Methods and preliminary results for a data linkage project to determine long-term survival after intensive care unit admission

Aims: To describe a local data linkage project to match hospital data with the Australian Institute of Health and Welfare (AIHW) National Death Index (NDI) to assess longterm outcomes of intensive care unit patients. Methods: Data were obtained from hospital intensive care and cardiac surgery databases on all patients aged 18 years and over admitted to either of two intensive care units at a tertiary-referral hospital between 1 January 1994 and 31 December 2005. Date of death was obtained from the AIHW NDI by probabilistic software matching, in addition to manual checking through hospital databases and other sources. Survival was calculated from time of ICU admission, with a censoring date of 14 February 2007. Data for patients with multiple hospital admissions requiring intensive care were analysed only from the first admission. Summary and descriptive statistics were used for preliminary data analysis. Kaplan-Meier survival analysis was used to analyse factors determining long-term survival. Results: During the study period, 21 415 unique patients had 22 552 hospital admissions that included an ICU admission; 19 058 surgical procedures were performed with a total of 20 092 ICU admissions. There were 4936 deaths. Median follow-up was 6.2 years, totalling 134 203 patient years. The casemix was predominantly cardiac surgery (80%), followed by cardiac medical (6%), and other medical (4%). The unadjusted survival at 1, 5 and 10 years was 97%, 84% and 70%, respectively. The 1-year survival ranged from 97% for cardiac surgery to 36% for cardiac arrest. An APACHE II score was available for 16 877 patients. In those discharged alive from hospital, the 1, 5 and 10-year survival varied with discharge location. Conclusions: ICU-based linkage projects are feasible to determine long-term outcomes of ICU patients

Surviving the Titanic disaster : economic, natural and social determinants

The sinking of the Titanic in April 1912 took the lives of 68 percent of the people aboard. Who survived? It was women and children who had a higher probability of being saved, not men. Likewise, people traveling in first class had a better chance of survival than those in second and third class. British passengers were more likely to perish than members of other nations. This extreme event represents a rare case of a well-documented life and death situation where social norms were enforced. This paper shows that economic analysis can account for human behavior in such situations.

Performance pressure an empirical analysis using world and Euro cups data

There is a notable shortage of empirical research directed at measuring the magnitude and direction of stress effects on performance in a controlled environment. One reason for this is the inherent difficulties in identifying and isolating direct performance measures for individuals. Additionally most traditional work environments contain a multitude of exogenous factors impacting individual performance, but controlling for all such factors is generally unfeasible (omitted variable bias). Moreover, instead of asking individuals about their self-reported stress levels we observe workers' behavior in situations that can be classified as stressful. For this reason we have stepped outside the traditional workplace in an attempt to gain greater controllability of these factors using the sports environment as our experimental space. We empirically investigate the relationship between stress and performance, in an extreme pressure situation (football penalty kicks) in a winner take all sporting environment (FIFA World Cup and UEFA European Cup competitions). Specifically, we examine all the penalty shootouts between 1976 and 2008 covering in total 16 events. The results indicate that extreme stressors can have a positive or negative impact on Individuals' performance. On the other hand, more commonly experienced stressors do not affect professionals' performances.

Fast and robust stereo object recognition for spheres

The paper presents a fast and robust stereo object recognition method. The method is currently unable to identify the rotation of objects. This makes it very good at locating spheres which are rotationally independent. Approximate methods for located non-spherical objects have been developed. Fundamental to the method is that the correspondence problem is solved using information about the dimensions of the object being located. This is in contrast to previous stereo object recognition systems where the scene is first reconstructed by point matching techniques. The method is suitable for real-time application on low-power devices.

