The development of an algorithm to track blood pressure accurately based on the pulse transit time method

Oscillometric blood pressure (BP) monitors are currently used to diagnose hypertension both in home and clinical settings. These monitors take BP measurements once every 15 minutes over a 24 hour period and provide a reliable and accurate system that is minimally invasive. Although intermittent cuff measurements have proven to be a good indicator of BP, a continuous BP monitor is highly desirable for the diagnosis of hypertension and other cardiac diseases. However, no such devices currently exist. A novel algorithm has been developed based on the Pulse Transit Time (PTT) method, which would allow non-invasive and continuous BP measurement. PTT is defined as the time it takes the BP wave to propagate from the heart to a specified point on the body. After an initial BP measurement, PTT algorithms can track BP over short periods of time, known as calibration intervals. After this time has elapsed, a new BP measurement is required to recalibrate the algorithm. Using the PhysioNet database as a basis, the new algorithm was developed and tested using 15 patients, each tested 3 times over a period of 30 minutes. The predicted BP of the algorithm was compared to the arterial BP of each patient. It has been established that this new algorithm is capable of tracking BP over 12 minutes without the need for recalibration, using the BHS standard, a 100% improvement over what has been previously identified. The algorithm was incorporated into a new system based on its requirements and was tested using three volunteers. The results mirrored those previously observed, providing accurate BP measurements when a 12 minute calibration interval was used. This new system provides a significant improvement to the existing method allowing BP to be monitored continuously and non-invasively, on a beat-to-beat basis over 24 hours, adding major clinical and diagnostic value.

Economic evaluations of clinical pharmacy services in Ireland, 2007-2015

Introduction The concept of this thesis was driven by stagnation within the Irish healthcare system. Multiple reports from pharmacy organisations had outlined possible future directions for the profession but progress was minimal, especially in comparison with other countries. The author’s directive was to evaluate the economic impact of a series of clinical pharmacy services (CPS) in hospital and community settings. Methods A systematic review of economic evaluations of clinical pharmacy services in hospital patients was undertaken to gain insight into recent research in the field. Eligible studies were evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), to establish the quality, consistency and transparency of relevant research. A retrospective analysis of an internal hospital pharmacy interventions database was conducted. A method first described by Nesbit et al. was implemented to estimate the level of cost avoidance achieved. A cost-effectiveness analysis based on data from a randomised controlled trial of a pharmacist-supervised patient self-testing (PST) of warfarin therapy is presented. Outcome measure was the incremental cost associated with six months of intervention management. A similar cost-effectiveness analysis based on previously published RCT data was used to evaluate a novel structured pharmacist review of medication in older hospitalised patients. Cost-effectiveness analysis was presented in the form of an incremental cost-effectiveness ratio (ICER). An ICER is an additional cost per unit effect, in the case of this study, the cost of preventing an additional non-trivial ADR in hospital. A method described by Preaud et al. was adapted to estimate the clinical and economic benefit gained from vaccination of patients by a community pharmacist in Ireland in 2013/14. Sample demographic data was obtained from a national chain of community pharmacies and applied to overall national vaccination data. Results Systematic review identified twenty studies which were eligible for inclusion. Overall, pharmacist interventions had a positive impact on hospital budgets. Only three studies (15%) were deemed to be “good-quality” studies. No ‘novel’ clinical pharmacist intervention was identified during the course of this review. Analysis of internal hospital database identified 4,257 interventions documented on 2,147 individual patients over a 12 month period. Substantial cost avoidance of €710,000 was generated over a 1 year period from the perspective of the health care provider. Mean cost avoidance of €166 per intervention was generated. The cost of providing these interventions was €82,000. Substantial net cost-benefits of €626,279 and a cost-benefit ratio of 8.64 : 1 were generated based on this evaluation of pharmacist interventions. Results from an evaluation of a novel pharmacist-led form of warfarin management indicated indicated that on a per patient basis, PST was slightly more expensive than established anticoagulant management. On a per patient basis over a six month period, PST resulted in an incremental cost of €59.08 in comparison with routine care. Overall cost of managing a patient through pharmacist-supervised PST for a six month period is €226.45. However, for this increase in cost a clinically significant improvement in care was provided. Patients achieved a significantly higher time in therapeutic range during the PST arm in comparison with routine care, (72 ± 19.7% vs 59 ± 13.5%). Difference in overall cost was minimal and PST was the dominant strategy in some scenarios examined during sensitivity analysis. Structured pharmacist review of medication was determined to be dominant in comparison to usual pharmaceutical care. Even if the healthcare payer was unwilling to pay any money for the prevention of an ADR, the intervention strategy is still likely to be cost-effective (probability of being determined cost-effective = 0.707). Implementation of pharmacist-led influenza vaccination has resulted in substantial clinical and economic benefits to the healthcare system. The majority of patients (64.9%) who availed of this service had identifiable influenza-related risk factors. Of patients with influenza-related risk factors, age ≥65 year was the most commonly cited risk factor. Pharmacist vaccination services averted a total of 848 influenza cases across all age groups during the 2013/2014 influenza season. Due to receipt of vaccination in a pharmacy setting, 444 influenza-related GP visits were prevented. In terms of more serious influenza-associated events, 11 hospitalisations and five influenza-related deaths were averted. Costs averted were approximately €305,000. These were principally wider societal-related costs associated with lost productivity. Conclusion Overall, clinical pharmacy services are adding value to the Irish healthcare system in both hospital and community settings, but provision of additional funding for new services would enable them to offer a great deal more.

