HELPING TO EXPLAIN LIGHTING QUALITY & ENERGY EFFICIENCY TO NON-EXPERTS

CIBSE & SLL International lighting Conferenc

End of life hospitalisations differ for older Australian women according to death trajectory: a longitudinal data linkage study

BACKGROUND: Hospitalisations are the prime contributor to healthcare expenditure, with older adults often identified as high hospital users. Despite the apparent high use of hospitals at the end of life, limited evidence currently exists regarding reasons for hospitalisation. Understanding complex end of life care needs is required for future health care planning as the global population ages. This study aimed to investigate patterns of hospitalisation in the last year of life by cause of death (COD) as well as reasons for admission and short-term predictors of hospital use. METHODS: Survey data from 1,205 decedents from the 1921-1926 cohort of the Australian Longitudinal Study on Women's Health were matched with the state-based hospital records and the National Death Index. Hospital patterns based on COD were graphically summarised and multivariate logistic regression models examined the impact of short-term predictors of length of stay (LOS). RESULTS: 85 % of women had at least one admission in the last year of life; and 8 % had their first observed admission during this time. Reasons for hospitalisation, timing of admissions and LOS differed by COD. Women who died of cancer, diabetes and 'other' causes were admitted earlier than women who died of organ failure, dementia and influenza. Women who died of organ failure overall spent the longest time in hospital, and women with cancer had the highest median LOS. Longer LOS was associated with previous short- and medium-term- hospitalisations and type of hospital separation. CONCLUSIONS: Reducing acute care admissions and LOS at the end of life is complex and requires a shift in perceptions and treatment regarding end of life care and chronic disease management

Expertise in Law Enforcement

Book Chapte

Angiogenic gene signature in human pancreatic cancer correlates with TGF-beta and inflammatory transcriptomes

Pancreatic ductal adenocarcinomas (PDACs) are hypovascular, but overexpress pro-angiogenic factors and exhibit regions of microvasculature. Using RNA-seq data from The Cancer Genome Atlas (TCGA), we previously reported that ~12% of PDACs have an angiogenesis gene signature with increased expression of multiple pro-angiogenic genes. By analyzing the recently expanded TCGA dataset, we now report that this signature is present in ~35% of PDACs but that it is mostly distinct from an angiogenesis signature present in pancreatic neuroendocrine tumors (PNETs). These PDACs exhibit a transcriptome that reflects active TGF-β signaling, and up-regulation of several pro-inflammatory genes, and many members of JAK signaling pathways. Moreover, expression of SMAD4 and HDAC9 correlates with endothelial cell abundance in PDAC tissues. Concomitantly targeting the TGF-β type I receptor (TβRI) kinase with SB505124 and JAK1-2 with ruxolitinib suppresses JAK1 phosphorylation and blocks proliferative cross-talk between human pancreatic cancer cells (PCCs) and human endothelial cells (ECs), and these anti-proliferative effects were mimicked by JAK1 silencing in ECs. By contrast, either inhibitor alone does not suppress their enhanced proliferation in 3D co-cultures. These findings suggest that targeting both TGF-β and JAK1 signaling could be explored therapeutically in the 35% of PDAC patients whose cancers exhibit an angiogenesis gene signature

Accuracy of self-reported medicines use compared to pharmaceutical claims data amongst a national sample of older Australian women

This study assessed agreement between two measures of medicine use, self-report by mail and pharmaceutical claims data, for a national sample (N = 4687) of older women aged 79 to84 in2005, from the Australian Longitudinal Study on Women’s Health. Medicines used for common chronic diseases in older people were selected, with pharmaceutical claims data retrieval periods of three and six months. For six month retrieval, Kappa’s ranged between 0.44 (nervous system medicines) and 0.94 (glucose lowering medicines). For three month retrieval, aspirin (Kappa: 0.35) and folic acid (Kappa = 0.48) had lowest agreement. Women were least able to accurately report use of nervous system medicines (sensitivity < 50%), and most accurately report glucose lowering medicines use (sensitivity > 80%). Specificity was consistently high across all classes, suggesting women could accurately report using a medicine. Pharmaceutical claims data can assist evaluation of judicious medicines use, changes to availability and uptake of medicines, and track medicine expenditure for chronic conditions. Over-the-counter medicines, medicines not covered by pharmaceutical subsidies and those used on an as needed basis may be best measured by self-report, as use may be underestimated using pharmaceutical claims data

Advancing ACTA: Developing Socio-Cognitive Competence/Insight

ABSTRACT Accelerating the cognitive expertise of engineering professionals is a critical challenge for many high reliability, international organizations. This paper reports a collaborative, longitudinal, academic practitioner project which aimed to elicit, document and accelerate the cognitive expertise of engineering professional working with the manufacture and management of petroleum additives. 25 engineering experts were trained by three academic psychologists to use applied cognitive task analysis (ACTA) interview techniques in order to document the cognition of their expert peers. Results had high face validity for practitioners who elicited hot/sensory based cognition, a number of perceptual skills and mental models, highlighting undocumented context specific expertise. We conclude from a peer review of findings combined with experienced CTA analysts that ACTA techniques can be advanced in context by the explicit recognition and development of socio-cognitive competence /insight

The Underpinnings of Workload in Unmanned Vehicle Systems

This paper identifies and characterizes factors that contribute to operator workload in unmanned vehicle systems. Our objective is to provide a basis for developing models of workload for use in design and operation of complex human-machine systems. In 1986, Hart developed a foundational conceptual model of workload, which formed the basis for arguably the most widely used workload measurement techniquethe NASA Task Load Index. Since that time, however, there have been many advances in models and factor identification as well as workload control measures. Additionally, there is a need to further inventory and describe factors that contribute to human workload in light of technological advances, including automation and autonomy. Thus, we propose a conceptual framework for the workload construct and present a taxonomy of factors that can contribute to operator workload. These factors, referred to as workload drivers, are associated with a variety of system elements including the environment, task, equipment and operator. In addition, we discuss how workload moderators, such as automation and interface design, can be manipulated in order to influence operator workload. We contend that workload drivers, workload moderators, and the interactions among drivers and moderators all need to be accounted for when building complex, human-machine systems