Towards a new model of successful faking

Existing literature has failed to find robust relationships between individual differences and the ability to fake psychological tests, possibly due to limitations in how successful faking is operationalised. In order to fake, individuals must alter their original profile to create a particular impression. Currently, successful faking is operationalised through statistical definitions, informant ratings, known groups comparisons, the use of archival and baseline data, and breaches of validity indexes. However, there are many methodological limitations to these approaches. This research proposed a three component model of successful faking to address this, where an original response is manipulated into a strategic response, which must match a criteria target. Further, by operationalising successful faking in this manner, this research takes into account the fact that individuals may have been successful in reaching their implicitly created profile, but that this may not have matched the criteria they were instructed to fake.Participants (N=48, 22 students and 26 non-students) completed the BDI-II honestly. Participants then faked the BDI-II as if they had no, mild, moderate and severe depression, as well as completing a checklist revealing which symptoms they thought indicated each level of depression. Findings were consistent with a three component model of successful faking, where individuals effectively changed their profile to what they believed was required, however this profile differed from the criteria defined by the psychometric norms of the test.One of the foremost issues for research in this area is the inconsistent manner in which successful faking is operationalised. This research allowed successful faking to be operationalised in an objective, quantifiable manner. Using this model as a template may allow researchers better understanding of the processes involved in faking, including the role of strategies and abilities in determining the outcome of test dissimulation.

An optimising compiler for generated tiny virtual machines

VMSCRIPT is a scripting language designed to allow small programs to be compiled for a range of generated tiny virtual machines, suitable for sensor network devices. The VMSCRIPT compiler is an optimising compiler designed to allow quick re-targeting, based on a template, code rewriting model. A compiler backend can be specified at the same time as a virtual machine, with the compiler reading the specification and using it as a code generator.

Spaces of hybridity : creating a sense of belonging through spatial awareness

When the colonisers first came to Australia there was an urgent desire to map, name and settle. This desire, in part, stemmed from a fear of the unknown. Once these tasks were completed it was thought that a sense of identity and belonging would automatically come. In Anglo-Australian geography the map of Australia was always perceived in relationship to the larger map of Europe and Britain. The quicker Australia could be mapped the quicker its connection with the ‘civilised’ world could be established. Official maps could be taken up in official history books and a detailed monumental history could begin. Australians would feel secure in where they were placed in the world. However, this was not the case and anxieties about identity and belonging remained. One of the biggest hurdles was the fear of the open spaces and not knowing how to move across the land. Attempts to transpose colonisers’ use of space onto the Australian landscape did not work and led to confusion. Using authors who are often perceived as writers of national fictions (Henry Lawson, Barbara Baynton, Patrick White, David Malouf and Peter Carey) I will reveal how writing about space becomes a way to create a sense of belonging. It is through spatial knowledge and its application that we begin to gain a sense of closeness and identity. I will also look at how one of the greatest fears for the colonisers was the Aboriginal spatial command of the country. Aborigines already had a strongly developed awareness of spatial belonging and their stories reveal this authority (seen in the work of Lorna Little, Mick McLean) Colonisers attempted to discredit this knowledge but the stories and the land continue to recognise its legitimacy. From its beginning Australian spaces have been spaces of hybridity and the more the colonisers attempted to force predetermined structures onto these spaces the more hybrid they became.

Physical activity and regulation of food intake: current evidence

Objective: The evidence was reviewed on how physical activity could influence the regulation of food intake by either adjusting the sensitivity of appetite control mechanisms or by generating an energy deficit that could adjust the drive to eat. Design: Interventionist and correlational studies that had a significant influence on the relationship between physical activity and food intake were reviewed. Interventionist studies involve a deliberate imposition of physical activity with subsequent monitoring of the eating response. Correlational studies make use of naturally occurring differences in the levels of physical activity (between and within subjects) with simultaneous assessment of energy expenditure and intake. Subjects: Studies using lean, overweight, and obese men and women were included. Results: Only 19% of interventionist studies report an increase in energy intake after exercise; 65% show no change and 16% show a decrease in appetite. Of the correlational studies, approximately half show no relationship between energy expenditure and intake. These data indicate a rather loose coupling between energy expenditure and intake. A common sense view is that exercise is futile as a form of weight control because the energy deficit drives a compensatory increase in food intake. However, evidence shows that this is not generally true. One positive aspect of this is that raising energy expenditure through physical activity (or maintaining an active life style) can cause weight loss or prevent weight gain. A negative feature is that when people become sedentary after a period of high activity, food intake is not “down-regulated” to balance a reduced energy expenditure. Conclusion: Evidence suggests that a high level of physical activity can aid weight control either by improving the matching of food intake to energy expenditure (regulation) or by raising expenditure so that it is difficult for people to eat themselves into a positive energy balance.