New weapons to fight old enemies: novel strategies for the (bio)control of bacterial biofilms in the food industry

Biofilms are microbial communities characterized by their adhesion to solid surfaces and the production of a matrix of exopolymeric substances, consisting of polysaccharides, proteins, DNA and lipids, which surround the microorganisms lending structural integrity and a unique biochemical profile to the biofilm. Biofilm formation enhances the ability of the producer/s to persist in a given environment. Pathogenic and spoilage bacterial species capable of forming biofilms are a significant problem for the healthcare and food industries, as their biofilm-forming ability protects them from common cleaning processes and allows them to remain in the environment post-sanitation. In the food industry, persistent bacteria colonize the inside of mixing tanks, vats and tubing, compromising food safety and quality. Strategies to overcome bacterial persistence through inhibition of biofilm formation or removal of mature biofilms are therefore necessary. Current biofilm control strategies employed in the food industry (cleaning and disinfection, material selection and surface preconditioning, plasma treatment, ultrasonication, etc.), although effective to a certain point, fall short of biofilm control. Efforts have been explored, mainly with a view to their application in pharmaceutical and healthcare settings, which focus on targeting molecular determinants regulating biofilm formation. Their application to the food industry would greatly aid efforts to eradicate undesirable bacteria from food processing environments and, ultimately, from food products. These approaches, in contrast to bactericidal approaches, exert less selective pressure which in turn would reduce the likelihood of resistance development. A particularly interesting strategy targets quorum sensing systems, which regulate gene expression in response to fluctuations in cell-population density governing essential cellular processes including biofilm formation. This review article discusses the problems associated with bacterial biofilms in the food industry and summarizes the recent strategies explored to inhibit biofilm formation, with special focus on those targeting quorum sensing.

Getting better teachers in the bush

This chapter explores concepts of identity, difference and disadvantage through a self-study that focuses on preparing teachers to teach for diversity. I consider influences of my rural, working class background in a homogeneous setting as it shapes my professional identity as a teacher educator. I begin the self-study by reflecting on my early career and work as a language and literacy teacher educator at a regional university where I began to carefully consider the discursive resources that students in regional and rural settings bring to teacher education a decade ago. A decade on, in a different but somewhat similar university, I am still grappling with ways of raising awareness of diversity and discussing issues of race, social class, gender and ability and implications for teaching and learning. In this chapter I use the process of self-study to examine my own practice as a teacher educator using the implications from my doctoral studies as a focus.

