Triage nurses' clinical decision making : an observational study of urgency assessment

Background. Researchers have described both the various decision tasks performed by triage nurses using self-report methods and identified time as a factor influencing the quality of triage decisions. However, little is known about the decision tasks performed by triage nurses when making acuity assessments, or the factors influencing triage duration in the real world.

Aims. The aims of this study were to: describe the data triage nurses collect from patients in order to allocate a triage priority using the Australasian Triage Scale (ATS); describe the duration of nurses' decision making for ATS categories 2–5; and to explore the impact of patient and nurse variables on the duration of the triage nurses' decision making in the clinical setting.

Design. A structured observational study was employed to address the research aims. Observational data was collected in one adult emergency department located in metropolitan Melbourne, Australia. A total of 26 triage nurses consented and were observed performing 404 occasions of triage. Data was collected by a single observer using a 20-item instrument that recorded the performance frequencies of a range of decision tasks and a number of observable patient, nurse and environmental variables. Additionally, the nurse–patient interaction was recorded as time in minutes.

Results. It was found that there was limited use of objective physiological data collected by the nurses' in order to decide patient acuity, and large variability in the duration of triage decisions observed. In addition, analysis of variance indicated strong evidence of a true difference between triage duration and a range of nurse, patient and environmental variables.

Conclusion. These findings have implications for the development of practice standards and triage education. In particular, it is argued that practice standards should include routine measurement of physiological parameters in all but the collapsed or obviously unwell patient, where further delay may impede the delivery oftime-critical intervention. Furthermore, the inclusion of arbitrary time frames for triage assessment in practice standards are not an appropriate method of evaluating triage decision making in the real world.

Neck muscle activation and head postures in common high performance aerial combat maneuvers

Introduction: Neck injuries are common in high performance combat pilots and have been attributed to high gravitational forces and the non-neutral head postures adopted during aerial combat maneuvers. There is still little known about the pathomechanics of these injuries.

Methods: Six Royal Australian Air Force Hawk pilots flew a sortie that included combinations of three +Gz levels (1, 3, and 5) and four head postures (Neutral, Turn, Extension, and Check-6). Surface electromyography from neck and shoulder muscles was recorded in flight. Three-dimensional measures of head postures adopted in flight were estimated postflight with respect to end-range of the cervical spine using an electromagnetic tracking device.

Results: Mean muscle activation increased significantly with both increasing +Gz and non-neutral head postures. Check-6 at +5 Gz (mean activation of all muscles = 51% MVIC) elicited significantly greater muscle activation in most muscles when compared with Neutral, Extension, and Turn head postures. High levels of muscle co-contraction were evident in high acceleration and non-neutral head postures. Head kinematics showed Check-6 was closest to end-range in any movement plane (86% ROM in rotation) and produced the greatest magnitude of rotation in other planes. Turn and Extension showed a large magnitude of rotation with reference to end-range in the primary plane of motion but displayed smaller rotations in other planes.

Discussion: High levels of neck muscle activation and co-contraction due to high +Gz and head postures close to end range were evident in this study, suggesting the major influence of these factors on the pathomechanics of neck injuries in high performance combat pilots.

Range-wide phylogeography of the Little Penguin (Eudyptula minor): evidence of long-distance dispersal

The Little Penguin (Eudyptula minor), a colonial-nesting seabird that is widespread in New Zealand and southern Australia, has high dispersal potential but exhibits regional variation in morphology, coloration, and breeding phenology. We present a distribution-wide survey of mitochondrial DNA variation in the Little Penguin to document phylogeographic relationships and genetic structuring and to test for concordance with intraspecific taxonomy. Phylogeographic structuring was absent among Australian colonies (27 localities, 94 individuals), but the distribution of haplotypes among colonies was significantly nonrandom (ϕST = 0.110, P < 0.01). The Australian individuals exhibited close phylogenetic relationships with a subset of New Zealand birds (4 localities, 22 individuals), whereas the remaining New Zealand birds (20 localities, 106 individuals) were phylogenetically distinct, with ≥7% sequence divergence, and exhibited greater levels of genetic variation and geographic structuring (ϕST = 0.774, P < 0.05). These patterns are consistent with earlier suggestions of an origin in New Zealand followed by recent colonization of Australia and back-dispersal to New Zealand. Extinction and re-establishment processes may have been important factors in the development of genetic structuring across a range of spatiotemporal scales. The genetic data are consistent with suggestions that a single subspecies exists in Australia, but not with the subspecies distributions within New Zealand that have been suggested on the basis of morphology and coloration.