An environmental assessment model for knowledge-based urban development

Purpose – In recent years, knowledge-based urban development (KBUD) has introduced as a new strategic development approach for the regeneration of industrial cities. It aims to create a knowledge city consists of planning strategies, IT networks and infrastructures that achieved through supporting the continuous creation, sharing, evaluation, renewal and update of knowledge. Improving urban amenities and ecosystem services by creating sustainable urban environment is one of the fundamental components for KBUD. In this context, environmental assessment plays an important role in adjusting urban environment and economic development towards a sustainable way. The purpose of this paper is to present the role of assessment tools for environmental decision making process of knowledge cities. Design/methodology/approach – The paper proposes a new assessment tool to figure a template of a decision support system which will enable to evaluate the possible environmental impacts in an existing and future urban context. The paper presents the methodology of the proposed model named ‘ASSURE’ which consists of four main phases. Originality/value –The proposed model provides a useful guidance to evaluate the urban development and its environmental impacts to achieve sustainable knowledge-based urban futures. Practical implications – The proposed model will be an innovative approach to provide the resilience and function of urban natural systems secure against the environmental changes while maintaining the economic development of cities.

The modulation of outdoor running speed : the influence of gradient

This thesis aimed to investigate the way in which distance runners modulate their speed in an effort to understand the key processes and determinants of speed selection when encountering hills in natural outdoor environments. One factor which has limited the expansion of knowledge in this area has been a reliance on the motorized treadmill which constrains runners to constant speeds and gradients and only linear paths. Conversely, limits in the portability or storage capacity of available technology have restricted field research to brief durations and level courses. Therefore another aim of this thesis was to evaluate the capacity of lightweight, portable technology to measure running speed in outdoor undulating terrain. The first study of this thesis assessed the validity of a non-differential GPS to measure speed, displacement and position during human locomotion. Three healthy participants walked and ran over straight and curved courses for 59 and 34 trials respectively. A non-differential GPS receiver provided speed data by Doppler Shift and change in GPS position over time, which were compared with actual speeds determined by chronometry. Displacement data from the GPS were compared with a surveyed 100m section, while static positions were collected for 1 hour and compared with the known geodetic point. GPS speed values on the straight course were found to be closely correlated with actual speeds (Doppler shift: r = 0.9994, p < 0.001, Δ GPS position/time: r = 0.9984, p < 0.001). Actual speed errors were lowest using the Doppler shift method (90.8% of values within ± 0.1 m.sec -1). Speed was slightly underestimated on a curved path, though still highly correlated with actual speed (Doppler shift: r = 0.9985, p < 0.001, Δ GPS distance/time: r = 0.9973, p < 0.001). Distance measured by GPS was 100.46 ± 0.49m, while 86.5% of static points were within 1.5m of the actual geodetic point (mean error: 1.08 ± 0.34m, range 0.69-2.10m). Non-differential GPS demonstrated a highly accurate estimation of speed across a wide range of human locomotion velocities using only the raw signal data with a minimal decrease in accuracy around bends. This high level of resolution was matched by accurate displacement and position data. Coupled with reduced size, cost and ease of use, the use of a non-differential receiver offers a valid alternative to differential GPS in the study of overground locomotion. The second study of this dissertation examined speed regulation during overground running on a hilly course. Following an initial laboratory session to calculate physiological thresholds (VO2 max and ventilatory thresholds), eight experienced long distance runners completed a self- paced time trial over three laps of an outdoor course involving uphill, downhill and level sections. A