988 resultados para meaningful use


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Cerebral activation associated with performance on a novel task involving two conditions was investigated with functional magnetic resonance imaging (fMRI). In the response initiation condition, subjects nominated the general superordinate category to which each of a series of exemplars (concrete nouns) belonged. In the response suppression condition, subjects were required to nominate a general superordinate category to which each exemplar did not belong, with the instruction that they were not to nominate the same category response twice in a row. Both conditions produced distinct patterns of activation relative to an articulation control condition employing identical stimuli. When initiation and suppression conditions were directly compared, response suppression produced activation in the right frontal pole, orbital frontal cortex and anterior cingulate, left dorsolateral prefrontal cortex and posterior cingulate, and bilaterally in the precuneus, visual association cortex and cerebellum. Response latencies were significantly longer in the suppression condition. Two broadly-defined strategies associated with the correct production of words during the suppression condition were a self-ordered selection from among the superordinate categories identified during the first section of the task and the generation of novel category responses. The neuroanatomical correlates of response initiation, suppression and strategy use are discussed, as are the respective roles of response suppression and strategy generation.

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Accurate identification of white matter structures and segmentation of fibers into tracts is important in neuroimaging and has many potential applications. Even so, it is not trivial because whole brain tractography generates hundreds of thousands of streamlines that include many false positive fibers. We developed and tested an automatic tract labeling algorithm to segment anatomically meaningful tracts from diffusion weighted images. Our multi-atlas method incorporates information from multiple hand-labeled fiber tract atlases. In validations, we showed that the method outperformed the standard ROI-based labeling using a deformable, parcellated atlas. Finally, we show a high-throughput application of the method to genetic population studies. We use the sub-voxel diffusion information from fibers in the clustered tracts based on 105-gradient HARDI scans of 86 young normal twins. The whole workflow shows promise for larger population studies in the future.

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Modal flexibility is a widely accepted technique to detect structural damage using vibration characteristics. Its application to detect damage in long span large diameter cables such as those used in suspension bridge main cables has not received much attention. This paper uses the modal flexibility method incorporating two damage indices (DIs) based on lateral and vertical modes to localize damage in such cables. The competency of those DIs in damage detection is tested by the numerically obtained vibration characteristics of a suspended cable in both intact and damaged states. Three single damage cases and one multiple damage case are considered. The impact of random measurement noise in the modal data on the damage localization capability of these two DIs is next examined. Long span large diameter cables are characterized by the two critical cable parameters named bending stiffness and sag-extensibility. The influence of these parameters in the damage localization capability of the two DIs is evaluated by a parametric study with two single damage cases. Results confirm that the damage index based on lateral vibration modes has the ability to successfully detect and locate damage in suspended cables with 5% noise in modal data for a range of cable parameters. This simple approach therefore can be extended for timely damage detection in cables of suspension bridges and thereby enhance their service during their life spans.

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Introduction Vascular access devices (VADs), such as peripheral or central venous catheters, are vital across all medical and surgical specialties. To allow therapy or haemodynamic monitoring, VADs frequently require administration sets (AS) composed of infusion tubing, fluid containers, pressure-monitoring transducers and/or burettes. While VADs are replaced only when necessary, AS are routinely replaced every 3–4 days in the belief that this reduces infectious complications. Strong evidence supports AS use up to 4 days, but there is less evidence for AS use beyond 4 days. AS replacement twice weekly increases hospital costs and workload. Methods and analysis This is a pragmatic, multicentre, randomised controlled trial (RCT) of equivalence design comparing AS replacement at 4 (control) versus 7 (experimental) days. Randomisation is stratified by site and device, centrally allocated and concealed until enrolment. 6554 adult/paediatric patients with a central venous catheter, peripherally inserted central catheter or peripheral arterial catheter will be enrolled over 4 years. The primary outcome is VAD-related bloodstream infection (BSI) and secondary outcomes are VAD colonisation, AS colonisation, all-cause BSI, all-cause mortality, number of AS per patient, VAD time in situ and costs. Relative incidence rates of VAD-BSI per 100 devices and hazard rates per 1000 device days (95% CIs) will summarise the impact of 7-day relative to 4-day AS use and test equivalence. Kaplan-Meier survival curves (with log rank Mantel-Cox test) will compare VAD-BSI over time. Appropriate parametric or non-parametric techniques will be used to compare secondary end points. p Values of <0.05 will be considered significant.

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Biophilic urbanism, or urban design that reflects humanity’s innate need for nature, stands to make significant contributions to a range of national, state and local government policies related to climate change mitigation and adaptation, by investigating ways in which nature can be integrated into, around and on top of buildings. Potential benefits of such design include reducing the heat island effect, reducing energy consumption for thermal control, enhancing urban biodiversity, improving well being and productivity, improving water cycle management, and assisting in the response to growing needs for densification and revitalisation of cities. This report will give an overview of the concept of biophilia and consider enablers and disablers to its application to urban planning and design. The paper will present findings from stakeholder engagement and a series of detailed case studies, related to a consideration of the economics of the use of biophilic elements (direct and indirect).

