923 resultados para Ward Round


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This research investigates the symbiotic relationship between composition and improvisation and the notion of improvisation itself. With a specific interest in developing, extending and experimenting with the relationship of improvisation within predetermined structures, the creative work component of this research involved composing six new works with varying approaches for The Andrea Keller Quartet and guest improvisers, for performance on a National Australian tour. This is documented in the CD recording Galumphing Round the Nation - Collaborations Tour 2009. The exegesis component is intended to run alongside the creative work and discusses the central issues surrounding improvisation in an ensemble context and the subject of composing for improvisers. Specifically, it questions the notion that when music emphasises a higher ratio of spontaneous to pre-determined elements, and is exposed to the many variables of a performance context, particularly through its incorporation of visitant improvisers, the resultant music should potentially be measurably altered with each performance. This practice-led research demonstrates the effect of concepts such as individuality, variability within context, and the interactive qualities of contemporary jazz ensemble music. Through the analysis and comparison of the treatment of the six pieces over thirteen performances with varying personnel, this exegesis proposes that, despite the expected potential for spontaneity in contemporary jazz music, the presence of established patterns, the desire for familiarity and the intuitive tendency towards accepted protocols ensure that the music which emerges is not as mutable as initially anticipated.

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This paper describes the cloning and characterization of a new member of the vascular endothelial growth factor (VEGF) gene family, which we have designated VRF for VEGF-related-factor. Sequencing of cDNAs from a human fetal brain library and RT-PCR products from normal and tumor tissue cDNA pools indicate two alternatively spliced messages with open reading frames of 621 and 564 bp, respectively. The predicted proteins differ at their carboxyl ends resulting from a shift in the open reading frame. Both isoforms show strong homology to VEGF at their amino termini, but only the shorter isoform maintains homology to VEGF at its carboxyl terminus and conserves all 16 cysteine residues of VEGF165. Similarity comparisons of this isoform revealed overall protein identity of 48% and conservative substitution of 69% with VEGF189. VRF is predicted to contain a signal peptide, suggesting that it may be a secreted factor. The VRF gene maps to the D11S750 locus at chromosome band 11q13, and the protein coding region, spanning approximately 5 kb, is comprised of 8 exons that range in size from 36 to 431 bp. Exons 6 and 7 are contiguous and the two isoforms of VRF arise through alternate splicing of exon 6. VRF appears to be ubiquitously expressed as two transcripts of 2.0 and 5.5 kb; the level of expression is similar among normal and malignant tissues.

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Aim: This qualitative study aims to provide insight into how Australian New Graduate Nurses (NGNs) experienced their transition to acute care nursing practice. Method: Nine NGNs each participated in three in-depth interviews conducted across their first year of practice. Constant comparative analysis was used to identify the emergent themes. Findings: The desire to fit in (establishment of secure social bonds) with ward staff is an important element of NGN transition experiences. Fitting in was about feeling one's self to be part of a social group, and participants made it clear that their perceptions of their success in establishing secure and meaningful social bonds in each new ward was extremely important for their sense of being as NGNs. Current NGN Transition Programmes (NGNTPs) involve multiple ward rotations, increasing the demand for the NGN to fit in. Thus participants were engaged in a deeply personal transition experience that was not necessarily aligned with multiple ward rotations. Conclusions: Although NGNTPs have the word “transition” in their title, it may be that current programmes are more focussed on organisations’ desire to “orient” NGNs to working within the acute care setting than facilitating personal transitions to practice. Further investigation of the impact of NGNTPs on NGNs and the associated multiple ward rotations is required.

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Introduction / objectives Many strategies are used to control MRSA in hospitals. Only a few have been assessed in clinical trials and it is not obvious how findings should be generalised between settings. Uncertainty remains about which strategies represent the most appropriate use of scarce resources. We assess the cost-effectiveness of alternative MRSA screening and infection control strategies in England and Wales and discuss international relevance. Methods Models of MRSA transmission in ICUs and general medical (GM) wards were developed and used to evaluate different screening methods combined with decolonisation or isolation. Strategies were compared in terms of costs and health benefits (quality adjusted life years, QALYs). Different prevalences, proportions of high risk patients and ward sizes were investigated, and probabilistic sensitivity analyses (PSA) conducted. Results Decolonisation strategies were cost-saving in ICUs at a 5% admission prevalence, with admission and weekly PCR screening the most cost-effective (£3,929/QALY). In ICUs, screening and isolation reduced infection rates by ~10%. With admission prevalence ≤5%, targeting screening and isolation to high risk patients was optimal. In GM wards decolonisation and isolation strategies, though able to reduce MRSA infection rates up to ~50%, were not cost-effective. Conclusion The largest reductions in MRSA infection were achieved by screening and decolonisation strategies, and were cost-effective in ICU settings. In comparison, there is limited potential for screening and control strategies to be cost-effective in GM wards due to lower infection and mortality rates.