portable gas analyser, GPS receiver and activity monitor were used to collect physiological, speed and stride frequency data. Participants ran 23% slower on uphills and 13.8% faster on downhills compared with level sections. Speeds on level sections were significantly different for 78.4 ± 7.0 seconds following an uphill and 23.6 ± 2.2 seconds following a downhill. Speed changes were primarily regulated by stride length which was 20.5% shorter uphill and 16.2% longer downhill, while stride frequency was relatively stable. Oxygen consumption averaged 100.4% of runner’s individual ventilatory thresholds on uphills, 78.9% on downhills and 89.3% on level sections. Group level speed was highly predicted using a modified gradient factor (r2 = 0.89). Individuals adopted distinct pacing strategies, both across laps and as a function of gradient. Speed was best predicted using a weighted factor to account for prior and current gradients. Oxygen consumption (VO2) limited runner’s speeds only on uphill sections, and was maintained in line with individual ventilatory thresholds. Running speed showed larger individual variation on downhill sections, while speed on the level was systematically influenced by the preceding gradient. Runners who varied their pace more as a function of gradient showed a more consistent level of oxygen consumption. These results suggest that optimising time on the level sections after hills offers the greatest potential to minimise overall time when running over undulating terrain. The third study of this thesis investigated the effect of implementing an individualised pacing strategy on running performance over an undulating course. Six trained distance runners completed three trials involving four laps (9968m) of an outdoor course involving uphill, downhill and level sections. The initial trial was self-paced in the absence of any temporal feedback. For the second and third field trials, runners were paced for the first three laps (7476m) according to two different regimes (Intervention or Control) by matching desired goal times for subsections within each gradient. The fourth lap (2492m) was completed without pacing. Goals for the Intervention trial were based on findings from study two using a modified gradient factor and elapsed distance to predict the time for each section. To maintain the same overall time across all paced conditions, times were proportionately adjusted according to split times from the self-paced trial. The alternative pacing strategy (Control) used the original split times from this initial trial. Five of the six runners increased their range of uphill to downhill speeds on the Intervention trial by more than 30%, but this was unsuccessful in achieving a more consistent level of oxygen consumption with only one runner showing a change of more than 10%. Group level adherence to the Intervention strategy was lowest on downhill sections. Three runners successfully adhered to the Intervention pacing strategy which was gauged by a low Root Mean Square error across subsections and gradients. Of these three, the two who had the largest change in uphill-downhill speeds ran their fastest overall time. This suggests that for some runners the strategy of varying speeds systematically to account for gradients and transitions may benefit race performances on courses involving hills. In summary, a non – differential receiver was found to offer highly accurate measures of speed, distance and position across the range of human locomotion speeds. Self-selected speed was found to be best predicted using a weighted factor to account for prior and current gradients. Oxygen consumption limited runner’s speeds only on uphills, speed on the level was systematically influenced by preceding gradients, while there was a much larger individual variation on downhill sections. Individuals were found to adopt distinct but unrelated pacing strategies as a function of durations and gradients, while runners who varied pace more as a function of gradient showed a more consistent level of oxygen consumption. Finally, the implementation of an individualised pacing strategy to account for gradients and transitions greatly increased runners’ range of uphill-downhill speeds and was able to improve performance in some runners. The efficiency of various gradient-speed trade- offs and the factors limiting faster downhill speeds will however require further investigation to further improve the effectiveness of the suggested strategy.