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Remote networked collaboration with business model documentation has many communication problems. The aim of this project is to solve some of these communication problems by using digital 3D representations of human visual cues. Results from this project increased our understanding of the role and effects of visual cues in remote collaboration, specifically for validating business process models. Technology designs to support such cues across a distance have been proposed in this thesis with qualitative and quantitative methods of analysis being combined to analyse the impact of these cues on the communication, coordination and performance of a team collaborating remotely.

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In life cycle assessment studies, greenhouse gas (GHG) emissions from direct land-use change have been estimated to make a significant contribution to the global warming potential of agricultural products. However, these estimates have a high uncertainty due to the complexity of data requirements and difficulty in attribution of land-use change. This paper presents estimates of GHG emissions from direct land-use change from native woodland to grazing land for two beef production regions in eastern Australia, which were the subject of a multi-impact life cycle assessment study for premium beef production. Spatially- and temporally consistent datasets were derived for areas of forest cover and biomass carbon stocks using published remotely sensed tree-cover data and regionally applicable allometric equations consistent with Australia's national GHG inventory report. Standard life cycle assessment methodology was used to estimate GHG emissions and removals from direct land-use change attributed to beef production. For the northern-central New South Wales region of Australia estimates ranged from a net emission of 0.03 t CO2-e ha-1 year-1 to net removal of 0.12 t CO2-e ha-1 year-1 using low and high scenarios, respectively, for sequestration in regrowing forests. For the same period (1990-2010), the study region in southern-central Queensland was estimated to have net emissions from land-use change in the range of 0.45-0.25 t CO2-e ha-1 year-1. The difference between regions reflects continuation of higher rates of deforestation in Queensland until strict regulation in 2006 whereas native vegetation protection laws were introduced earlier in New South Wales. On the basis of liveweight produced at the farm-gate, emissions from direct land-use change for 1990-2010 were comparable in magnitude to those from other on-farm sources, which were dominated by enteric methane. However, calculation of land-use change impacts for the Queensland region for a period starting 2006, gave a range from net emissions of 0.11 t CO2-e ha-1 year-1 to net removals of 0.07 t CO2-e ha-1 year-1. This study demonstrated a method for deriving spatially- and temporally consistent datasets to improve estimates for direct land-use change impacts in life cycle assessment. It identified areas of uncertainty, including rates of sequestration in woody regrowth and impacts of land-use change on soil carbon stocks in grazed woodlands, but also showed the potential for direct land-use change to represent a net sink for GHG.

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Sustainable land use policies are concerned with the kind of world we want to live in now, and in future, and therefore inevitably involve some form of community involvement or consultation process. Hong Kong's sustainable land use planning system is well developed, involving considerable community participation and therefore serves as a good model for similarly situated cities. However, although there are several recent studies involving aspects of its land use planning system, none has yet examined the system as a whole from the perspective of sustainability. To correct this, this paper describes the land use conditions of Hong Kong from both demand and supply perspectives, reviewing its statutory and administrative procedures of land development and allocation together with the sustainable urban renewal practices involved. Problems in current sustainable land use planning and management, such as difficulties in urban renewal, the inherent shortage of land and the lengthy time involved due to need for coordination and responsiveness to multiple stakeholders, and outdated and overcomplicated administrative processes were also analyzed.

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The antenatal paper hand-held record (PHR) has been used extensively in general practice (GP) shared-care management of pregnant women, but recently the antenatal electronic health record (EHR) was introduced. This study aimed to examine the experiences of women and health care providers who use the PHR and the EHR, and find out the relative role of these records in the integration of care. Purposive homogenous samples of women and health care providers were interviewed as users of the PHR in phase 1 and the EHR in phase 2 of the study. Qualitative data were collected via interview with women and GPs and focus groups held with hospital health care providers. Interviews were coded manually and analysed using qualitative content analysis. Fifteen women participated in phase 1 and 12 in phase 2. Seventeen GPs participated in phase 1 and 15 in phase 2. Five focus groups with hospital health care providers were conducted in each phase. Results were categorised into four themes: 1. Record purpose; 2. Perception of the record; 3. Content of the record, and; 4. Sharing information in the record. Both women and health care providers were familiar with the PHR, but identified that some information was missing or not utilised well, and reported underuse of the EHR. The study identified continued widespread use of the PHR and several issues concerning the use of the EHR. An improvement in the strategic implementation of the EHR is suggested as a mechanism to facilitate its wider adoption.