Narrativization of actuality : convergence of form and genre in film and television

The thesis concerns the treatment of actuality in film and television, particularly the narrativization of actuality images, and the context of their placement within audio/visual texts. Several instances of the convergence of media form and genre are analyzed, and the conventions of classificatory systems and boundaries that pertain to film and television representations are reconsidered in light of changes in the conventions of genre. The distinction between, and convergence of fictional and non-fictional conventions of narrative are therefore central to the thesis, as are the related issues of viewer response, the nature of subjectivity in the viewer, the connectivity of text and culture, and the relations of actuality to the text. The thesis traces the narrativization of actuality through textual, formal and genre boundaries, adopting a ‘line of flight or deterritorialization’ that enables the thesis to ‘change in nature and connect with other multiplicities.’This line of flight passes through the conventional separation of genre groupings and texts, and, similarly, has been applied in the thesis as a rationale for the diminution of theoretical boundaries. A multiperpectival approach is applied to the permeability of, or transcendent relations of the analysis to the boundaries between genres, between texts and culture, and between actuality and virtual representation. In the thesis there is also a theoretical deterritorialization that consents to a pluralism of theory, which is an approach demonstrated by Deleuze and Guattari in A Thousand Plateaus. The model of multi-perspectivalism adopted in the thesis engages in establishing connections and similarities between theories, rather than emphasizing contradictory and exclusive practices. The Foucauldian notion of the rules of formation in discourse, Nichols’ theories of documentary representation of reality, Bordwell’s schematic interpretation, and several other positions are critiqued, as the line of flight embarked upon in the thesis intersects with, and passes through both textual and theoretical boundaries. The thesis consists of two parts: firstly, a location of theoretical perspective, in which the issues of theory pertaining to actuality and narrative are explicated, and the methodological approach of the thesis is defined. The second part commences with an analysis of the most familiar instances of actuality in film and television, with particular attention to documentary forms. It then engages in the analysis of films that represent actuality but which, in the process of narrativization, display a convergence of genre conventions. The films selected for analysis include Steven Speilberg's Schindler's List, (1993) Oliver Stone's JFK, (1991) and Robert Zemeckis' Forrest Gump, (1994) and Contact, (1996). Hence the thesis is concerned with the application of a pluralist theoretical approach, with, however, an emphasis on the Deleuzo-Guattarian notions of rhizome and assemblage. Within this theoretical frame, the connections between actuality and the audio/visual text are explicated, and the formation of text as ‘a rhizome with the world’, is analyzed across a range of examples.

Comparison of static and dynamic engine models on the transient performance of a passenger vehicle powertrain

This paper presents experimental and computational results obtained on the Ford Barra 190 4.0 litres I6 gasoline engine and on the Ford Falcon car equipped with this engine. Measurements of steady engine performance, fuel consumption and exhaust emissions were first collected using an automated test facility for a wide range of cam and spark timings vs. throttle position and engine speed. Simulations were performed for a significant number of measured operating points at full and part load by using a coupled Gamma Technologies GT-POWER/GT-COOL engine model for gas exchange, combustion and heat transfer. The fluid model was made up of intake and exhaust systems, oil circuit, coolant circuit and radiator cooling air circuit. The thermal model was made up of finite element components for cylinder head, cylinder, piston, valves and ports and wall thermal masses for pipes. The model was validated versus measured steady state air and fuel flow rates, cylinder pressure parameters, indicated and brake mean effective pressures, and temperature of metal, oil and coolant in selected locations. Computational results agree well with experiments, demonstrating the ability of the approach to produce fairly accurate steady state maps of BMEP and BSFC, as well as to optimize engine operation changing geometry, throttle position, cam and spark timing. Measurements of the transient performance and fuel consumption of the full vehicle were then collected over the NEDC cycle. Simulations were performed by using a coupled Gamma Technologies GT-POWER/GT-COOL/GT-DRIVE model for instantaneous engine gas exchange, combustion and heat transfer and vehicle motion. The full vehicle model is made up of transmission, driveshaft, axles, and car components and the previous engine model. The model was validated with measured fuel flow rates through the engine, engine throttle position, and engine speed and oil and coolant temperatures in selected locations. Instantaneous engine states following a time dependent demand for torque and speed differ from those obtained by interpolating steady state maps of BSFC vs. BMEP and speed. Computational results agree well with experiments, demonstrating the utility of the approach in providing a more accurate prediction of the fuel consumption over test cycles.