Modulation of dermal microvascular endithelial cell responses to growth factors and haemostatic factors in the presence of vitronectin

In order to effect permanent closure in burns patients suffering from full thickness wounds, replacing their skin via split thickness autografting, is essential. Dermal substitutes in conjunction with widely meshed split thickness autografts (+/- cultured keratinocytes) reduce scarring at the donor and recipient sites of burns patients by reducing demand for autologous skin (both surface area and thickness), without compromising dermal delivery at the wound face. Tissue engineered products such as Integra consist of a dermal template which is rapidly remodelled to form a neodermis, at which time the temporary silicone outer layer is removed and replaced with autologous split thickness skin. Whilst provision of a thick tissue engineered dermis at full thickness burn sites reduces scarring, it is hampered by delays in vascularisation which results in clinical failure. The ultimate success of any skin graft product is dependent upon a number of basic factors including adherence, haemostasis and in the case of viable tissue grafts, success is ultimately dependent upon restoration of a normal blood supply, and hence this study. Ultimately, the goal of this research is to improve the therapeutic properties of tissue replacements, through impregnation with growth factors aimed at stimulating migration and proliferation of microvascular endothelial cells into the donor tissue post grafting. For the purpose of my masters, the aim was to evaluate the responsiveness of a dermal microvascular endothelial cell line to growth factors and haemostatic factors, in the presence of the glycoprotein vitronectin. Vitronectin formed the backbone for my hypothesis and research due to its association with both epithelial and, more specifically, endothelial migration and proliferation. Early work using a platform technology referred to as VitroGro (Tissue Therapies Ltd), which is comprised of vitronectin bound BP5/IGF-1, aided keratinocyte proliferation. I hypothesised that this result would translate to another epithelium - endothelium. VitroGro had no effect on endothelial proliferation or migration. Vitronectin increases the presence of Fibroblast Growth Factor (FGF) and Vascular Endothelial Growth Factor (VEGF) receptors, enhancing cell responsiveness to their respective ligands. So, although Human Microvascular Endothelial Cell line 1 (HMEC-1) VEGF receptor expression is generally low, it was hypothesised that exposure to vitronectin would up-regulate this receptor. HMEC-1 migration, but not proliferation, was enhanced by vitronectin bound VEGF, as well as vitronectin bound Epidermal Growth Factor (EGF), both of which could be used to stimulate microvascular endothelial cell migration for the purpose of transplantation. In addition to vitronectin's synergy with various growth factors, it has also been shown to play a role in haemostasis. Vitronectin binds thrombin-antithrombin III (TAT) to form a trimeric complex that takes on many of the attributes of vitronectin, such as heparin affinity, which results in its adherence to endothelium via heparan sulfate proteoglycans (HSP), followed by unaltered transcytosis through the endothelium, and ultimately its removal from the circulation. This has been documented as a mechanism designed to remove thrombin from the circulation. Equally, it could be argued that it is a mechanism for delivering vitronectin to the matrix. My results show that matrix-bound vitronectin dramatically alters the effect that conformationally altered antithrombin three (cATIII) has on proliferation of microvascular endothelial cells. cATIII stimulates HMEC-1 proliferation in the presence of matrix-bound vitronectin, as opposed to inhibiting proliferation in its absence. Binding vitronectin to tissues and organs prior to transplant, in the presence of cATIII, will have a profound effect on microvascular infiltration of the graft, by preventing occlusion of existing vessels whilst stimulating migration and proliferation of endothelium within the tissue.

Acoustic keyword spotting in speech with applications to data mining

Keyword Spotting is the task of detecting keywords of interest within continu- ous speech. The applications of this technology range from call centre dialogue systems to covert speech surveillance devices. Keyword spotting is particularly well suited to data mining tasks such as real-time keyword monitoring and unre- stricted vocabulary audio document indexing. However, to date, many keyword spotting approaches have su®ered from poor detection rates, high false alarm rates, or slow execution times, thus reducing their commercial viability. This work investigates the application of keyword spotting to data mining tasks. The thesis makes a number of major contributions to the ¯eld of keyword spotting. The ¯rst major contribution is the development of a novel keyword veri¯cation method named Cohort Word Veri¯cation. This method combines high level lin- guistic information with cohort-based veri¯cation techniques to obtain dramatic improvements in veri¯cation performance, in particular for the problematic short duration target word class. The second major contribution is the development of a novel audio document indexing technique named Dynamic Match Lattice Spotting. This technique aug- ments lattice-based audio indexing principles with dynamic sequence matching techniques to provide robustness to erroneous lattice realisations. The resulting algorithm obtains signi¯cant improvement in detection rate over lattice-based audio document indexing while still maintaining extremely fast search speeds. The third major contribution is the study of multiple veri¯er fusion for the task of keyword veri¯cation. The reported experiments demonstrate that substantial improvements in veri¯cation performance can be obtained through the fusion of multiple keyword veri¯ers. The research focuses on combinations of speech background model based veri¯ers and cohort word veri¯ers. The ¯nal major contribution is a comprehensive study of the e®ects of limited training data for keyword spotting. This study is performed with consideration as to how these e®ects impact the immediate development and deployment of speech technologies for non-English languages.

Semantic search and inferencing in health informatics

Consider a person searching electronic health records, a search for the term ‘cracked skull’ should return documents that contain the term ‘cranium fracture’. A information retrieval systems is required that matches concepts, not just keywords. Further more, determining relevance of a query to a document requires inference – its not simply matching concepts. For example a document containing ‘dialysis machine’ should align with a query for ‘kidney disease’. Collectively we describe this problem as the ‘semantic gap’ – the difference between the raw medical data and the way a human interprets it. This paper presents an approach to semantic search of health records by combining two previous approaches: an ontological approach using the SNOMED CT medical ontology; and a distributional approach using semantic space vector space models. Our approach will be applied to a specific problem in health informatics: the matching of electronic patient records to clinical trials.