Interventions to control nosocomial infections : study designs and statistical issues

There is a wide range of potential study designs for intervention studies to decrease nosocomial infections in hospitals. The analysis is complex due to competing events, clustering, multiple timescales and time-dependent period and intervention variables. This review considers the popular pre-post quasi-experimental design and compares it with randomized designs. Randomization can be done in several ways: randomization of the cluster [intensive care unit (ICU) or hospital] in a parallel design; randomization of the sequence in a cross-over design; and randomization of the time of intervention in a stepped-wedge design. We introduce each design in the context of nosocomial infections and discuss the designs with respect to the following key points: bias, control for nonintervention factors, and generalizability. Statistical issues are discussed. A pre-post-intervention design is often the only choice that will be informative for a retrospective analysis of an outbreak setting. It can be seen as a pilot study with further, more rigorous designs needed to establish causality. To yield internally valid results, randomization is needed. Generally, the first choice in terms of the internal validity should be a parallel cluster randomized trial. However, generalizability might be stronger in a stepped-wedge design because a wider range of ICU clinicians may be convinced to participate, especially if there are pilot studies with promising results. For analysis, the use of extended competing risk models is recommended.

Out of the Box Festival for 3 to 8 year olds (Artistic Director)

The Out of the Box Festival was founded in 1994 by the Queensland Performing Arts Centre and has been held biannually ever since both within and around the centre in what is now known as the Cultural Precinct at Southbank. It is unique in Australia in that it caters entirely to children aged 8 years and under, with a highly curated program of ticketed performance events, workshops and free arts-based events. It is attended by school and kindergarten groups and by families, and besides engaging children in high quality arts experiences, the festival is also a platform for advocating the developmental and educational benefits of the arts for children. Dr Mark Radvan was the artistic director of the 2008 festival, with responsibility for developing the curatorial direction of each festival, for creating and programming its events, and for working with festival partners The Queensland Art Gallery, The Queensland Museum, The State Library of Queensland and The Queensland Theatre Company. Radvan designed selected and commissioned works to demonstrate how the arts create memorable, celebratory and immersive experiences that stimulate children’s imagination, their curiosity and confidence about the material world and the cultures of its people. A core event was an outdoor music and dance performance space featuring entirely Indigenous performers that was not only the beating heart of the festival, but served to underlie the importance of mainstreaming awareness of our first peoples in the increasingly culturally diverse communities of children attending.

Automated fit quantification of tibial nail designs during the insertion using computer three-dimensional modelling

Intramedullary nailing is the standard fixation method for displaced diaphyseal fractures of the tibia. An optimal nail design should both facilitate insertion and anatomically fit the bone geometry at its final position in order to reduce the risk of stress fractures and malalignments. Due to the nonexistence of suitable commercial software, we developed a software tool for the automated fit assessment of nail designs. Furthermore, we demonstrated that an optimised nail, which fits better at the final position, is also easier to insert. Three-dimensional models of two nail designs and 20 tibiae were used. The fitting was quantified in terms of surface area, maximum distance, sum of surface areas and sum of maximum distances by which the nail was protruding into the cortex. The software was programmed to insert the nail into the bone model and to quantify the fit at defined increment levels. On average, the misfit during the insertion in terms of the four fitting parameters was smaller for the Expert Tibial Nail Proximal bend (476.3 mm2, 1.5 mm, 2029.8 mm2, 6.5 mm) than the Expert Tibial Nail (736.7 mm2, 2.2 mm, 2491.4 mm2, 8.0 mm). The differences were statistically significant (p ≤ 0.05). The software could be used by nail implant manufacturers for the purpose of implant design validation.

Is there a bone-nail specific entry point? automated fit quantification of tibial nail designs during the insertion for six different nail entry points

Intramedullary nailing is the standard fixation method for displaced diaphyseal fractures of tibia. Selection of the correct nail insertion point is important for axial alignment of bone fragments and to avoid iatrogenic fractures. However, the standard entry point (SEP) may not always optimise the bone-nail fit due to geometric variations of bones. This study aimed to investigate the optimal entry for a given bone-nail pair using the fit quantification software tool previously developed by the authors. The misfit was quantified for 20 bones with two nail designs (ETN and ETN-Proximal Bend) related to the SEP and 5 entry points which were 5 mm and 10 mm away from the SEP. The SEP was the optimal entry point for 50% of the bones used. For the remaining bones, the optimal entry point was located 5 mm away from the SEP, which improved the overall fit by 40% on average. However, entry points 10 mm away from the SEP doubled the misfit. The optimised bone-nail fit can be achieved through the SEP and within the range of a 5 mm radius, except posteriorly. The study results suggest that the optimal entry point should be selected by considering the fit during insertion and not only at the final position.