Studies of natriuretic peptides in Tradescantia

The idea that plant development and physiological responses to the environment are governed largely by the five classical hormones is being superseded by the view that a much larger range of very different molecules also have such functions in plants. Recent evidence suggests that natriuretic peptides (NPs) known to function in vertebrates as regulators of salt and water balance may also play this role in plants. This thesis adds experimental results obtained in vitro and in situ that contribute to further establishing NPs as novel endogenous regulators in plants.

It's not that bad : the views of consumers and carers about routine outcome measurement in mental health

The mandatory use of routine outcome measurement (ROM) has been introduced into all public sector mental health services in Australia over the past 6 years. Qualitative processes were used to engage consumers and carers in suggesting how the measures can be used in clinical practice. The project involved an audit by survey, followed by a range of interactive workshops designed to elicit the views of consumers, carers and clinicians, as well as to involve all parties in dialogue about ROM. In addition, there was engagement of consumers and carers in the training of clinicians in the clinical use of ROM, and in the production of promotional materials aimed at informing consumers and carers about ROM. When consumers and carers have had an opportunity to be involved in ROM they have found it a useful experience, and those who had not been involved can see the potential. Consumers and carers indicated that they believe the greatest opportunity arising from the suite of measures is the use of the consumer self-assessment measure the Behaviour and Symptom Identification Scale (BASIS-32).

The cinema of Kathryn Bigelow : Hollywood transgressor

Kathryn Bigelow has undoubtedly been one of Hollywood's most significant female players, well known in popular terms for films such as Point Breakand Blue Steel, yet relatively unexplored in academia. Soundbites about women and guns and speculation about the role of ex-husband James Cameron ( Aliens, Titanic) in her career have often helped obscure rather than elucidate an understanding of her work. This collection explores how Bigelow can be seen to provide a point of intersection to a whole range of issues at the forefront of contemporary film studies and of the transformation of Hollywood into a post-classical cinema machine, with a particular emphasis on her most ambitious and controversial picture, Strange Days. Her place within new Hollywood is as a filmmaker that blurs genre conventions, reinscribes gender identites, and produces a breathless cinema of attractions.

Toward automatic extraction of expressive elements from motion pictures : tempo

This paper addresses the challenge of bridging the semantic gap that exists between the simplicity of features that can be currently computed in automated content indexing systems and the richness of semantics in user queries posed for media search and retrieval. It proposes a unique computational approach to extraction of expressive elements of motion pictures for deriving high-level semantics of stories portrayed, thus enabling rich video annotation and interpretation. This approach, motivated and directed by the existing cinematic conventions known as film grammar, as a first step toward demonstrating its effectiveness, uses the attributes of motion and shot length to define and compute a novel measure of tempo of a movie. Tempo flow plots are defined and derived for a number of full-length movies and edge analysis is performed leading to the extraction of dramatic story sections and events signaled by their unique tempo. The results confirm tempo as a useful high-level semantic construct in its own right and a promising component of others such as rhythm, tone or mood of a film. In addition to the development of this computable tempo measure, a study is conducted as to the usefulness of biasing it toward either of its constituents, namely, motion or shot length. Finally, a refinement is made to the shot length normalizing mechanism, driven by the peculiar characteristics of shot length distribution exhibited by movies. Results of these additional studies, and possible applications and limitations are discussed.