Placemaking as good practice

This chapter describes a process (i.e. placemaking) and the principles one may use when attempting to transform existing and new settings into positive contributions within the urban environment. It does this by introducing a number of early approaches intended to improve the 'setting' in which people live. Following this introduction, I will give a brief conceptual framing of placemaking and highlight the source of inspiration for the chapter's concluding placemaking principles. A detailed discussion of placemaking and its attributes leads to a series of concluding remarks that are intended to fully embrace the process of placemaking and to guard against token efforts when attempting to develop good urban places.

Imaging Tectonic Plates - Structure and Deformation of North America

The outermost layer of the Earth is broken into tectonic plates whose motions cause earthquakes and volcanism. Much of what we know about the structure of these plates comes from studying the Earth's surface. Seismic waves recorded by the EarthScope Transportable Array, however, show us the internal structure of plates down to 200 km deep and help us understand the relationship between deep structure and the Earth's surface. EarthScope images for the western United States hint at the presence of the mid-depth discontinuities. To better understand these features, Dr. Lekic relates them to the geologic history of the west.

Structural, metamorphic and geochronological relations between the Zanskar Shear Zone and the Miyar Shear Zone (NW Indian Himalaya): Evidence for two distinct tectonic structures and implications for the evolution of the High Himalayan Crystalline of Zanskar

The geologic structures and metamorphic zonation of the northwestern Indian Himalaya contrast significantly with those in the central and eastern parts of the range, where the high-grade metamorphic rocks of the High Himalayan Crystalline (HHC) thrust southward over the weakly metamorphosed sediments of the Lesser Himalaya along the Main Central Thrust (MCT). Indeed, the hanging wall of the MCT in the NW Himalaya mainly consists of the greenschist facies metasediments of the Chamba zone, whereas HHC high-grade rocks are exposed more internally in the range as a large-scale dome called the Gianbul dome. This Gianbul dome is bounded by two oppositely directed shear zones, the NE-dipping Zanskar Shear Zone (ZSZ) on the northern flank and the SW-dipping Miyar Shear Zone (MSZ) on the southern limb. Current models for the emplacement of the HHC in NW India as a dome structure differ mainly in terms of the roles played by both the ZSZ and the MSZ during the tectonothermal evolution of the HHC. In both the channel flow model and wedge extrusion model, the ZSZ acts as a backstop normal fault along which the high-grade metamorphic rocks of the HHC of Zanskar are exhumed. In contrast, the recently proposed tectonic wedging model argues that the ZSZ and the MSZ correspond to one single detachment system that operates as a subhorizontal backthrust off of the MCT. Thus, the kinematic evolution of the two shear zones, the ZSZ and the MSZ, and their structural, metamorphic and chronological relations appear to be diagnostic features for discriminating the different models. In this paper, structural, metamorphic and geochronological data demonstrate that the MSZ and the ZSZ experienced two distinct kinematic evolutions. As such, the data presented in this paper rule out the hypothesis that the MSZ and the ZSZ constitute one single detachment system, as postulated by the tectonic wedging model. Structural, metamorphic and geochronological data are used to present an alternative tectonic model for the large-scale doming in the NW Indian Himalaya involving early NE-directed tectonics, weakness in the upper crust, reduced erosion at the orogenic front and rapid exhumation along both the ZSZ and the MSZ.

