The efficacy of an augmented virtual reality system to alleviate pain in children undergoing burns dressing changes : a randomised controlled trial

In children, the pain and anxiety associated with acute burn dressing changes can be severe, with drug treatment alone frequently proving to be inadequate. Virtual reality (VR) systems have been successfully trialled in limited numbers of adult and paediatric burn patients. Augmented reality (AR) differs from VR in that it overlays virtual images onto the physical world, instead of creating a complete virtual world. This prospective randomised controlled trial investigated the use of AR as an adjunct to analgesia and sedation in children with acute burns. Forty-two children (30 male and 12 female), with an age range of 3–14 years (median age 9 years) and a total burn surface area ranging from 1 to 16% were randomised into a treatment (AR) arm and a control (basic cognitive therapy) arm after administration of analgesia and/or sedation. Pain scores, pulse rates (PR), respiratory rates (RR) and oxygen saturations (SaO2) were recorded pre-procedurally, at 10 min intervals and post-procedurally. Parents were also asked to grade their child's overall pain score for the dressing change. Mean pain scores were significantly lower (p = 0.0060) in the AR group compared to the control group, as were parental pain assessment scores (p = 0.015). Respiratory and pulse rates showed significant changes over time within groups, however, these were not significantly different between the two study groups. Oxygen saturation did not differ significantly over time or between the two study groups. This trial shows that augmented reality is a useful adjunct to pharmacological analgesia.

The efficacy of the Sortino ratio and other benchmarked performance measures under skewed return distributions

This paper will investigate the suitability of existing performance measures under the assumption of a clearly defined benchmark. A range of measures are examined including the Sortino Ratio, the Sharpe Selection ratio (SSR), the Student’s t-test and a decay rate measure. A simulation study is used to assess the power and bias of these measures based on variations in sample size and mean performance of two simulated funds. The Sortino Ratio is found to be the superior performance measure exhibiting more power and less bias than the SSR when the distribution of excess returns are skewed.

Sensitivity analysis of voltage imbalance in distribution networks with rooftop PVs

A comprehensive voltage imbalance sensitivity analysis and stochastic evaluation based on the rating and location of single-phase grid-connected rooftop photovoltaic cells (PVs) in a residential low voltage distribution network are presented. The voltage imbalance at different locations along a feeder is investigated. In addition, the sensitivity analysis is performed for voltage imbalance in one feeder when PVs are installed in other feeders of the network. A stochastic evaluation based on Monte Carlo method is carried out to investigate the risk index of the non-standard voltage imbalance in the network in the presence of PVs. The network voltage imbalance characteristic based on different criteria of PV rating and location and network conditions is generalized. Improvement methods are proposed for voltage imbalance reduction and their efficacy is verified by comparing their risk index using Monte Carlo simulations.

Power management and power flow control with back-to-back converters in a utility connected microgrid

This paper proposes a method for power flow control between utility and microgrid through back-to-back converters, which facilitates desired real and reactive power flow between utility and microgrid. In the proposed control strategy, the system can run in two different modes depending on the power requirement in the microgrid. In mode-1, specified amount of real and reactive power are shared between the utility and the microgrid through the back-to-back converters. Mode-2 is invoked when the power that can be supplied by the DGs in the microgrid reaches its maximum limit. In such a case, the rest of the power demand of the microgrid has to be supplied by the utility. An arrangement between DGs in the microgrid is proposed to achieve load sharing in both grid connected and islanded modes. The back-to-back converters also provide total frequency isolation between the utility and the microgrid. It is shown that the voltage or frequency fluctuation in the utility side has no impact on voltage or power in microgrid side. Proper relay-breaker operation coordination is proposed during fault along with the blocking of the back-to-back converters for seamless resynchronization. Both impedance and motor type loads are considered to verify the system stability. The impact of dc side voltage fluctuation of the DGs and DG tripping on power sharing is also investigated. The efficacy of the proposed control ar-rangement has been validated through simulation for various operating conditions. The model of the microgrid power system is simulated in PSCAD.

