The Capability of Nurse Practitioners may be Diminished by the Use of Controlling Protocols

Nurse practitioners will become a vital component of the health workforce because of the growing need to manage chronic illness, to deliver effective primary health services, and to manage workforce challenges effectively. In addition, the role of nurse practitioner is an excellent example of increased workforce flexibility and changes to occupational boundaries. This paper draws on an Australasian research project which defined the core role of nurse practitioners, and identified capability as the component of their level of practice that makes their service most useful. We argue that any tendency to write specific protocols to define the limits of nurse practitioner practice will reduce the efficacy of their contribution. The distinction we wish to make in this paper is between guidelines aiming to support practice, and protocols which aim to control practice.

Image acquisition and manipulation protocols for CT-PET fusion to improve the accuracy of gross tumour volume localisation for 3D conformal radiotherapy for lung cancer

Aims: To develop clinical protocols for acquiring PET images, performing CT-PET registration and tumour volume definition based on the PET image data, for radiotherapy for lung cancer patients and then to test these protocols with respect to levels of accuracy and reproducibility. Method: A phantom-based quality assurance study of the processes associated with using registered CT and PET scans for tumour volume definition was conducted to: (1) investigate image acquisition and manipulation techniques for registering and contouring CT and PET images in a radiotherapy treatment planning system, and (2) determine technology-based errors in the registration and contouring processes. The outcomes of the phantom image based quality assurance study were used to determine clinical protocols. Protocols were developed for (1) acquiring patient PET image data for incorporation into the 3DCRT process, particularly for ensuring that the patient is positioned in their treatment position; (2) CT-PET image registration techniques and (3) GTV definition using the PET image data. The developed clinical protocols were tested using retrospective clinical trials to assess levels of inter-user variability which may be attributed to the use of these protocols. A Siemens Somatom Open Sensation 20 slice CT scanner and a Philips Allegro stand-alone PET scanner were used to acquire the images for this research. The Philips Pinnacle3 treatment planning system was used to perform the image registration and contouring of the CT and PET images. Results: Both the attenuation-corrected and transmission images obtained from standard whole-body PET staging clinical scanning protocols were acquired and imported into the treatment planning system for the phantom-based quality assurance study. Protocols for manipulating the PET images in the treatment planning system, particularly for quantifying uptake in volumes of interest and window levels for accurate geometric visualisation were determined. The automatic registration algorithms were found to have sub-voxel levels of accuracy, with transmission scan-based CT-PET registration more accurate than emission scan-based registration of the phantom images. Respiration induced image artifacts were not found to influence registration accuracy while inadequate pre-registration over-lap of the CT and PET images was found to result in large registration errors. A threshold value based on a percentage of the maximum uptake within a volume of interest was found to accurately contour the different features of the phantom despite the lower spatial resolution of the PET images. Appropriate selection of the threshold value is dependant on target-to-background ratios and the presence of respiratory motion. The results from the phantom-based study were used to design, implement and test clinical CT-PET fusion protocols. The patient PET image acquisition protocols enabled patients to be successfully identified and positioned in their radiotherapy treatment position during the acquisition of their whole-body PET staging scan. While automatic registration techniques were found to reduce inter-user variation compared to manual techniques, there was no significant difference in the registration outcomes for transmission or emission scan-based registration of the patient images, using the protocol. Tumour volumes contoured on registered patient CT-PET images using the tested threshold values and viewing windows determined from the phantom study, demonstrated less inter-user variation for the primary tumour volume contours than those contoured using only the patient’s planning CT scans. Conclusions: The developed clinical protocols allow a patient’s whole-body PET staging scan to be incorporated, manipulated and quantified in the treatment planning process to improve the accuracy of gross tumour volume localisation in 3D conformal radiotherapy for lung cancer. Image registration protocols which factor in potential software-based errors combined with adequate user training are recommended to increase the accuracy and reproducibility of registration outcomes. A semi-automated adaptive threshold contouring technique incorporating a PET windowing protocol, accurately defines the geometric edge of a tumour volume using PET image data from a stand alone PET scanner, including 4D target volumes.