Geologic-hydrologic setting and surface sedimentology in the Persian Gulf

1. Morphology and sedimentation The deepest parts of the Persian Gulf lie off the Iranian coast. Several swells separate the Persian Gulf into the Western Basin, the Central Basin and the Strait of Hormuz, which leads without noticeable morphological interruption onto the Biaban Shelf; the latter gradually drops off towards the continental slope, which itself has a strongly subdivided morphology. The sediment distribution in the Western Basin runs parallel to the basin's axis to a depth of 50 -60 m. This is caused by the shallow and uniform slope of the Iranian coast into the Western Basin, by clear exposure of the area to the Shamal-Winds and by tidal currents parallel to the basin's axis. Most other parameters also show isolines parallel to the coast line. Data from the sediment analyses show a net transport which extends out along the Central Swell: coarse fraction > 63 µ, total carbonate content, carbonate in fine fractions < 2 µ, 2-6 µ and 20-63 µ, calcite-aragonite ratios in the fine fractions 2-6 µ and 20-63 µ and quartz-dolomite ratios in fine fraction 2-6 µ. At least the uppermost 10-40 m of this sediment is late Holocene. This implies sedimentation rates of several meters per 1000 years. The slope from the Iranian coast into the Central Basin (max. depth 100 m) is generally steeper, with interspersed islands and flats. Both facts tend to disturb a sediment dustribition parallel to the basin's axis over extensive areas and may preclude any such trend from being detected by the methods and sample net used. The spatial distribution of the coarse fraction, however, seems to indicate sediment transport at greater water depths perpendicular to the basin's long axis and along the steepest gradients well into the Central Basin. The flats of the Central Basin have a sediment cover distinctly different from those of the deeper basin areas. Characteristic parameters are the extremely high percentages of coarse grained sediments, total content of carbonate CO2 over 40, low total organic carbon content, (however values are high if calculated on the basis of the < 63 µ fraction), low total N-content, and low C/N ratios. These characteristics probably result from the absence of any terrigenous material being brought in as well as from exposure to wave action. Finest terrigenous material is deposited in the innermost protected part of the Hormuz Bay. In the deep channel cut into the Biaban Shelf which carries the Persian Gulf out-flow water to the Indian Ocean, no fine grained sediment is deposited as shown by grain size data. 2. Geographic settings and sedimentation Flat lands border the Arabian coast of the Persian Gulf except for the Oman region. The high and steep Zagros Mountains form the Iranian coastline. Flat topography in combination with generally low precipitation precludes fluviatile sediment being added from the South. Inorganic and biogenic carbonates accumulating under low sedimentation rates are dominant on the shallow Arabic Shelf and the slopes into the Western and Central Basins. The fluviatile sediment brought in from the Iranian side, however decisively determine the composition of the Holocene sediment cover in the Persian Gulf and on the Biaban Shelf. Holocene sediments extend 20-30 km seaward into the Western Basin and about 25 km on to the Biaban Shelf. As mentioned before, sedimentation rates are of several meters/1000 years. The rocks exposed in the hinterland influence the sediments. According to our data the Redbeds of the Zagros Mountains determine the colour of the very fine grained sediments near the Iranian Coast of the Persian Gulf. To the West of Hormuz, addition of carbonate minerals is particularly high. Dolomite and protodolomite, deposited only in this area, as well as palygorskite, have proven to be excellent trace minerals. To the East of Hormuz, the supply of terrigenous carbonates is considerably lower. Clay minerals appear to bring in inorganically bound nitrogen thus lowering the C/N ratio in these sediments especially off river mouths. 3. Climate and sedimentation The Persian Gulf is located in a climatically arid region. This directly affects sedimentation through increased wind action and the infrequent but heavy rainfalls which cause flash floods. Such flash floods could be responsible for transporting sedheats into the Central Basin in a direction perpendicular to the Gulf's axis. Eolian influx is difficult to asses from our data; however, it probably is of minor importance from the Iranian side and may add, at the most, a few centimeters of fine sediment per 1000 years. 4. Hydrology and sedimentation High water temperatures favor inorganic carbonate precipitation in southern margin of the Gulf, and probably on the flats, as well as biogenic carbonate production in general. High evaporation plus low water inflow through rivers and precipitation cause a circulation pattern that is typical for epicontinental seas within the arid climate region. Surface water flows in from the adjoining ocean, in this case the Indian Ocean and sinks to the bottom of the Persian Gulf mainly in the northern part of the Western Basin, on the "Mesopotamischer Flachschelf" ard probably in the area of the "Arabischer Flachschelf". This sinking water continually rejuvenates the bottom out-flow water. The inflowing surface water from the Indian Ocean brings organic matter into the Persian Gulf, additional nutrients are added by the "fresh" upwelling waters of the Gulf of Oman. Both nutrients and organic matter diminish very rapidly as the water moves into the Persian Gulf. This depletion of nutrients and organic matter is the reasonfor generally low organic carbon contents of the Persian Gulf sediments. The Central Swell represents a distinct boundary, to the west of which the organic carbon content are lower than to the east when sediment samples of similar grain size distribution are compared. The outflow carries well oxygenated water over the bottom of the Persian Gulf and the resulting oxidation further decreases the content of organic matter. In the Masandam-Channel and in the Biaban-Shelf channel, the outflowing water prevents deposition of fine material and transports sediment particles well beyond the shelf margin. The outflowing water remains at a depth of 200-300 m depending on its density and releases ist suspending sediment load to the ocean floor, irrespectative of the bottom morphology. This is reflected in several parameters in which the sediments from beneath the outflow differ from nearby sediments not affected by the outflowing water. High carbonate content of total samples and of the individual size fraction as well as high aragonite and dolomite contents of individual size fractions characterize the sediment beneath the outflowing water. The tidal currents, which avt more or less parallel to the Gulf's axis, favor mixing of the water masses, they rework sediments at velocities reported here. This fact enlarges to a certain degree the extent of our interfaces which are based on only a few sample points (Persian Gulf and Biaban Shelf one sample per 620 km**2, continental slope one sample per 1000 km**2). The water on the continental slope shows and oxygen minimum at 200-1200 m which favors preservation of organically-bound carbon in the sediment. The low pH-values may even permit dissolution of carbonate minerals.