Towards automatic extraction of expressive elements from motion pictures : tempo

This paper proposes a unique computational approach to extraction of expressive elements of motion pictures for deriving high level semantics of stories portrayed, thus enabling better video annotation and interpretation systems. This approach, motivated and directed by the existing cinematic conventions known as film grammar, as a first step towards demonstrating its effectiveness, uses the attributes of motion and shot length to define and compute a novel measure of tempo of a movie. Tempo flow plots are defined and derived for four full-length movies and edge analysis is performed leading to the extraction of dramatic story sections and events signaled by their unique tempo. The results confirm tempo as a useful attribute in its own right and a promising component of semantic constructs such as tone or mood of a film.

Study of shot length and motion as contributing factors to movie tempo

This work seeks to lay the framework of film grammar over the video to be analyzed. We use the shot attributes of motion and shot length to produce a novel continuous measure of one of the aesthetic elements of films, namely the movie tempo. We refer to our previous work detailing the study of this construct and its automatic derivation, and also demonstrating its usefulness as an expressive element and as a sound basis for higher semantic descriptions such as dramatic events and story elements. Initial assessment of tempo was performed in our study on the basis that the relative importance of both shot length and motion in formulating the tempo function was the same. In this paper, we analyze their relative contributions to tempo, and demonstrate how these two factors can be manipulated to influence audience perception of movie time.

Insect based navigation and its applications to the autonomous control of mobile robots

Giving robots the ability to autonomously move around in various real-world environments has been a major goal of AI (artificial intelligence) for quite some time. To this end it is vital for robots to be able to perceive their surroundings in 3D; they must be able to estimate the range of obstacles in their path.

Animals navigate through various uncontrolled environments with seemingly little effort. Flying insects, especially, are quite adept at manoeuvring in complex, unpredictable and possibly hostile and hazardous environments.

In this paper it is shown that very simple motion cues, inspired by the visual navigation of flying insects, can be used to provide a mobile robot with the ability to successfully traverse a corridor environment. Equipping an autonomous mobile robot with the ability to successfully navigate real-word environments (in real-time) constitutes a major challenge for AI and robotics. It is in this area that insect based navigation has something to offer.

Phenological response of sea turtles to environmental variation across a species' northern range

Variations in environmental parameters (e. g. temperature) that form part of global climate change have been associated with shifts in the timing of seasonal events for a broad range of organisms. Most studies evaluating such phenological shifts of individual taxa have focused on a limited number of locations, making it difficult to assess how such shifts vary regionally across a species range. Here, by using 1445 records of the date of first nesting for loggerhead sea turtles (Caretta caretta) at different breeding sites, on different continents and in different years across a broad latitudinal range (25-39 degrees ' N), we demonstrate that the gradient of the relationship between temperature and the date of first breeding is steeper at higher latitudes, i.e. the phenological responses to temperature appear strongest at the poleward range limit. These findings support the hypothesis that biological changes in response to climate change will be most acute at the poleward range limits and are in accordance with the predictions of MacArthur's hypothesis that poleward range limit for species range is environmentally limited. Our findings imply that the poleward populations of loggerheads are more sensitive to climate variations and thus they might display the impacts of climate change sooner and more prominently.

Motion analysis of a robotic assisted surgery and microsurgery system - experimental verification

Motion analysis of a parallel robot assisted minimally invasive surgery/microsurgery system (PRAMiSS) and the control structures enabling it to achieve milli/micromanipulations under the constraint of moving through a fixed penetration point or so-called remote centre-of-motion (RCM) are presented in this article. Two control algorithms are proposed suitable for minimally invasive surgery (MIS) with submillimeter accuracy and for minimally invasive micro-surgery (MIMS) with submicrometer accuracy. The RCM constraint is performed without having any mechanical constraint. Control algorithms also apply orientation constraint preventing the tip to orient relative to the soft tissues due to the robot movements. Experiments were conducted to verify accuracy and effectiveness of the proposed control algorithms for MIS and MIMS operations. The experimental results demonstrate accuracy and performance of the proposed position control algorithms.