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The need for accessible housing in Australia is acute. Both government and the community service sector recognise the importance of well designed accessible housing to optimise the integration of older people and people with disability, to encourage a prudent use of scarce health and community services and to enhance the liveability of our cities. In 2010, the housing industry, negotiated with the Australian Government and community representatives to adopt a nationally consistent voluntary code (Livable Housing Design) and a strategy to provide minimal level of accessibility in all new housing by 2020. Evidence from the implementation of such programs in the United Kingdom and USA, however, serves to question whether this aspirational goal can be achieved through voluntary codes. Minimal demand at the point of new sale, and problems in the production of housing to the required standards have raised questions regarding the application of program principles in the context of a voluntary code. In addressing the latter issue, this paper presents early findings from the analysis of qualitative interviews conducted with developers, builders and designers in various housing contexts. It identifies their “logics in use” in the production of housing in response to Livable Housing Design’s voluntary code and indicates factors that are likely to assist and impede the attainment of the 2020 aspirational goal.

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The effect of sample geometry on the melting rates of burning iron rods was assessed. Promoted-ignition tests were conducted with rods having cylindrical, rectangular, and triangular cross-sectional shapes over a range of cross-sectional areas. The regression rate of the melting interface (RRMI) was assessed using a statistical approach which enabled the quantification of confidence levels for the observed differences in RRMI. Statistically significant differences in RRMI were observed for rods with the same cross-sectional area but different cross-sectional shape. The magnitude of the proportional difference in RRMI increased with the cross-sectional area. Triangular rods had the highest RRMI, followed by rectangular rods, and then cylindrical rods. The dependence of RRMI on rod shape is shown to relate to the action of molten metal at corners. The corners of the rectangular and triangular rods melted faster than the faces due to their locally higher surface area to volume ratios. This phenomenon altered the attachment geometry between liquid and solid phases, increasing the surface area available for heat transfer, causing faster melting. Findings relating to the application of standard flammability test results in industrial situations are also presented.

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Two-party key exchange (2PKE) protocols have been rigorously analyzed under various models considering different adversarial actions. However, the analysis of group key exchange (GKE) protocols has not been as extensive as that of 2PKE protocols. Particularly, an important security attribute called key compromise impersonation (KCI) resilience has been completely ignored for the case of GKE protocols. Informally, a protocol is said to provide KCI resilience if the compromise of the long-term secret key of a protocol participant A does not allow the adversary to impersonate an honest participant B to A. In this paper, we argue that KCI resilience for GKE protocols is at least as important as it is for 2PKE protocols. Our first contribution is revised definitions of security for GKE protocols considering KCI attacks by both outsider and insider adversaries. We also give a new proof of security for an existing two-round GKE protocol under the revised security definitions assuming random oracles. We then show how to achieve insider KCIR in a generic way using a known compiler in the literature. As one may expect, this additional security assurance comes at the cost of an extra round of communication. Finally, we show that a few existing protocols are not secure against outsider KCI attacks. The attacks on these protocols illustrate the necessity of considering KCI resilience for GKE protocols.

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The existing Collaborative Filtering (CF) technique that has been widely applied by e-commerce sites requires a large amount of ratings data to make meaningful recommendations. It is not directly applicable for recommending products that are not frequently purchased by users, such as cars and houses, as it is difficult to collect rating data for such products from the users. Many of the e-commerce sites for infrequently purchased products are still using basic search-based techniques whereby the products that match with the attributes given in the target user's query are retrieved and recommended to the user. However, search-based recommenders cannot provide personalized recommendations. For different users, the recommendations will be the same if they provide the same query regardless of any difference in their online navigation behaviour. This paper proposes to integrate collaborative filtering and search-based techniques to provide personalized recommendations for infrequently purchased products. Two different techniques are proposed, namely CFRRobin and CFAg Query. Instead of using the target user's query to search for products as normal search based systems do, the CFRRobin technique uses the products in which the target user's neighbours have shown interest as queries to retrieve relevant products, and then recommends to the target user a list of products by merging and ranking the returned products using the Round Robin method. The CFAg Query technique uses the products that the user's neighbours have shown interest in to derive an aggregated query, which is then used to retrieve products to recommend to the target user. Experiments conducted on a real e-commerce dataset show that both the proposed techniques CFRRobin and CFAg Query perform better than the standard Collaborative Filtering (CF) and the Basic Search (BS) approaches, which are widely applied by the current e-commerce applications. The CFRRobin and CFAg Query approaches also outperform the e- isting query expansion (QE) technique that was proposed for recommending infrequently purchased products.