Continuous infusion of ticarcillin-clavulanate for home treatment of serious infections : clinical efficacy, safety, pharmacokinetics and pharmacodynamics

Continuous infusion (CI) ticarcillin–clavulanate is a potential therapeutic improvement over conventional intermittent dosing because the major pharmacodynamic (PD) predictor of efficacy of β-lactams is the time that free drug levels exceed the MIC. This study incorporated a 6-year retrospective arm evaluating efficacy and safety of CI ticarcillin–clavulanate in the home treatment of serious infections and a prospective arm additionally evaluating pharmacokinetics (PK) and PD. In the prospective arm, steady-state serum ticarcillin and clavulanate levels and MIC testing of significant pathogens were performed. One hundred and twelve patients (median age, 56 years) were treated with a CI dose of 9.3–12.4 g/day and mean CI duration of 18.0 days. Infections treated included osteomyelitis (50 patients), septic arthritis (6), cellulitis (17), pulmonary infections (12), febrile neutropenia (7), vascular infections (7), intra-abdominal infections (2), and Gram-negative endocarditis (2); 91/112 (81%) of patients were cured, 14 (13%) had partial response and 7 (6%) failed therapy. Nine patients had PICC line complications and five patients had drug adverse events. Eighteen patients had prospective PK/PD assessment although only four patients had sufficient data for a full PK/PD evaluation (both serum steady-state drug levels and ticarcillin and clavulanate MICs from a bacteriological isolate), as this was difficult to obtain in home-based patients, particularly as serum clavulanate levels were found to deteriorate rapidly on storage. Three of four patients with matched PK/PD assessment had free drug levels exceeding the MIC of the pathogen. Home CI of ticarcillin–clavulanate is a safe, effective, convenient and practical therapy and is a therapeutic advance over traditional intermittent dosing when used in the home setting.

Digital design communication : measuring learner technological prowess and self-efficacy in problem resolution

Currently the Bachelor of Design is the generic degree offered to the four disciplines of Architecture, Landscape Architecture, Industrial Design, and Interior Design within the School of Design at the Queensland University of Technology. Regardless of discipline, Digital Communication is a core unit taken by the 600 first year students entering the Bachelor of Design degree. Within the design disciplines the communication of the designer's intentions is achieved primarily through the use of graphic images, with written information being considered as supportive or secondary. As such, Digital Communication attempts to educate learners in the fundamentals of this graphic design communication, using a generic digital or software tool. Past iterations of the unit have not acknowledged the subtle difference in design communication of the different design disciplines involved, and has used a single generic software tool. Following a review of the unit in 2008, it was decided that a single generic software tool was no longer entirely sufficient. This decision was based on the recognition that there was an increasing emergence of discipline specific digital tools, and an expressed student desire and apparent aptitude to learn these discipline specific tools. As a result the unit was reconstructed in 2009 to offer both discipline specific and generic software instruction, if elected by the student. This paper, apart from offering the general context and pedagogy of the existing and restructured units, will more importantly offer research data that validates the changes made to the unit. Most significant of this new data is the results of surveys that authenticate actual student aptitude versus desire in learning discipline specific tools. This is done through an exposure of student self efficacy in problem resolution and technological prowess - generally and specifically within the unit. More traditional means of validation is also presented that includes the results of the generic university-wide Learning Experience Survey of the unit, as well as a comparison between the assessment results of the restructured unit versus the previous year.

Shared leadership in Queensland schools : a collective case study

Shared leadership has been identified as a key governance base for the future of government and Catholic schools in Queensland, the state’s two largest providers of school education. Shared leadership values the contributions that many individuals can make through collaboration and teamwork. It claims to improve organisational performance and reduce the increasing pressures faced by principals. However despite these positive features, shared leadership is generally not well understood, not well accepted and not valued by those who practice or study leadership. A collective case study method was chosen, incorporating a series of semi-structured interviews with principals and the use of official school documents. The study has explored the current understanding and practice of shared leadership in four Queensland schools and investigated its potential for use.

Self-efficacy, outcome expectations and self-care behaviour in people with type 2 diabetes in Taiwan

Aims. To explore differences in self-care behaviour according to demographic and illness characteristics; and relationships among self-care behaviour and demographic and illness characteristics, efficacy expectations and outcome expectations of people with type 2 diabetes in Taiwan. Background. Most people with diabetes do not control their disease appropriately in Taiwan. Enhanced self-efficacy towards managing diseases can be an effective way of improving disease control as proposed by the self-efficacy model which provides a useful framework for understanding adherence to self-care behaviours. Design and methods. The sample comprised 145 patients with type 2 diabetes aged 30 years or more from diabetes outpatient clinics in Taipei. Data were collected using a self-administered questionnaire for this study. One-way anova, t-tests, Pearson product moment correlation and hierarchical regression were analysed for the study. Results. Significant differences were found: between self-care behaviour and complications (t = −2·52, p < 0·01) and patient education (t = −1·96, p < 0·05). Self-care behaviour was significantly and positively correlated with duration of diabetes (r = 0·36, p < 0·01), efficacy expectations (r = 0·54, p < 0·01) and outcome expectations (r = 0·44, p < 0·01). A total of 39·1% of variance in self-care behaviour can be explained by duration of diabetes, efficacy expectations and outcome expectations. Conclusions. Findings support the use of the self-efficacy model as a framework for understanding adherence to self-care behaviour. Relevance to clinical practice. Using self-efficacy theory when designing patient education interventions for people with type 2 diabetes will enhance self-management routines and assist in reducing major complications in the future.