Catalytic activity evaluation of industrial Pd/C catalyst via gray-box dynamic modeling and simulation of hydropurification reactor

In this paper, dynamic modeling and simulation of the hydropurification reactor in a purified terephthalic acid production plant has been investigated by gray-box technique to evaluate the catalytic activity of palladium supported on carbon (0.5 wt.% Pd/C) catalyst. The reaction kinetics and catalyst deactivation trend have been modeled by employing artificial neural network (ANN). The network output has been incorporated with the reactor first principle model (FPM). The simulation results reveal that the gray-box model (FPM and ANN) is about 32 percent more accurate than FPM. The model demonstrates that the catalyst is deactivated after eleven months. Moreover, the catalyst lifetime decreases about two and half months in case of 7 percent increase of reactor feed flowrate. It is predicted that 10 percent enhancement of hydrogen flowrate promotes catalyst lifetime at the amount of one month. Additionally, the enhancement of 4-carboxybenzaldehyde concentration in the reactor feed improves CO and benzoic acid synthesis. CO is a poison to the catalyst, and benzoic acid might affect the product quality. The model can be applied into actual working plants to analyze the Pd/C catalyst efficient functioning and the catalytic reactor performance.

Making trouble: Ethnographic designs on ruling relations for students and teachers in non-academic pathways

Since 2009, all Australian states require young people to be ‘earning or learning’ until age 17. Secondary schools and vocational colleges now accommodate students for whom the conventional academic pathways of the past were not designed. The paper reflects on a project designed to explore the moral orders in these institutional settings for managing such students in extended compulsory schooling. Originally designed as classroom ethnographies, the project involved observations over three to four weeks and interviews with teachers and students in five sites in towns experiencing high youth unemployment. The project aimed to support teachers to work productively in such classrooms with such students, under the assumption that teachers orchestrate classroom interactions. However, it became clear events in these classrooms were being shaped by relations and parties above and beyond the classroom, as much as by those present. Teachers and students were observed to both comply with, and push against, the layers of policy and institutional processes regulating their behaviours. This paper re-thinks the original project through the gaze and resources of institutional ethnography, to better account for the layers of accountabilities and documentation practices that impacted on both teacher and student behaviours. By tracing the extended webs of ‘ruling relations’, it shows both how teachers and students could make trouble for the institutional moral order, and then be held accountable for this trouble.

What is the available evidence concerning relative performance of different designs of mixed-species plantings for smallholder and community forestry in the tropics? A systematic map protocol

Background There has been growing interest in mixed species plantation systems because of their potential to provide a range of socio-economic and bio-physical benefits which can be matched to the diverse needs of smallholders and communities. Potential benefits include the production of a range of forest products for home and commercial use; improved soil fertility especially when nitrogen fixing species are included; improved survival rates and greater productivity of species; a reduction in the amount of damage from pests or disease; and improved biodiversity and wildlife habitats. Despite these documented services and growing interest in mixed species plantation systems, the actual planting areas in the tropics are low, and monocultures are still preferred for industrial plantings and many reforestation programs because of perceived higher economic returns and readily available information about the species and their silviculture. In contrast, there are few guidelines for the design and management of mixed-species systems, including the social and ecological factors of successful mixed species plantings. Methods This protocol explains the methodology used to investigate the following question: What is the available evidence for the relative performance of different designs of mixed-species plantings for smallholder and community forestry in the tropics? This study will systematically search, identify and describe studies related to mixed species plantings across tropical and temperate zones to identify the social and ecological factors that affect polyculture systems. The objectives of this study are first to identify the evidence of biophysical or socio-economic factors that have been considered when designing mixed species systems for community and smallholder forestry in the tropics; and second, to identify gaps in research of mixed species plantations. Results of the study will help create guidelines that can assist practitioners, scientists and farmers to better design mixed species plantation systems for smallholders in the tropics.