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Interfaces for children have continued to evolve in terms of complexity, with toys ranging from traditional tangible interfaces to apps with digital interfaces and hybrid toys with mixed physical and digital interfaces. However, there is limited research done to investigate their potential for intuitive use. This research study compares a tangible toy and an equivalent toy in the digital world (app) for intuitive use. Non-parametric Mann-Whitney U test results showed that the tangible toy was more intuitive than the intangible counter part. Tangible systems are less complex to use and they require less time to encode and retrieve associated knowledge to use them intuitively. They are associated with low domain transfer distance and easily discoverable features. Intangible interfaces, on the other ha nd, require greater complexity and time to encode and retrieve associated experiential knowledge. Intangibles are associated with larger domain transfer distance and undiscoverable features which affects their intuitive use. Design implications and future work are discussed, emphasising the need for investigating aspects that make tangible systems intuitive to use.

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This study used the specific example of 3D printing with acrylonitrile butadiene styrene (ABS) as a means to investigate the potential usefulness of benchtop rapid prototyping as a technique for producing patient specific phantoms for radiotherapy dosimetry. Three small cylinders and one model of a human lung were produced via in-house 3D printing with ABS, using 90%, 50%, 30% and 10% ABS infill densities. These phantom samples were evaluated in terms of their geometric accuracy, tissue equivalence and radiation hardness, when irradiated using a range of clinical radiotherapy beams. The measured dimensions of the small cylindrical phantoms all matched their planned dimensions, within 1mm. The lung phantom was less accurately matched to the lung geometry on which it was based, due to simplifications introduced during the phantom design process. The mass densities, electron densities and linear attenuation coefficients identified using CT data, as well as the results of film measurements made using megavoltage photon and electron beams, indicated that phantoms printed with ABS, using infill densities of 30% or more, are potentially useful as lung- and tissue-equivalent phantoms for patient-specific radiotherapy dosimetry. All cylindrical 3D printed phantom samples were found to be unaffected by prolonged radiation and to accurately match their design specifications. However, care should be taken to avoid oversimplifying anatomical structures when printing more complex phantoms.

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Frequency Domain Spectroscopy (FDS) is one of the major techniques used for determining the condition of the cellulose based paper and pressboard components in large oil/paper insulated power transformers. This technique typically makes use of a sinusoidal voltage source swept from 0.1 mHz to 1 kHz. The excitation test voltage source used must meet certain characteristics, such as high output voltage, high fidelity, low noise and low harmonic content. The amplifier used; in the test voltage source; must be able to drive highly capacitive loads. This paper proposes that a switch-mode assisted linear amplifier (SMALA) can be used in the test voltage source to meet these criteria. A three level SMALA prototype amplifier was built to experimentally demonstrate the effectiveness of this proposal. The developed SMALA prototype shows no discernable harmonic distortion in the output voltage waveform, or the need for output filters, and is therefore seen as a preferable option to pulse width modulated digital amplifiers. The lack of harmonic distortion and high frequency switching noise in the output voltage of this SMALA prototype demonstrates its feasibility for applications in FDS, particularly on highly capacitive test objects such as transformer insulation systems.

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Compelling evidence demonstrates the importance of regular exercise following breast cancer, and this is particularly important for those who develop breast cancer-related lymphoedema. However, fear of lymphoedema exacerbation and the need to wear compression while exercising present as significant barriers for these women. This Master's research evaluated the need for wearing compression during exercise in women with breast cancer-related lymphoedema. Findings demonstrated that exercise performed without compression does not exacerbate lymphoedema or related symptoms. These findings are clinically relevant as they highlight that compression use during exercise should be prescribed on an individual basis, taking into consideration patient preferences and adherence issues.

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Previous research into young people’s drinking behaviour has studied how social practices influence their actions and how they negotiate drinking-related identities. Here, adopting the perspective of discursive psychology we examine how, for young people, social influences are bound up with issues of drinking and of identity. We conducted 19 focus groups with undergraduate students in Australia aged between 18 and 24 years. Thematic analysis of participants’ accounts for why they drink or do not drink was used to identify passages of talk that referred to social influence, paying particular attention to terms such as ‘pressure’ and ‘choice’. These passages were then analysed in fine-grained detail, using discourse analysis, to study how participants accounted for social influence. Participants treated their behaviour as accountable and produced three forms of account that: (1) minimised the choice available to them, (2) explained drinking as culture and (3) described resisting peer pressure. They also negotiated gendered social dynamics related to drinking. These forms of account allowed the participants to avoid individual responsibility for drinking or not drinking. These findings demonstrate that the effects of social influence on young people’s drinking behaviour cannot be assumed, as social influence itself becomes negotiable within local contexts of talk about drinking.

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High efficiency organic photovoltaic cells discussed in literature are normally restricted to devices fabricated on glass substrates. This is a consequence of the extreme brittleness and inflexibility of the commonly used transparent conductive oxide electrode, indium tin oxide (ITO). This shortcoming of ITO along with other concerns such as increasing scarcity of indium, migration of indium to organic layer, etc. makes it imperative to move away from ITO. Here we demonstrate a highly flexible Ag electrode that possesses low sheet resistances even in ultra-thin layers. It retains its conductivity under severe bending stresses where ITO fails completely. A P3HT:PCBM blend organic solar cell fabricated on this highly flexible electrode gives an efficiency of 2.3%.