Using microteaching to enhance teacher efficacy in pre-service teachers

This study examined pre-service teachers’ efficacy in relation to the utilisation of microteaching as an assessment tool for postgraduate education students in Australia. Three hundred and fifteen pre-service teachers completed the teacher efficacy survey and additional qualitative questions at Time 1 and 208 completed the survey and questions at Time 2. A principal components analysis conducted on the Time 1 survey data revealed teacher efficacy to be comprised of two components: ‘teacher efficacy in classroom management’ and ‘personal teacher efficacy’. Repeated measures ANOVAs conducted on the 208 participants who completed the survey at Time 1 and 2 revealed that efficacy on both components increased significantly over time, and that internet students had higher efficacy levels than internal students. The qualitative data revealed that pre-service teachers enter teaching in order to positively impact on children, yet are concerned about behaviour management in the classroom. In addition, this data highlighted the positive impact that microteaching had on their developing teacher identity.

On collective unintelligence

The idea of collective unintelligence is examined in this paper to highlight some of the conceptual and practical problems faced in modeling groups. Examples drawn from international crises and economics provide illustrative problems of collective failures to act in intelligent ways, despite the inputs and efforts of many skilled and intelligent parties. Choices made of “appropriate” perceptions, analysis and evaluations are examined along with how these might be combined. A simple vector representation illustrates some of the issues and creative possibilities in multi-party actions. Revealed as manifest (un-)intelligence are the resolutions of various problems and potentials that arise in dealing with the “each and all” of a group (wherein items are necessarily non-parallel and of unequal valency). Such issues challenge those seeking to model collective intelligence, but much may be learned.

Validation of the Drinking Refusal Self-Efficacy Questionnaire - Revised in an Adolescent Sample (DRSEQ-RA)

Adolescent drinking is a significant issue yet valid psychometric tools designed for this group are scarce. The Drinking Refusal Self-Efficacy Questionnaire—Revised Adolescent Version (DRSEQ-RA) is designed to assess an individual's belief in their ability to resist drinking alcohol. The original DRSEQ-R consists of three factors reflecting social pressure refusal self-efficacy, opportunistic refusal self-efficacy and emotional relief refusal self-efficacy. A large sample of 2020 adolescents aged between 12 and 19 years completed the DRSEQ and measures of alcohol consumption in small groups. Using confirmatory factor analysis, the three factor structure was confirmed. All three factors were negatively correlated with both frequency and volume of alcohol consumption. Drinkers reported lower drinking refusal self-efficacy than non-drinkers. Taken together, these results suggest that the adolescent version of the Drinking Refusal Self-Efficacy Questionnaire (DRSEQ-RA) is a reliable and valid measure of drinking refusal self-efficacy.

Immunogenicity and protective efficacy of an anti-Streptococcus pyogenes vaccine candidate in multiple animal species

