges, they nonetheless build on a small number of universal key principles. This paper documents these principles and indicates the possible implications of this transition from production and prosumption to produsage.

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.

Integrating Creative Practice and Research in the Digital Media Arts

Research is often characterised as the search for new ideas and understanding. The language of this view privileges the cognitive and intellectual aspects of discovery. However, in the research process theoretical claims are usually evaluated in practice and, indeed, the observations and experiences of practical circumstances often lead to new research questions. This feedback loop between speculation and experimentation is fundamental to research in many disciplines, and is also appropriate for research in the creative arts. In this chapter we will examine how our creative desire for artistic expressivity results in interplay between actions and ideas that direct the development of techniques and approaches for our audio/visual live-coding activities.

Data mining on prices of highway project main material based on WEB

The management of main material prices of provincial highway project quota has problems of lag and blindness. Framework of provincial highway project quota data MIS and main material price data warehouse were established based on WEB firstly. Then concrete processes of provincial highway project main material prices were brought forward based on BP neural network algorithmic. After that standard BP algorithmic, additional momentum modify BP network algorithmic, self-adaptive study speed improved BP network algorithmic were compared in predicting highway project main prices. The result indicated that it is feasible to predict highway main material prices using BP NN, and using self-adaptive study speed improved BP network algorithmic is the relatively best one.

The relationship between personality characteristics and postconcussion symptoms in a non-clinical sample

Postconcussion symptoms are relatively common in the acute recovery period following mild traumatic brain injury (MTBI). However, for a small subset of patients, self reported postconcussion symptoms continue long after injury. Many factors have been proposed to account for the presence of persistent postconcussion symptoms. The influence of personality traits has been proposed as one explanation. The purpose of this study was to examine the relation between postconcussion-like symptom reporting and personality traits in a sample of 96 healthy participants. Participants completed the British Columbia Postconcussion Symptom Inventory (BC-PSI) and the Millon Clinical Multiaxial Inventory III (MCMI-III). There was a strong positive relation between the majority of MCMI-III scales and postconcussion-like symptom reporting. Approximately half of the sample met the International Classification of Diseases-10 Criterion C symptoms for Postconcussional Syndrome (PCS). Compared with those participants who did not meet this criterion, the PCS group had significant elevations on the negativistic, depression, major depression, dysthymia, anxiety, dependent, sadistic, somatic, and borderline scales of the MCMI-III. These findings support the hypothesis that personality traits can play a contributing role in self reported postconcussion-like symptoms.