Reaching Out to Tribal Communities: Lessons Learned and Approaches to Consider

When transportation safety decision-making is desired, the involvement and engagement with a community is essential. A streamlined delivery of a project or program is more likely to occur when active dialogue and an exchange of ideas occurs in advance and occurs frequently. This is particularly important in tribal communities, who value sustained relationships and represent the focus population of this study. The research team, on six separate occasions, met with local and regional tribal leaders to explore and discuss transportation safety needs within and outside tribal communities, as well as discern the recommended approaches to foster ongoing dialogue about these needs. In all cases these discussions closely correlated with existing research studies or activities; transportation safety and equity is not seen as separate from other tribal foci and community needs. Specific recommendations to consider, in no particular order, included the following: invest respectfully enough time for people to talk; tribes think long-term and consider the impact of any decision from a long-term viewpoint so an iterative process and re-sharing of ideas is critical; the power of decision is in the hands of the tribe and its members; do not lump tribes together as each tribe is sovereign and unique and every community should be expected to think differently; all tribes are unique as is the environmental and social context; to disseminate information widely and iteratively, do so when there is a large group or event; be sure to understand the Tribal governance, decision making, and organizational structure; know who is the tribal Chairman or Chairwoman; and develop an emic and etic understanding of the community

The Role of Blockchain in Cyber Security

Cyber security breaches are on the rise globally. Due to the introduction of legislation like the EU’s General Data Protection Regulation (GDPR),companies are now subject to further financial penalties if they fail to meet requirements in protecting user information. In 2018, 75% of CEOs and board members considered cyber security and technology acquisitions among their top priorities, and blockchain based solutions were among the most considered options. Blockchain is a decentralised structure that offers multiple security benefits over traditional, centralised network architectures. These two approaches are compared in this chapter in areas such as data storage, the Internet of Things (IoT) and Domain Name System (DNS) in order to determine blockchain’s potential in the future of cyber securit

An investigation of the response of entities in the South African JSE ICT sector in 2005 to environmental sustainability reporting

Pressure is on organisations the world over to report to their stakeholders, not only on their economic performance, but also on their environmental and social performance. In South Africa the King II code of corporate governance provides the guidance and impetus for this integrated “triple bottom line” sustainability reporting. The ICT sector in South Africa has been cited as lagging behind other sectors with regards to sustainability reporting, particularly in environmental sustainability reporting. Many ICT organisations would appear to be using their office and service based existence as reasons for having little or no impact on the environment. The study of the impacts of ICT on environmental sustainability in this research suggests that this is not necessarily the case. An assessment tool based on the internationally recognised Global Reporting Initiative Guidelines was developed in this research to investigate the level of environmental sustainability reporting in the South African ICT sector. The investigation showed the level of environmental sustainability reporting in the sector’s 2005 annual reports to be low. To get an indication of the level of reporting in more developed countries, a small sample of international ICT and service organisations was assessed using the tool, which showed significantly higher levels of environmental sustainability reporting. A set of ICT specific environmental sustainability performance indicators are proposed to enhance and encourage more significant levels of environmental sustainability reporting in South Africa

A comparison study of search heuristics for an autonomous multi-vehicle air-sea rescue system

The immense power of the sea presents many life-threatening dangers to humans, and many fall foul of its unforgiving nature. Since manned rescue operations at sea (and indeed other search and rescue operations) are also inherently dangerous for rescue workers, it is common to introduce a level of autonomy to such systems. This thesis investigates via simulations the application of various search algorithms to an autonomous air-sea rescue system, which consists of an unmanned surface vessel as the main hub, and four unmanned helicopter drones. The helicopters are deployed from the deck of the surface vessel and are instructed to search certain areas for survivors of a stricken ship. The main aim of this thesis is to investigate whether common search algorithms can be applied to the autonomous air-sea rescue system to carry out an efficient search for survivors, thus improving the present-day air-sea rescue operations. Firstly, the mathematical model of the helicopter is presented. The helicopter model consists of a set of differential equations representing the translational and rotational dynamics of the whole body, the flapping dynamics of the main rotor blades, the rotor speed dynamics, and rotational transformations from the Earth-fixed frame to the body frame. Next, the navigation and control systems are presented. The navigation system consists of a line-of-sight autopilot which points each vehicle in the direction of its desired waypoint. Collision avoidance is also discussed using the concept of a collision cone. Using the mathematical models, controllers are developed for the helicopters: Proportional-Integral-Derivative (PID) and Sliding Mode controllers are designed and compared. The coordination of the helicopters is carried out using common search algorithms, and the theory, application, and analysis of these algorithms is presented. The search algorithms used are the Random Search, Hill Climbing, Simulated Annealing, Ant Colony Optimisation, Genetic Algorithms, and Particle Swarm Optimisation. Some variations of these methods are also tested, as are some hybrid algorithms. As well as this, three standard search patterns commonly used in maritime search and rescue are tested: Parallel Sweep, Sector Search, and Expanding Square. The effect of adding to the objective function a probability distribution of target locations is also tested. This probability distribution is designed to indicate the likely locations of targets and thus guide the search more effectively. It is found that the probability distribution is generally very beneficial to the search, and gives the search the direction it needs to detect more targets. Another interesting result is that the local algorithms perform significantly better when given good starting points. Overall, the best approach is to search randomly at the start and then hone in on target areas using local algorithms. The best results are obtained when combining a Random Search with a Guided Simulated Annealing algorithm

