'Online' geriatric assessment procedure for older adults referred for geriatric assessment during an acute care episode for consideration of reliability of triage decisions

Background Comprehensive geriatric assessment has been shown to improve patient outcomes, but the geriatricians who deliver it are in short-supply. A web-based method of comprehensive geriatric assessment has been developed with the potential to improve access to specialist geriatric expertise. The current study aims to test the reliability and safety of comprehensive geriatric assessment performed “online” in making geriatric triage decisions. It will also explore the accuracy of the procedure in identifying common geriatric syndromes, and its cost relative to conventional “live” consultations. Methods/Design The study population will consist of 270 acutely hospitalized patients referred for geriatric consultation at three sites. Paired assessments (live and online) will be conducted by independent, blinded geriatricians and the level of agreement examined. This will be compared with the level of agreement between two independent, blinded geriatricians each consulting with the patient in person (i.e. “live”). Agreement between the triage decision from live-live assessments and between the triage decision from live-online assessments will be calculated using kappa statistics. Agreement between the online and live detection of common geriatric syndromes will also be assessed using kappa statistics. Resource use data will be collected for online and live-live assessments to allow comparison between the two procedures. Discussion If the online approach is found to be less precise than live assessment, further analysis will seek to identify patient subgroups where disagreement is more likely. This may enable a protocol to be developed that avoids unsafe clinical decisions at a distance. Trial registration Trial registration number: ACTRN12611000936921

A method for Estimating the Degree of Uncertainty With Respect to Life Cycle Assessment During Design

Life cycle assessment (LCA) is used to estimate a product's environmental impact. Using LCA during the earlier stages of design may produce erroneous results since information available on the product's lifecycle is typically incomplete at these stages. The resulting uncertainty must be accounted for in the decision-making process. This paper proposes a method for estimating the environmental impact of a product's life cycle and the associated degree of uncertainty of that impact using information generated during the design process. Total impact is estimated based on aggregation of individual product life cycle processes impacts. Uncertainty estimation is based on assessing the mismatch between the information required and the information available about the product life cycle in each uncertainty category, as well as their integration. The method is evaluated using pre-defined scenarios with varying uncertainty. DOI: 10.1115/1.4002163]

Cumulative or sequential assessment during hermit crab shell fights: effects of oxygen on decision rules

Agonistic interactions between animals are often settled by the use of repeated signals which advertise the resource-holding potential of the sender. According to the sequential assessment game this repetition increases the accuracy with which receivers may assess the signal, but under the cumulative assessment model the repeated performances accumulate to give a signal of stamina. These models may be distinguished by the temporal pattern of signalling they predict and by the decision rules used by the contestants. Hermit crabs engage in shell fights over possession of the gastropod shells that they inhabit. During these interactions the two roles of signaller and receiver may be examined separately because they are fixed for the duration of the encounter. Attackers rap their shell against that of the defender in a series of bouts whereas defenders remain tightly withdrawn into their shells for the duration of the contest. At the end of a fight the attacker may evict the defender from its shell or decide to give up without first effecting an eviction; the decision for defenders is either to maintain a grip on its shell or to release the shell and allow itself to be evicted. We manipulated fatigue levels separately for attackers and defenders, by varying the oxygen concentration of the water that they are held in prior to fighting, and examined the effects that this has on the likelihood of each decision and on the temporal pattern of rapping. We show that the vigour of rapping and the likelihood of eviction are reduced when the attacker is subjected to low oxygen but that this treatment has no effect on rates of eviction when applied to defenders. We conclude that defenders compare the vigour of rapping with an absolute threshold rather than with a relative threshold when making their decision. The data are compatible with the cumulative assessment model and with the idea that shell rapping signals the stamina of attackers, but do not fit the predictions of the sequential assessment game.

