9 research outputs found

    Precision antimicrobial therapy: the application of therapeutic drug monitoring in critical illness

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    Despite advances in critical care medicine, severe infections and sepsis-related mortality remain a pressing problem. There is considerable evidence of under- and overexposure from standard dosing regimens across numerous antimicrobial classes in critically ill patients, a result of pharmacokinetic alterations arising from unique pathophysiologic changes. Timely initiation of adequately dosed antimicrobial therapy is recognised to be paramount in improving clinical outcomes in sepsis. Therapeutic drug monitoring (TDM), a tool traditionally used to minimise toxicity of glycopeptides and aminoglycosides, is increasingly being used to increase the precision of antimicrobial dose regimens in critical illness. ‘Emerging’ candidates for which TDM is recommended include β-lactam antibiotics, linezolid, ciprofloxacin, and antifungal, antiviral and antimycobacterial drugs. Little is known about the current uptake of TDM for these agents in Australian hospitals and the barriers to TDM implementation. Performing TDM also presents a learning opportunity whereby the probability of attaining therapeutic targets using empiric dosing strategies may be (re)evaluated. Chapter 1 presents an overview of the challenges facing clinicians prescribing antimicrobials for critically ill patients and potential ways TDM data can be used to overcome these challenges. Chapter 2 explores performance, clinician attitudes and barriers to implementation of TDM for emerging antimicrobial candidates, mapping out current unmet clinical need and providing a framework for TDM data driven precision antimicrobial dosing in subsequent chapters. Chapter 3 examines concentration–toxicity relationships in critically ill patients treated with β-lactam antibiotics and defines threshold concentrations associated with neuro- and nephrotoxicity. Chapter 3 also identifies factors that contribute to underexposure of antibiotics in critically ill patients. Chapter 4 investigates the pharmacokinetics and current dosing regimens of the antifungal drug fluconazole, another emerging TDM candidate. These findings are extended in Chapter 5 with an evaluation of a novel model-based dosing strategy for fluconazole. The findings from Chapters 3 and 4 leverage TDM data to provide insights into critically ill patients at risk of under- and overexposure of antimicrobials, and the use of novel antimicrobial dosing strategies. Chapter 6 discusses the clinical implications of this work and recommendations for future research

    Teaching-Learning-Research: Design and Environments

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    This is Manchester: We do things differently here Manchester, once the ‘Industrial Capital’ of the world, has long been a test bed for architectural and urban experimentation. From the early settlements that challenged the resilience of the Romans, and then the Vikings, through the massive boom of the industrial period, when such was the frenzy in the city that it earned the sobriquet Cottonopolis, beyond the economic melancholia of the late 20th century, to the unbridled optimism of the 21st. As a progressive city, Manchester has continually reinvented itself. The present reincarnation was led through cultural regeneration facilitated by the adaptive reuse of those great redundant industrial structures, it is a city that encourages smart technologies and embraces a community of 24 Hour Party People. Where better then to hold a conference that explores progressive architectural pedagogy – especially a virtual one! The architectural, landscape, and design studio is a laboratory for experimentation where students are encouraged and expected to question and disrupt the status quo, to explore possible different futures, and to propose radical solutions to unsolvable problems. The need to fuel this move away from more traditional tabular rasa education is the responsibility of academics, and this conference was a wonderful vehicle to explore, expound, discuss, and debate the future of architectural education. During the pandemic we have had to learn to do things differently, not to be down heartened by the difficulty of interacting solely through the computer, but to embrace the nearness that digital communication provides. We have adapted methods of teaching and learning to accommodate this extraordinary situation, we have creatively responded to the pandemic and developed strategies that encourage endeavour, promote wellbeing, and support scholarship. Extraordinary strategies are needed for an extraordinary situation. It was a great pleasure to be able to host the AMPS Teaching – Learning – Research: Design and Environments conference at the Manchester School of Architecture. It was lovely to welcome so many virtual guests to the city. The great success of the online event was the demonstrated by the enthusiasm with which speakers engaged with the conference, the quality of the post-session debate combined with the international dialogue and collaboration, (especially in this time of uncertainty) created by such global citizens. It is an honour to introduce the conference proceedings, presented here as collection of well argued, forward thinking, deliberately controversial, and valuable papers

    Formation and mitigation of toxic emissions from blasting in mining: Experimental investigation and development of aerial sampling methods