The study design and rationale of the randomized controlled trial: translating COPD guidelines into primary care practice

Background: Chronic obstructive pulmonary disease (COPD) is a progressive, debilitating disease associated with significant clinical burden and is estimated to affect 15 million individuals in the US. Although a large number of individuals are diagnosed with COPD, many individuals still remain undiagnosed due to the slow progression of the disorder and lack of recognition of early symptoms. Not only is there under-diagnosis but there is also evidence of sub-optimal evidence-based treatment of those who have COPD. Despite the development of international COPD guidelines, many primary care physicians who care for the majority of patients with COPD are not translating this evidence into effective clinical practice. Method/Design This paper describes the design and rationale for a randomized, cluster design trial (RCT) aimed at translating the COPD evidence-based guidelines into clinical care in primary care practices. During Phase 1, a needs assessment evaluated barriers and facilitators to implementation of COPD guidelines into clinical practice through focus groups of primary care patients and providers. Using formative evaluation and feedback from focus groups, three tools were developed. These include a computerized patient activation tool (an interactive iPad with wireless data transfer to the spirometer); a web-based COPD guideline tool to be used by primary care providers as a decision support tool; and a COPD patient education toolkit to be used by the practice team. During phase II, an RCT will be performed with one year of intervention within 30 primary care practices. The effectiveness of the materials developed in Phase I are being tested in Phase II regarding physician performance of COPD guideline implementation and the improvement in the clinically relevant outcomes (appropriate diagnosis and management of COPD) compared to usual care. We will also examine the use of a patient activation tool - ‘MyLungAge’ - to prompt patients at risk for or who have COPD to request spirometry confirmation and to request support for smoking cessation if a smoker. Discussion Using a multi-modal intervention of patient activation and a technology-supported health care provider team, we are testing the effectiveness of this intervention in activating patients and improving physician performance around COPD guideline implementation. Trial registration ClinicalTrials.gov, NCT0123756

Systematic review of high-dose amikacin regimens for the treatment of Gram-negative infections based on EUCAST dosing recommendations

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI linkBackground: Updated European Committee on Antimicrobial Susceptibility Testing (EUCAST) amikacin breakpoints for Enterobacterales and Pseudomonas aeruginosa included revised dosing recommendations of 25–30 mg/kg to achieve key pharmacokinetic/pharmacodynamic parameters, higher than recommended in the British National Formulary. The objectives of this review were to identify clinical evidence for high-dose amikacin regimens and to determine drug exposures that are related to adverse events and toxicity. Methods: The literature search was conducted in October 2021 and updated in May 2022 using electronic databases for any study reporting adult participants treated with amikacin at doses ≥20 mg/kg/day. Reference lists of included papers were also screened for potential papers. Data were extracted for pharmacokinetic parameters and clinical outcomes, presented in a summary table and consolidated narratively. Meta-analysis was not possible. Each study was assessed for bias before, during and after the intervention using the ROBINS-I tool. Results: Nine studies (total 501 participants in 10 reports) were identified and included, eight of which were observational studies. Assessment of bias showed substantial flaws. Dosing regimens ranged from 25 to 30 mg/kg/day. Six studies adjusted the dose in obesity when participants had a body mass index of ≥30 kg/m2. Target peak serum concentrations ranged from 60 mg/L to 80 mg/L and 59.6–81.8% of patients achieved these targets, but there was no information on clinical outcomes. Two studies reported the impact of high-dose amikacin on renal function. No studies reporting auditory or vestibular toxicity were identified. Conclusion: All included papers were limited by a significant risk of bias, while methodological and reporting heterogeneity made drawing conclusions challenging. Lack of information on the impact on renal function or ototoxicity means high-dose regimens should be used cautiously in older people. There is a need for a consensus guideline for high-dose amikacin to be written. Trial registration number: PROSPERO (CRD42021250022