Better Lesion Creation And Assessment During Catheter Ablation

Permanent destruction of abnormal cardiac tissue responsible for cardiac arrhythmogenesis whilst avoiding collateral tissue injury forms the cornerstone of catheter ablation therapy. As the acceptance and performance of catheter ablation increases worldwide, limitations in current technology are becoming increasingly apparent in the treatment of complex arrhythmias such as atrial fibrillation. This review will discuss the role of new technologies aimed to improve lesion formation with the ultimate goal of improving arrhythmia-free survival of patients undergoing catheter ablation of atrial arrhythmias.

Assessing for work integrated learning experiences : a pre-service teacher perspective

A critical aspect of the debate about work integrated learning in the university context is the blurring of boundaries and responsibilities in terms of student learning. In an Australian pre-service teacher education program this blurring of boundaries is apparent in stakeholder tensions about the nature and role of assessment during the practicum. In the study reported in this paper, students responded positively to the content of assessment tasks but maintained that their efforts to implement the associated planning in the workplace were stymied because of disparate understandings between university and school staff about the purpose of the task.

Preservice practicum supervision : researching an on-line communication system

Practicum is widely recognised as an essential component of preservice professional teacher education. The effective supervision of preservice teachers while undertaking practicum is fundamental to the success of the field experience. However, many of the traditional models of supervision are under pressure. Alternative models for the supervision of preservice teacher practicum are needed to encourage stronger communication links between the university and field placement sites. This paper describes one such model, PracLink, an on-line communication infrastructure used to facilitate and support student learning during practicum. Research findings regarding the use of PracLink are reported, which highlight the strengths and potential of this model while also addressing its shortcomings.

The librarian is in: a consultation model for information literacy formative assessment

Formative assessment was introduced in Rehabilitation Therapy students’ information literacy programs in Fall Term 2006 in the course OT/PT 892: Evidence-Based Practice. It was subsequently employed in the Winter Term 2008 and again in the Spring Term 2008. Formative assessment during student/librarian face-to-face consultations was one of a variety of teaching techniques used in the program. Other techniques included: a required reading; an interactive hands-on searching session; and a summative assessment of the final revised search strategy assignment (these techniques varied somewhat over the 3 classes). With the 2008 entrance class, this course content moved to OT/PT 898: Critical Enquiry, largely in Module 3: Reviewing the Literature. One of the Critical Enquiry’s learning objectives is: “recognize and reflect on the complexity of gathering evidence to inform decision-making.”

A pilot study to develop an assessment tool for sheep welfare after long journey transport

Sheep transport within Europe involves 9.5 million animals yearly, 63% of which travel over longjourneys (> 8 h). Livestock transport, particularly over long journeys, gives rise to concern about the welfare of transported animals. The European Commission stimulates the development of market-oriented animal welfare standards for all phases of livestock production, providing an alternative to the 'regulatory approach'. This study aimed to develop and test a new sheep welfare assessment protocol to be used following transport, irrespective of the journey purpose. The protocol included outcome (animal-based measures) and input variables (resource-based and management-based measures), being welfare-relevant aspects of both transport and unloading procedures. Weighted Cohen's Kappa and Heiss' Kappa index of agreement were calculated to evaluate the raters accuracy and the inter-observer reliability.Overall, good agreement levels were found. The protocol was tested on 40 commercial transports arriving at previously selected assembly centres and slaughterhouses in Italy and Greece. The protocol was found to be feasible when applied to commercial transports, allowing for a comprehensive and quick sheep welfare assessment during unloading, without impairing stockman work. Univariate analysis was carried out to evaluate associations between outcome and input variables. In this study, significant association between outcome measures and risk factors were identified when associated to unloading procedures but not to travel conditions. In collaboration with the relevant stakeholders, this protocol might be developed into a tool for routine checks for certification purposes and could provide direct feedback to all professionals involved in animal transportation on the weaknesses and strengths of their work.

