Management of delirium in medicine : experience of a close observation unit

Objective(s): A new model of care for the management of patients with delirium was developed and evaluated. Method: A 4-bedded Close Observation Unit (COU) was introduced. The model comprised an education strategy for assistants in nursing (AIN), environmental adaptations and AIN to patient ratio of 1:4. Outcomes in all patients with delirium before and after introduction of the new model of care were compared. Results: 105 patients were admitted to COU, of whom 100 (95%) were diagnosed with delirium. In-hospital mortality improved after introduction of the unit (15% versus 5%; p=0.002) without significant change in length of stay, discharge destination or falls frequency. Conclusion: A dedicated unit for delirium management within medicine achieved a reduction in mortality.

First year industrial design studio-based teaching pedagogies and students’ engagement

Student engagement tends to be viewed as a reflection of learning processes, and in the context of first year university studies, it is a crucial means of an educational process that establishes the foundations for successful later year studies (Krausse and Coates, 2008). In the context of first year design studio teaching in higher education, fostering students’ positive engagement poses challenges to design educators as current trends set these design studios to be large size classes that makes difficult to manage and follow up students’ individual learning experiences. At QUT’s first year industrial design studio classes we engage in a variety of teaching pedagogies from which we identify two of them as instrumental vehicles to foster positive student engagement. Concept bombs and the field trip experience provide such platform as shown in student responses through a learning experience survey.

Managing intensified urban development and industrial uses in Qld : affected area notations

The Queensland government planning policies actively encourage increased dwelling density, sustainable infill development and transit oriented development to maximise land use and minimise urban sprawl. One of the detriments of such a policy is the potential for intensified residential development to create conflict between lawfully operating existing industrial uses and residences. In particular the government is concerned that intensified urban development will increase the risk of litigation from landowners and tenants detrimentally affected by the emission of aerosols, fumes, light, noise, odour, particles or smoke from existing industrial premises.

The process and patterns of combining the use of traditional Chinese medicine and Western medicine in Taiwanese people with cancer

Objective: The nature of contemporary cancer therapy means that patients are faced with difficult treatment decisions about surgery, chemotherapy and radiotherapy. For some, this process may also involve consideration of therapies that sit outside the biomedical approach to cancer treatment, in our research, traditional Chinese medicine (TCM). Thus, it is important to explore how cancer patients in Taiwan incorporate TCM into their cancer treatment journey. This paper aims to explore of the patterns of combining the use of TCM and Western medicine into cancer treatment journey in Taiwanese people with cancer. Methods: The sampling was purposive and the data collected through in-depth interviews. Data collection occurred over an eleven month. The research was grounded in the premises of symbolic interactionism and adopted the methods of grounded theory. Twenty four participants who were patients receiving cancer treatment were recruited from two health care settings in Taiwan. Results: The study findings suggest that perceptions of health and illness are mediated through ongoing interactions with different forms of therapy. The participants in this study had a clear focus on “process and patterns of using TCM and Western medicine”. Further, ‘different importance in Western medicine and TCM’, ‘taken for granted to use TCM’, ‘each has specialized skills in Western medicine and TCM’ and ‘different symptoms use different approaches (Western medicine or TCM)’ may explicit how the participants in this study see CAM and Western medicine. Conclusions/Implications for practice: The descriptive frame of the study suggests that TCM and Western medicine occupy quite distinct domains in terms of decision making over their use. People used TCM based on interpretations of the present and against a background of an enduring cultural legacy grounded in Chinese philosophical beliefs about health and healthcare. The increasingly popular term of 'integrative medicine' obscures the complex contexts of the patterns of use of both therapeutic modalities. It is this latter point that is worthy of further exploration.

Efficient route update and maintenance processes for multipath routing in large-scale industrial wireless sensor networks

Reliable communications is one of the major concerns in wireless sensor networks (WSNs). Multipath routing is an effective way to improve communication reliability in WSNs. However, most of existing multipath routing protocols for sensor networks are reactive and require dynamic route discovery. If there are many sensor nodes from a source to a destination, the route discovery process will create a long end-to-end transmission delay, which causes difficulties in some time-critical applications. To overcome this difficulty, the efficient route update and maintenance processes are proposed in this paper. It aims to limit the amount of routing overhead with two-tier routing architecture and introduce the combination of piggyback and trigger update to replace the periodic update process, which is the main source of unnecessary routing overhead. Simulations are carried out to demonstrate the effectiveness of the proposed processes in improvement of total amount of routing overhead over existing popular routing protocols.