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The lack of satisfactory consensus for characterizing the system intelligence and structured analytical decision models has inhibited the developers and practitioners to understand and configure optimum intelligent building systems in a fully informed manner. So far, little research has been conducted in this aspect. This research is designed to identify the key intelligent indicators, and develop analytical models for computing the system intelligence score of smart building system in the intelligent building. The integrated building management system (IBMS) was used as an illustrative example to present a framework. The models presented in this study applied the system intelligence theory, and the conceptual analytical framework. A total of 16 key intelligent indicators were first identified from a general survey. Then, two multi-criteria decision making (MCDM) approaches, the analytic hierarchy process (AHP) and analytic network process (ANP), were employed to develop the system intelligence analytical models. Top intelligence indicators of IBMS include: self-diagnostic of operation deviations; adaptive limiting control algorithm; and, year-round time schedule performance. The developed conceptual framework was then transformed to the practical model. The effectiveness of the practical model was evaluated by means of expert validation. The main contribution of this research is to promote understanding of the intelligent indicators, and to set the foundation for a systemic framework that provide developers and building stakeholders a consolidated inclusive tool for the system intelligence evaluation of the proposed components design configurations.

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Nursing training for an Intensive Care Unit (ICU) is a resource intensive process. High demands are made on staff, students and physical resources. Interactive, 3D computer simulations, known as virtual worlds, are increasingly being used to supplement training regimes in the health sciences; especially in areas such as complex hospital ward processes. Such worlds have been found to be very useful in maximising the utilisation of training resources. Our aim is to design and develop a novel virtual world application for teaching and training Intensive Care nurses in the approach and method for shift handover, to provide an independent, but rigorous approach to teaching these important skills. In this paper we present a virtual world simulator for students to practice key steps in handing over the 24/7 care requirements of intensive care patients during the commencing first hour of a shift. We describe the modelling process to provide a convincing interactive simulation of the handover steps involved. The virtual world provides a practice tool for students to test their analytical skills with scenarios previously provided by simple physical simulations, and live on the job training. Additional educational benefits include facilitation of remote learning, high flexibility in study hours and the automatic recording of a reviewable log from the session. To the best of our knowledge, we believe this is a novel and original application of virtual worlds to an ICU handover process. The major outcome of the work was a virtual world environment for training nurses in the shift handover process, designed and developed for use by postgraduate nurses in training.

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Purpose---The aim of this study is to identify complexity measures for building projects in the People’s Republic of China (PRC). Design/Methodology/Approach---A three-round of Delphi questionnaire survey was conducted to identify the key parameters that measure the degree of project complexity. A complexity index (CI) was developed based on the identified measures and their relative importance. Findings---Six key measures of project complexity have been identified, which include, namely (1) building structure & function; (2) construction method; (3) the urgency of the project schedule; (4) project size/scale; (5) geological condition; and (6) neighboring environment. Practical implications---These complexity measures help stakeholders assess degrees of project complexity and better manage the potential risks that might be induced to different levels of project complexity. Originality/Value---The findings provide insightful perspectives to define and understand project complexity. For stakeholders, understanding and addressing the complexity help to improve project planning and implementation.

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The design-build (DB) system has been demonstrated as an effective delivery method and has gained popularity worldwide. However it is observed that a number of operational variations of DB system have emerged since the last decade to cater for different client’s requirements. After the client decides to procure his project through the DB system, he still has to choose an appropriate configuration to deliver their projects optimally. However, there is little research on the selection of DB operational variations. One of the main reasons for this is the lack of evaluation criteria for determining the appropriateness of each operational variation. To obtain such criteria, a three-round Delphi survey has been conducted with 20 construction experts in the People’s Republic of China (PRC). Seven top selection criteria were identified. These are: (1) availability of competent design-builders; (2) client’s capabilities; (3) project complexity; (4) client’s control of project; (5) early commencement & short duration; (6) reduced responsibility or involvement; and (7) clearly defined end user’s requirements. These selection criteria were found to have a statistically significant agreement. These findings may furnish various stakeholders, DB clients in particular, with better insight to understand and compare the different operational variations of the DB system.

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Many academic researchers have conducted studies on the selection of design-build (DB) delivery method; however, there are few studies on the selection of DB operational variations, which poses challenges to many clients. The selection of DB operational variation is a multi-criteria decision making process that requires clients to objectively evaluate the performance of each DB operational variation with reference to the selection criteria. This evaluation process is often characterized by subjectivity and uncertainty. In order to resolve this deficiency, the current investigation aimed to establish a fuzzy multicriteria decision-making (FMCDM) model for selecting the most suitable DB operational variation. A three-round Delphi questionnaire survey was conducted to identify the selection criteria and their relative importance. A fuzzy set theory approach, namely the modified horizontal approach with the bisector error method, was applied to establish the fuzzy membership functions, which enables clients to perform quantitative calculations on the performance of each DB operational variation. The FMCDM was developed using the weighted mean method to aggregate the overall performance of DB operational variations with regard to the selection criteria. The proposed FMCDM model enables clients to perform quantitative calculations in a fuzzy decision-making environment and provides a useful tool to cope with different project attributes.