(Table 1) Lead, thorium and uranium isotopic concentration and ages of zircons from Yenisey Ridge metapelites

Reconstruction of the geologic history of the Yenisey Ridge, which developed as an accretionary collision orogen on the western margin of the Siberian craton is essential to understanding the evolution of mobile belts surrounding older cratons, as well as to resolving the recently much debated problem of whether Siberia was part of the supercontinent Rodinia. Available paleotectonic models suggest that this supercontinent was assembled at the Middle-Late Riphean boundary (1100-900 Ma) as a result of the Grenville orogeny, the first long-lived mountain building event which occurred in geosynclinal areas during the Neogaea. However, the character of crustal evolution at that stage is still speculative due to the lack of reliable and conclusive isotope data. In many current geodynamic models, a common underlying assumption is that the Yenisey Ridge showed very little endogenic activity for 1 Gyr, from the time of Tarak granite emplacement (1900-1840 Ma) to the Middle Neoproterozoic (~750 Ma). On the basis of this assumption, several recent studies suggested the absence of Grenvillian collisional events within the Yenisey Ridge. The results of the SHRIMP II U-Pb analysis of rift-related plagiogranites of the Nemtikha Complex, Yenisey Ridge (1380-1360 Ma) suggest an increase in magmatic activity in the Mesoproterozoic. Interpretation of these results in terms of a supercontinent cycle may help find evidence for possible occurrence of the Grenville orogeny on the western margin of the Siberian craton. With this in mind, we attempted to reconstruct using recent geochronological constraints the evolution of metapelitic rocks from the Teya polymetamorphic complex (TPMC), which is a good example of superimposed zoning of low and medium-pressure facies series. High precision age determinations from rock complexes formed in different geodynamic settings under different thermodynamic conditions and geothermal gradients were used to distinguish several major metamorphic events and unravel their time relations with tectonic and magmatic activity in the region.

River and Hillslope Response to Localized Uplift Along a Left Bend of the San Andreas Fault, Santa Cruz Mountains, CA