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    A key aspect in optimising blasting operations in mining is reducing toxic species in post-blast fumes, notably NOx from ammonium nitrate-based mixes, which pose a direct threat to miners' health and neighbouring settlements. Reducing these pollutants can be done mainly through improving the explosive formulation and blasting practices which in turn require both A) an understanding of the physical and chemical parameters involved and B) the ability to validate any improvement through the direct field-sampling of post-blast fumes. A series of lab-based experiments on the thermal decomposition of ammonium nitrate was carried out with the complete quantification of each product using FTIR, μGC and IC. The physical parameters that varied were temperature, residence time, and whether to have reagents in dry or aqueous forms. The chemical parameters changed were the presence of oxygen gas and urea. The substantial aspect developed in those experiments relates to using high-heating rates believed to be of comparable magnitude to those occurring in blast holes in mining during detonation. The thesis then reports on developing and testing custom-designed drone sampling systems for emissions from blasting operations in mining. The key features in the final aerial sampling system developed (weighing ≤ 10 kg including drone) are i) the fast spectroscopic real-time measurement of NO, NO2, CO, CO2, N2O, NH3, VOCs and PM; and ii) the collection of VOCs and PM2.5 for post-sampling analysis using analytical techniques such as GC-MS and XRD. While sampling in a mine site was not possible, all samplers have been tested with fumes from industrial and transport sources around Perth, Western Australia and a blasting chamber in New South Wales. Two smaller systems (weighing ≤ 2 kg, including drone) sampled air toxics from urban sources

    An assigned responsibility system for robotic teleoperation control

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    This paper proposes an architecture that explores a gap in the spectrum of existing strategies for robot control mode switching in adjustable autonomy. In situations where the environment is reasonably known and/or predictable, pre-planning these control changes could relieve robot operators of the additional task of deciding when and how to switch. Such a strategy provides a clear division of labour between the automation and the human operator(s) before the job even begins, allowing for individual responsibilities to be known ahead of time, limiting confusion and allowing rest breaks to be planned. Assigned Responsibility is a new form of adjustable autonomy-based teleoperation that allows the selective inclusion of automated control elements at key stages of a robot operation plan’s execution. Progression through these stages is controlled by automatic goal accomplishment tracking. An implementation is evaluated through engineering tests and a usability study, demonstrating the viability of this approach and offering insight into its potential applications

    Enhancing our lives with immersive virtual reality

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    Virtual reality (VR) started about 50 years ago in a form we would recognize today [stereo head-mounted display (HMD), head tracking, computer graphics generated images] – although the hardware was completely different. In the 1980s and 1990s, VR emerged again based on a different generation of hardware (e.g., CRT displays rather than vector refresh, electromagnetic tracking instead of mechanical). This reached the attention of the public, and VR was hailed by many engineers, scientists, celebrities, and business people as the beginning of a new era, when VR would soon change the world for the better. Then, VR disappeared from public view and was rumored to be “dead.” In the intervening 25 years a huge amount of research has nevertheless been carried out across a vast range of applications – from medicine to business, from psychotherapy to industry, from sports to travel. Scientists, engineers, and people working in industry carried on with their research and applications using and exploring different forms of VR, not knowing that actually the topic had already passed away. The purpose of this article is to survey a range of VR applications where there is some evidence for, or at least debate about, its utility, mainly based on publications in peer-reviewed journals. Of course not every type of application has been covered, nor every scientific paper (about 186,000 papers in Google Scholar): in particular, in this review we have not covered applications in psychological or medical rehabilitation. The objective is that the reader becomes aware of what has been accomplished in VR, where the evidence is weaker or stronger, and what can be done. We start in Section 1 with an outline of what VR is and the major conceptual framework used to understand what happens when people experience it – the concept of “presence.” In Section 2, we review some areas where VR has been used in science – mostly psychology and neuroscience, the area of scientific visualization, and some remarks about its use in education and surgical training. In Section 3, we discuss how VR has been used in sports and exercise. In Section 4, we survey applications in social psychology and related areas – how VR has been used to throw light on some social phenomena, and how it can be used to tackle experimentally areas that cannot be studied experimentally in real life. We conclude with how it has been used in the preservation of and access to cultural heritage. In Section 5, we present the domain of moral behavior, including an example of how it might be used to train professionals such as medical doctors when confronting serious dilemmas with patients. In Section 6, we consider how VR has been and might be used in various aspects of travel, collaboration, and industry. In Section 7, we consider mainly the use of VR in news presentation and also discuss different types of VR. In the concluding Section 8, we briefly consider new ideas that have recently emerged – an impossible task since during the short time we have written this page even newer ideas have emerged! And, we conclude with some general considerations and speculations. Throughout and wherever possible we have stressed novel applications and approaches and how the real power of VR is not necessarily to produce a faithful reproduction of “reality” but rather that it offers the possibility to step outside of the normal bounds of reality and realize goals in a totally new and unexpected way. We hope that our article will provoke readers to think as paradigm changers, and advance VR to realize different worlds that might have a positive impact on the lives of millions of people worldwide, and maybe even help a little in saving the planet

    Assigned responsibility for remote robot operation

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    The remote control of robots, known as teleoperation, is a non-trivial task, requiring the operator to make decisions based on the information relayed by the robot about its own status as well as its surroundings. This places the operator under significant cognitive load. A solution to this involves sharing this load between the human operator and automated operators. This paper builds on the idea of adjustable autonomy, proposing Assigned Responsibility, a way of clearly delimiting control responsibility over one or more robots between human and automated operators. An architecture for implementing Assigned Responsibility is presented

    Educational Technology and Education Conferences, January to June 2016

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