Improving the efficiency of high power piezoelectric transducers for industrial applications

Most high-power ultrasound applications are driven by two-level inverters. However, the broad spectral content of the two-level pulse results in undesired harmonics that can decrease the performance of the system significantly. On the other hand, it is crucial to excite the piezoelectric devices at their main resonant frequency in order to have maximum energy conversion. Therefore a high-quality, low-distorted power signal is needed to excite the high-power piezoelectric transducer at its resonant frequency. This study proposes an efficient approach to develop the performance of high-power ultrasonic applications using multilevel inverters along with a frequency estimation algorithm. In this method, the resonant frequencies are estimated based on relative minimums of the piezoelectric impedance frequency response. The algorithm follows the resonant frequency variation and adapts the multilevel inverter reference frequency to drive an ultrasound transducer at high power. Extensive simulation and experimental results indicate the effectiveness of the proposed approach.

A proposed Australian industrial control system security curriculum

The security of industrial control systems in critical infrastructure is a concern for the Australian government and other nations. There is a need to provide local Australian training and education for both control system engineers and information technology professionals. This paper proposes a postgraduate curriculum of four courses to provide knowledge and skills to protect critical infrastructure industrial control systems. Our curriculum is unique in that it provides security awareness but also the advanced skills required for security specialists in this area. We are aware that in the Australian context there is a cultural gap between the thinking of control system engineers who are responsible for maintaining and designing critical infrastructure and information technology professionals who are responsible for protecting these systems from cyber attacks. Our curriculum aims to bridge this gap by providing theoretical and practical exercises that will raise the awareness and preparedness of both groups of professionals.

Intern underperformance is detected more frequently in emergency medicine rotations

Objective: To determine the frequency and nature of intern underperformance as documented on in-training assessment forms. Methods: A retrospective review of intern assessment forms from a 2 year period (2009–2010) was conducted at a tertiary referral hospital in Brisbane, Queensland. The frequency of interns assessed as ‘requiring substantial assistance’ and/or ‘requires further development’ on mid- or end-of-term assessment forms was determined. Forms were analysed by the clinical rotation, time of year and domain(s) of clinical practice in which underperformance was documented. Results: During 2009 and 2010 the overall documented incidence of intern underperformance was 2.4% (95% CI 1.5–3.9%). Clinical rotation in emergency medicine detected significantly more underperformance compared with other rotations (P < 0.01). Interns predominantly had difficulty with ‘clinical judgment and decision-making skills’, ‘time management skills’ and ‘teamwork and colleagues’ (62.5%, 55% and 32.5% of underperforming assessments, respectively). Time of the year did not affect frequency of underperformance. A proportion of 13.4% (95% CI 9.2–19.0%) of interns working at the institution over the study period received at least one assessment in which underperformance was documented. Seventy-six per cent of those interns who had underperformance identified by mid-term assessment successfully completed the term following remediation. Conclusion: The prevalence of underperformance among interns is low, although higher than previously suggested. Emergency medicine detects relatively more interns in difficulty than other rotations.

The potential contributions of traditional Chinese medicine to emergency medicine

BACKGROUND: Despite the fact that traditional Chinese medicine (TCM) has been developed and used to treat acute and urgent illness for many thousands of years. TCM has been widely perceived in western societies that TCM may only be effective to treat chronic diseases. The aim of this article is to provide some scientific evidence regarding the application of TCM in emergency medicine and its future potential. METHODS: Multiple databases (PubMed, ProQuest, Academic Search Elite and Science Direct) were searched using the terms: Traditional Chinese Medicine/ Chinese Medicine, Emergency Medicine, China. In addition, three leading TCM Journals in China were searched via Oriprobe Information Services for relevant articles (published from 1990—2012). Particular attention was paid to those articles that are related to TCM treatments or combined medicine in dealing with intensive and critical care. RESULTS: TCM is a systematic traditional macro medicine. The clinical practice of TCM is guided by the TCM theoretical framework – a methodology founded thousands of years ago. As the methodologies between TCM and Biomedicine are significantly different, it provides an opportunity to combine two medicines, in order to achieve clinical efficacy. Nowadays, combined medicine has become a common clinical model particular in TCM hospitals in China. CONCLUSIONS: It is evident that TCM can provide some assistance in emergency although to combine them in practice is stillits infant form and is mainly at TCM hospitals in China. The future effort could be put into TCM research, both in laboratories and clinics, with high quality designs, so that TCM could be better understood and then applied in emergency medicine.