To err (on the road) is human? An on-road study of driver errors

Human error, its causes and consequences, and the ways in which it can be prevented, remain of great interest to road safety practitioners. This paper presents the findings derived from an on-road study of driver errors in which 25 participants drove a pre-determined route using MUARC's On-Road Test Vehicle (ORTeV). In-vehicle observers recorded the different errors made, and a range of other data was collected, including driver verbal protocols, forward, cockpit and driver video, and vehicle data (speed, braking, steering wheel angle, lane tracking etc). Participants also completed a post trial cognitive task analysis interview. The drivers tested made a range of different errors, with speeding violations, both intentional and unintentional, being the most common. Further more detailed analysis of a sub-set of specific error types indicates that driver errors have various causes, including failures in the wider road 'system' such as poor roadway design, infrastructure failures and unclear road rules. In closing, a range of potential error prevention strategies, including intelligent speed adaptation and road infrastructure design, are discussed.

Compliant cryptologic protocols

Literally, the word compliance suggests conformity in fulfilling official requirements. The thesis presents the results of the analysis and design of a class of protocols called compliant cryptologic protocols (CCP). The thesis presents a notion for compliance in cryptosystems that is conducive as a cryptologic goal. CCP are employed in security systems used by at least two mutually mistrusting sets of entities. The individuals in the sets of entities only trust the design of the security system and any trusted third party the security system may include. Such a security system can be thought of as a broker between the mistrusting sets of entities. In order to provide confidence in operation for the mistrusting sets of entities, CCP must provide compliance verification mechanisms. These mechanisms are employed either by all the entities or a set of authorised entities in the system to verify the compliance of the behaviour of various participating entities with the rules of the system. It is often stated that confidentiality, integrity and authentication are the primary interests of cryptology. It is evident from the literature that authentication mechanisms employ confidentiality and integrity services to achieve their goal. Therefore, the fundamental services that any cryptographic algorithm may provide are confidentiality and integrity only. Since controlling the behaviour of the entities is not a feasible cryptologic goal,the verification of the confidentiality of any data is a futile cryptologic exercise. For example, there exists no cryptologic mechanism that would prevent an entity from willingly or unwillingly exposing its private key corresponding to a certified public key. The confidentiality of the data can only be assumed. Therefore, any verification in cryptologic protocols must take the form of integrity verification mechanisms. Thus, compliance verification must take the form of integrity verification in cryptologic protocols. A definition of compliance that is conducive as a cryptologic goal is presented as a guarantee on the confidentiality and integrity services. The definitions are employed to provide a classification mechanism for various message formats in a cryptologic protocol. The classification assists in the characterisation of protocols, which assists in providing a focus for the goals of the research. The resulting concrete goal of the research is the study of those protocols that employ message formats to provide restricted confidentiality and universal integrity services to selected data. The thesis proposes an informal technique to understand, analyse and synthesise the integrity goals of a protocol system. The thesis contains a study of key recovery,electronic cash, peer-review, electronic auction, and electronic voting protocols. All these protocols contain message format that provide restricted confidentiality and universal integrity services to selected data. The study of key recovery systems aims to achieve robust key recovery relying only on the certification procedure and without the need for tamper-resistant system modules. The result of this study is a new technique for the design of key recovery systems called hybrid key escrow. The thesis identifies a class of compliant cryptologic protocols called secure selection protocols (SSP). The uniqueness of this class of protocols is the similarity in the goals of the member protocols, namely peer-review, electronic auction and electronic voting. The problem statement describing the goals of these protocols contain a tuple,(I, D), where I usually refers to an identity of a participant and D usually refers to the data selected by the participant. SSP are interested in providing confidentiality service to the tuple for hiding the relationship between I and D, and integrity service to the tuple after its formation to prevent the modification of the tuple. The thesis provides a schema to solve the instances of SSP by employing the electronic cash technology. The thesis makes a distinction between electronic cash technology and electronic payment technology. It will treat electronic cash technology to be a certification mechanism that allows the participants to obtain a certificate on their public key, without revealing the certificate or the public key to the certifier. The thesis abstracts the certificate and the public key as the data structure called anonymous token. It proposes design schemes for the peer-review, e-auction and e-voting protocols by employing the schema with the anonymous token abstraction. The thesis concludes by providing a variety of problem statements for future research that would further enrich the literature.

Obstacle-free range determination for rail track maintenance vehicles

Maintenance trains travel in convoy. In Australia, only the first train of the convoy pays attention to the track sig- nalization (the other convoy vehicles simply follow the preceding vehicle). Because of human errors, collisions can happen between the maintenance vehicles. Although an anti-collision system based on a laser distance meter is already in operation, the existing system has a limited range due to the curvature of the tracks. In this paper, we introduce an anti-collision system based on vision. The two main ideas are, (1) to warp the camera image into an image where the rails are parallel through a projective transform, and (2) to track the two rail curves simultaneously by evaluating small parallel segments. The performance of the system is demonstrated on an image dataset.