Studying landscape evolution of the Earthís surface is difficult because both tectonic forces and surface processes control its response to perturbation, and ultimately, its shape and form. Researchers often use numerical models to study erosional response to deformation because there are rarely natural settings in which we can evaluate both tectonic activity and topographic response over appropriate time scales (103-105 years). In certain locations, however, geologic conditions afford the unique opportunity to study the relationship between tectonics and topography. One such location is along the Dragonís Back Pressure Ridge in California, where the landscape moves over a structural discontinuity along the San Andreas Fault and landscape response to both the initiation and cessation of uplift can be observed. In their landmark study, Hilley and Arrowsmith (2008) found that geomorphic metrics such as channel steepness tracked uplift and that hillslope response lagged behind that of rivers. Ideal conditions such as uniform vegetation density and similar lithology allowed them to view each basin as a developmental stage of response to uplift only. Although this work represents a significant step forward in understanding landscape response to deformation, it remains unclear how these results translate to more geologically complex settings. In this study, I apply similar methodology to a left bend along the San Andreas Fault in the Santa Cruz Mountains, California. At this location, the landscape is translated through a zone of localized uplift caused by the bend, but vegetation, lithology, and structure vary. I examine the geomorphic response to uplift along the San Andreas Fault bend in order to determine whether predicted landscape patterns can be observed in a larger, more geologically complex setting than the Dragonís Back Pressure Ridge. I find that even with a larger-scale and a more complex setting, geomorphic metrics such as channel steepness index remain useful tools for evaluating landscape evolution through time. Steepness indices in selected streams of study record localized uplift caused by the restraining bend, while hillslope adjustment in the form of landsliding occurs over longer time scales. This project illustrates that it is possible to apply concepts of landscape evolution models to complex settings and is an important contribution to the body of geomorphological study.

Enhancing students' self-concepts and related constructs: A critical longitudinal analysis capitalising on and combining promising enhancement techniques for educational settings

Enhancing children's self-concepts is widely accepted as a critical educational outcome of schooling and is postulated as a mediating variable that facilitates the attainment of other desired outcomes such as improved academic achievement. Despite considerable advances in self-concept research, there has been limited progress in devising teacher-administered enhancement interventions. This is unfortunate as teachers are crucial change agents during important developmental periods when self-concept is formed. The primary aim of the present investigation is to build on the promising features of previous self-concept enhancement studies by: (a) combining two exciting research directions developed by Burnett and Craven to develop a potentially powerful cognitive-based intervention; (b) incorporating recent developments in theory and measurement to ensure that the multidimensionality of self-concept is accounted for in the research design; (c) fully investigating the effects of a potentially strong cognitive intervention on reading, mathematics, school and learning self-concepts by using a large sample size and a sophisticated research design; (d) evaluating the effects of the intervention on affective and cognitive subcomponents of reading, mathematics, school and learning self-concepts over time to test for differential effects of the intervention; (e) modifying and extending current procedures to maximise the successful implementation of a teacher-mediated intervention in a naturalistic setting by incorporating sophisticated teacher training as suggested by Hattie (1992) and including an assessment of the efficacy of implementation; and (f) examining the durability of effects associated with the intervention.

Safeguarding rural Australia : addressing masculinity and violence in rural settings. Data report No. 4 - Risky behaviour - misuse of alcohol, illicit drugs, firearms use and abuse, other risky behaviour

This report focuses on our examination of extant data which have been sourced with respect to personally and socially risky behaviour associated with males living in regional and remote Australia . The AIHW (2008: PHE 97:89) defines personally risky behaviour, on the one hand, as working, swimming, boating, driving or operating hazardous machinery while intoxicated with alcohol or an illicit drug. Socially risky behaviour, on the other hand, is defined as creating a public disturbance, damaging property, stealing or verbally or physically abusing someone while intoxicated with alcohol or an illicit drug. Additional commentary resulting from exploration, examination and analyses of secondary data is published online in complementary reports in this series.

Safeguarding rural Australia : addressing masculinity and violence in rural settings. Data report no. 5. Consequences of violence - juvenile offenders, long-term health consequences, anxiety and repression, other chronic disabilities

This report considers extant data which have been sourced with respect to some of the consequences of violent acts and incidents and risky behaviour for males living in regional and remote Australia . This has been collated and presented under the headings: juvenile offenders; long-term health consequences; anxiety and repression; and other chronic disabilities. Additional commentary resulting from exploration, examination and analyses of secondary data is published online in complementary reports in this series.