Streptococcus pyogenes, also known as Group A Streptococcus (GAS) has been associated with a range of diseases from the mild pharyngitis and pyoderma to more severe invasive infections such as streptococcal toxic shock. GAS also causes a number of non-suppurative post-infectious diseases such as rheumatic fever, rheumatic heart disease and glomerulonephritis. The large extent of GAS disease burden necessitates the need for a prophylactic vaccine that could target the diverse GAS emm types circulating globally. Anti-GAS vaccine strategies have focused primarily on the GAS M-protein, an extracellular virulence factor anchored to GAS cell wall. As opposed to the hypervariable N-terminal region, the C-terminal portion of the protein is highly conserved among different GAS emm types and is the focus of a leading GAS vaccine candidate, J8-DT/alum. The vaccine candidate J8-DT/alum was shown to be immunogenic in mice, rabbits and the non-human primates, hamadryas baboons. Similar responses to J8-DT/alum were observed after subcutaneous and intramuscular immunization with J8-DT/alum, in mice and in rabbits. Further assessment of parameters that may influence the immunogenicity of J8-DT demonstrated that the immune responses were identical in male and female mice and the use of alum as an adjuvant in the vaccine formulation significantly increased its immunogenicity, resulting in a long-lived serum IgG response. Contrary to the previous findings, the data in this thesis indicates that a primary immunization with J8-DT/alum (50ƒÊg) followed by a single boost is sufficient to generate a robust immune response in mice. As expected, the IgG response to J8- DT/alum was a Th2 type response consisting predominantly of the isotype IgG1 accompanied by lower levels of IgG2a. Intramuscular vaccination of rabbits with J8-DT/alum demonstrated that an increase in the dose of J8-DT/alum up to 500ƒÊg does not have an impact on the serum IgG titers achieved. Similar to the immune response in mice, immunization with J8-DT/alum in baboons also established that a 60ƒÊg dose compared to either 30ƒÊg or 120ƒÊg was sufficient to generate a robust immune response. Interestingly, mucosal infection of naive baboons with a M1 GAS strain did not induce a J8-specific serum IgG response. As J8-DT/alum mediated protection has been previously reported to be due to the J8- specific antibody formed, the efficacy of J8-DT antibodies was determined in vitro and in vivo. In vitro opsonization and in vivo passive transfer confirmed the protective potential of J8-DT antibodies. A reduction in the bacterial burden after challenge with a bioluminescent M49 GAS strain in mice that were passively administered J8-DT IgG established that protection due to J8-DT was mediated by antibodies. The GAS burden in infected mice was monitored using bioluminescent imaging in addition to traditional CFU assays. Bioluminescent GAS strains including the ‘rheumatogenic’ M1 GAS could not be generated due to limitations with transformation of GAS, however, a M49 GAS strain was utilized during BLI. The M49 serotype is traditionally a ‘nephritogenic’ serotype associated with post-streptococcal glomerulonephritis. Anti- J8-DT antibodies now have been shown to be protective against multiple GAS strains such as M49 and M1. This study evaluated the immunogenicity of J8-DT/alum in different species of experimental animals in preparation for phase I human clinical trials and provided the ground work for the development of a rapid non-invasive assay for evaluation of vaccine candidates.

Parents’ self-efficacy, outcome expectations, and self-reported task performance when managing atopic dermatitis in children: Instrument reliability and validity

BACKGROUND: Support and education for parents faced with managing a child with atopic dermatitis is crucial to the success of current treatments. Interventions aiming to improve parent management of this condition are promising. Unfortunately, evaluation is hampered by lack of precise research tools to measure change. OBJECTIVES: To develop a suite of valid and reliable research instruments to appraise parents' self-efficacy for performing atopic dermatitis management tasks; outcome expectations of performing management tasks; and self-reported task performance in a community sample of parents of children with atopic dermatitis. METHODS: The Parents' Eczema Management Scale (PEMS) and the Parents' Outcome Expectations of Eczema Management Scale (POEEMS) were developed from an existing self-efficacy scale, the Parental Self-Efficacy with Eczema Care Index (PASECI). Each scale was presented in a single self-administered questionnaire, to measure self-efficacy, outcome expectations, and self-reported task performance related to managing child atopic dermatitis. Each was tested with a community sample of parents of children with atopic dermatitis, and psychometric evaluation of the scales' reliability and validity was conducted. SETTING AND PARTICIPANTS: A community-based convenience sample of 120 parents of children with atopic dermatitis completed the self-administered questionnaire. Participants were recruited through schools across Australia. RESULTS: Satisfactory internal consistency and test-retest reliability was demonstrated for all three scales. Construct validity was satisfactory, with positive relationships between self-efficacy for managing atopic dermatitis and general perceived self-efficacy; self-efficacy for managing atopic dermatitis and self-reported task performance; and self-efficacy for managing atopic dermatitis and outcome expectations. Factor analyses revealed two-factor structures for PEMS and PASECI alike, with both scales containing factors related to performing routine management tasks, and managing the child's symptoms and behaviour. Factor analysis was also applied to POEEMS resulting in a three-factor structure. Factors relating to independent management of atopic dermatitis by the parent, involving healthcare professionals in management, and involving the child in the management of atopic dermatitis were found. Parents' self-efficacy and outcome expectations had a significant influence on self-reported task performance. CONCLUSIONS: Findings suggest that PEMS and POEEMS are valid and reliable instruments worthy of further psychometric evaluation. Likewise, validity and reliability of PASECI was confirmed.