A comprehensive dual-scale wood torrefaction model : application to the analysis of thermal run-away in industrial heat treatment processes

A dual-scale model of the torrefaction of wood was developed and used to study industrial configurations. At the local scale, the computational code solves the coupled heat and mass transfer and the thermal degradation mechanisms of the wood components. At the global scale, the two-way coupling between the boards and the stack channels is treated as an integral component of the process. This model is used to investigate the effect of the stack configuration on the heat treatment of the boards. The simulations highlight that the exothermic reactions occurring in each single board can be accumulated along the stack. This phenomenon may result in a dramatic eterogeneity of the process and poses a serious risk of thermal runaway, which is often observed in industrial plants. The model is used to explain how thermal runaway can be lowered by increasing the airflow velocity, the sticker thickness or by gas flow reversal.

Use of thermal imaging in sports medicine research : a short report

The assessment of skin temperature (Tsk) in athletic therapy and sports medicine research is an extremely important physiological outcome measure.Various methodsof recording Tsk, including thermistors, thermocouples and thermocrons are currently being used for research purposes. These techniques are constrained by their wires limiting the freedom of the subject, slow response times, and/or sensors falling off. Furthermore, as these products typically are directly attached to the skin and cover the measurement site, their validity may be questionable.This manuscript addresses the use and potential benefits of using thermal imaging (TI) in sport medicine research.Non-contact infrared TI offers a quick, non-invasive, portable and athlete-friendly method of assessing Tsk. TI is a useful Tsk diagnostic tool that has potential to be an integral part of sport medicine research in the future. Furthermore, as the technique is non-contact it has several advantages over existing methods of recording skin temperature

Industrial land price and its impact on urban growth : a Chinese case study

China is experiencing rapid progress in industrialization, with its own rationale toward industrial land development based on a deliberate change from an extensive to intensive form of urban land use. One result has been concerted attempts by local government to attract foreign investment by a low industrial land price strategy, which has resulted in a disproportionally large amount of industrial land within the total urban land use structure at the expense of the urban sprawl of many cities. This paper first examines “Comparable Benchmark Price as Residential land use” (CBPR) as the theoretical basis of the low industrial land price phenomenon. Empirical findings are presented from a case study based on data from Jinyun County, China. These data are analyzed to reveal the rationale of industrial land price from 2000 to 2010 concerning the CBPR model. We then explore the causes of low industrial land prices in the form of a “Centipede Game Model”, involving two neighborhood regions as “major players” to make a set of moves (or strategies). When one of the players unilaterally reduces the land price to attract investment with the aim to maximize profits arising from the revenues generated from foreign investment and land premiums, a two-player price war begins in the form of a dynamic game, the effect of which is to produce a downward spiral of prices. In this context, the paradox of maximizing profits for each of the two players are not accomplished due to the inter-regional competition of attracted investment leading to a lose-lose situation for both sides’ in competing for land premium revenues. A short-term solution to the problem is offered involving the establishment of inter-regional cooperative partnerships. For the longer term, however, a comprehensive reform of the local financial system, more adroit regional planning and an improved means of evaluating government performance is needed to ensure the government's role in securing pubic goods is not abandoned in favor of one solely concerned with revenue generation.

High frequency high power converters for industrial applications

The main contribution of this project was to investigate power electronics technology in designing and developing high frequency high power converters for industrial applications. Therefore, the research was conducted at two levels; first at system level which mainly encapsulated the circuit topology and control scheme and second at application level which involves with real-world applications. Pursuing these objectives, varied topologies have been developed and proposed within this research. The main aim was to resolving solid-state switches limited power rating and operating speed while increasing the system flexibility considering the application characteristics. The developed new power converter configurations were applied to pulsed power and high power ultrasound applications for experimental validation.