Formative assessment in teacher education: the development of a diagnostic language test for trainee teachers of German

This article describes the development and validation of a diagnostic test of German and its integration in a programme of formative assessment during a one-year initial teacher-training course. The test focuses on linguistic aspects that cause difficulty for trainee teachers of German as a foreign language and assesses implicit and explicit grammatical knowledge as well as students' confidence in this knowledge. Administration of the test to 57 German speakers in four groups (first-year undergraduates, fourth-year undergraduates, postgraduate trainees, and native speakers) provided evidence of its reliability and validity.

Energy expenditure during daily activities as measured by two motion sensors in patients with COPD

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Forget about theory - practice is all? - Student teachers' learning in practicum

In 1999, all student teachers at secondary I level at the University of Bern who had to undertake an internship were asked to participate in a study on learning processes during practicum: 150 students and their mentors in three types of practicum participated—introductory practicum (after the first half‐year of studies), intermediate practicum (after two years of studies) and final practicum (after three years of studies). At the end of the practicum, student teachers and mentors completed questionnaires on preparing, teaching and post‐processing lessons. All student teachers, additionally, rated their professional skills and aspects of personality (attitudes towards pupils, self‐assuredness and well‐being) before and after the practicum. Forty‐six student teachers wrote daily semi‐structured diaries about essential learning situations during their practicum. Results indicate that in each practicum students improved significantly in preparing, conducting and post‐processing lessons. The mentors rated these changes as being greater than did the student teachers. From the perspective of the student teachers their general teaching skills also improved, and their attitudes toward pupils became more open. Furthermore, during practicum their self‐esteem and subjective well‐being increased. Diary data confirmed that there are no differences between different levels of practicum in terms of learning outcomes, but give some first insight into different ways of learning during internship.

Technology, design and process innovation in the built environment

Buildings and infrastructure represent principal assets of any national economy as well as prime sources of environmental degradation. Making them more sustainable represents a key challenge for the construction, planning and design industries and governments at all levels; and the rapid urbanisation of the 21st century has turned this into a global challenge. This book embodies the results of a major research programme by members of the Australia Co-operative Research Centre for Construction Innovation and its global partners, presented for an international audience of construction researchers, senior professionals and advanced students. It covers four themes, applied to regeneration as well as to new build, and within the overall theme of Innovation: Sustainable Materials and Manufactures, focusing on building material products, their manufacture and assembly – and the reduction of their ecological ‘fingerprints’, the extension of their service lives, and their re-use and recyclability. It also explores the prospects for applying the principles of the assembly line. Virtual Design, Construction and Management, viewed as increasing sustainable development through automation, enhanced collaboration (such as virtual design teams), real time BL performance assessment during design, simulation of the construction process, life-cycle management of project information (zero information loss) risk minimisation, and increased potential for innovation and value adding. Integrating Design, Construction and Facility Management over the Project Life Cycle, by converging ICT, design science engineering and sustainability science. Integration across spatial scales, enabling building–infrastructure synergies (such as water and energy efficiency). Convergences between IT and design and operational processes are also viewed as a key platform increased sustainability.

A hierarchical evolutionary algorithmic design (HEAD) system for generating and evolving building design models