Designs and architectures for the next generation of organic solar cells

Organic solar cells show great promise as an economically and environmentally friendly technology to utilize solar energy because of their simple fabrication processes and minimal material usage. However, new innovations and breakthroughs are needed for organic solar cell technology to become competitive in the future. This article reviews research efforts and accomplishments focusing on three issues: power conversion efficiency, device stability and processability for mass production, followed by an outlook for optimizing OSC performance through device engineering and new architecture designs to realize next generation organic solar cells.

Big tobacco's box fetish: Plain packaging at the High Court

Tobacco, says the World Health Organisation (WHO), is “the only legal consumer product that kills when used exactly as intended by the manufacturer.”

Opening Pandora's box: Secret treaty threatens human rights

The Anti-Counterfeiting Trade Agreement (ACTA) 2011 - Twitter hashtag #ACTA - is a controversial trade agreement designed to provide for stronger enforcement of intellectual property rights.

Inside the black box of food safety: A qualitative study of ‘non-compliance’ among food businesses

Issue addressed The paper examines the meanings of food safety among food businesses deemed non-compliant and considers the need for an ‘insider perspective’ to inform a more nuanced health promotion practice. Methods In-depth interviews were conducted with 29 food business operators who had been recently deemed ‘non-compliant’ through Council inspection. Result Paradoxically, these ‘non-compliers’ revealed a strong belief in the importance of food safety as well as a desire to comply with the regulations as communicated to them by Environmental Health Officers (EHOs). Conclusions The evidence base of food safety is largely informed by the science of food hazards, yet there is a very important need to illuminate the ‘insider’ experience of food businesses doing food safety on a daily basis. This requires a more socially nuanced appreciation of food businesses beyond the simple dichotomy of compliant/ non-compliant. So what? Armed with a deeper understanding of the social context surrounding food safety practice, it is anticipated that a more balanced, collaborative mode of food safety health promotion could develop which could add to the current signature model of regulation.

Ticking the box and closing the loop: Can dialogue be mandated?

Dialogue is a spontaneous, free-flowing, and untrammeled form of two-way communication between participants who respect, trust, and empathize with each other. Its ethical superiority and effectiveness in bringing participants together mean it is an important aspect of organizational responses to increasingly-empowered stakeholders. But what happens when dialogue is legally mandated between participants who view each other as a problem, if not actually the enemy? When dialogue is perceived as a contest with the winner securing the prize of dictating organizational behavior? Is this – can this ever be – dialogue? Sometimes what happens in the name of dialogue is far from dialogic, and ‘dialogue’ is reduced to ticking a box on a form, or closing a communication loop. This challenges those very characteristics that are the basis of dialogue’s claim to superiority. This conclusion demonstrates the need for a radical reconsideration of both the theory and practice of dialogue in public relations.

Populations of models, experimental designs and coverage of parameter space by Latin Hypercube and Orthogonal Sampling

In this paper we have used simulations to make a conjecture about the coverage of a t-dimensional subspace of a d-dimensional parameter space of size n when performing k trials of Latin Hypercube sampling. This takes the form P(k,n,d,t) = 1 - e^(-k/n^(t-1)). We suggest that this coverage formula is independent of d and this allows us to make connections between building Populations of Models and Experimental Designs. We also show that Orthogonal sampling is superior to Latin Hypercube sampling in terms of allowing a more uniform coverage of the t-dimensional subspace at the sub-block size level. These ideas have particular relevance when attempting to perform uncertainty quantification and sensitivity analyses.

Automated fit assessment of intramedullary nail designs during insertion

Modern intramedullary nails, which are utilised for the treatment of bone fractures, need to be designed to fit the anatomy of the patient population. Traditional and recent semi-automated approaches for quantifying the anatomical fit between bones and nail designs suffer from various drawbacks. This thesis proposed an automated comprehensive nail design validation method. The developed software tool was utilised to quantify the anatomical fit of four commercial nail designs. Furthermore, the thesis demonstrated the existence of a bone-nail specific nail entry point. The developed method is of great benefit for the implant manufacturing industry as a nail design validation tool.