This thesis develops a detailed conceptual design method and a system software architecture defined with a parametric and generative evolutionary design system to support an integrated interdisciplinary building design approach. The research recognises the need to shift design efforts toward the earliest phases of the design process to support crucial design decisions that have a substantial cost implication on the overall project budget. The overall motivation of the research is to improve the quality of designs produced at the author's employer, the General Directorate of Major Works (GDMW) of the Saudi Arabian Armed Forces. GDMW produces many buildings that have standard requirements, across a wide range of environmental and social circumstances. A rapid means of customising designs for local circumstances would have significant benefits. The research considers the use of evolutionary genetic algorithms in the design process and the ability to generate and assess a wider range of potential design solutions than a human could manage. This wider ranging assessment, during the early stages of the design process, means that the generated solutions will be more appropriate for the defined design problem. The research work proposes a design method and system that promotes a collaborative relationship between human creativity and the computer capability. The tectonic design approach is adopted as a process oriented design that values the process of design as much as the product. The aim is to connect the evolutionary systems to performance assessment applications, which are used as prioritised fitness functions. This will produce design solutions that respond to their environmental and function requirements. This integrated, interdisciplinary approach to design will produce solutions through a design process that considers and balances the requirements of all aspects of the design. Since this thesis covers a wide area of research material, 'methodological pluralism' approach was used, incorporating both prescriptive and descriptive research methods. Multiple models of research were combined and the overall research was undertaken following three main stages, conceptualisation, developmental and evaluation. The first two stages lay the foundations for the specification of the proposed system where key aspects of the system that have not previously been proven in the literature, were implemented to test the feasibility of the system. As a result of combining the existing knowledge in the area with the newlyverified key aspects of the proposed system, this research can form the base for a future software development project. The evaluation stage, which includes building the prototype system to test and evaluate the system performance based on the criteria defined in the earlier stage, is not within the scope this thesis. The research results in a conceptual design method and a proposed system software architecture. The proposed system is called the 'Hierarchical Evolutionary Algorithmic Design (HEAD) System'. The HEAD system has shown to be feasible through the initial illustrative paper-based simulation. The HEAD system consists of the two main components - 'Design Schema' and the 'Synthesis Algorithms'. The HEAD system reflects the major research contribution in the way it is conceptualised, while secondary contributions are achieved within the system components. The design schema provides constraints on the generation of designs, thus enabling the designer to create a wide range of potential designs that can then be analysed for desirable characteristics. The design schema supports the digital representation of the human creativity of designers into a dynamic design framework that can be encoded and then executed through the use of evolutionary genetic algorithms. The design schema incorporates 2D and 3D geometry and graph theory for space layout planning and building formation using the Lowest Common Design Denominator (LCDD) of a parameterised 2D module and a 3D structural module. This provides a bridge between the standard adjacency requirements and the evolutionary system. The use of graphs as an input to the evolutionary algorithm supports the introduction of constraints in a way that is not supported by standard evolutionary techniques. The process of design synthesis is guided as a higher level description of the building that supports geometrical constraints. The Synthesis Algorithms component analyses designs at four levels, 'Room', 'Layout', 'Building' and 'Optimisation'. At each level multiple fitness functions are embedded into the genetic algorithm to target the specific requirements of the relevant decomposed part of the design problem. Decomposing the design problem to allow for the design requirements of each level to be dealt with separately and then reassembling them in a bottom up approach reduces the generation of non-viable solutions through constraining the options available at the next higher level. The iterative approach, in exploring the range of design solutions through modification of the design schema as the understanding of the design problem improves, assists in identifying conflicts in the design requirements. Additionally, the hierarchical set-up allows the embedding of multiple fitness functions into the genetic algorithm, each relevant to a specific level. This supports an integrated multi-level, multi-disciplinary approach. The HEAD system promotes a collaborative relationship between human creativity and the computer capability. The design schema component, as the input to the procedural algorithms, enables the encoding of certain aspects of the designer's subjective creativity. By focusing on finding solutions for the relevant sub-problems at the appropriate levels of detail, the hierarchical nature of the system assist in the design decision-making process.

Ensuring student success : establishing a community of practice for culturally and linguistically diverse preservice teachers

This paper discusses the primacy of communities of practice within learning contexts at university and during practicum for culturally and linguistically diverse preservice teachers. The study illustrates that learning occurs when there are adequate opportunities for participation and practice. Data from interviews with 28 culturally and linguistically diverse preservice teachers illustrate that tensions created by social, cultural differences impact upon modes of identification and dimensions of practice (Lave & Wenger, 1991; Wenger, 1998). The study concludes by reiterating the importance of establishing proactive communities of practice to ensure success in learning and practice for this group of preservice teachers.