By assessing nonhospitalized asymptomatic patients, community-based studies inform the prevalence, key clinical characteristics, and outcomes associated with diastolic dysfunction. As the number of ...parameters to define and grade diastolic function continues to increase, there has been a shift to a focus on readily obtainable measurements with minimal interobserver variability. In this regard, mitral inflow and annular tissue Doppler velocities, as well as measurement of left atrial volume index, are the most feasible and reproducible. Within communities, variations in definitions have limited generalizability regarding the prevalence and risks associated with diastolic dysfunction. Nevertheless, community-based studies have established important associations with hypertension, obesity, and diabetes. Randomized controlled trials of treatment in heart failure with preserved ejection fraction have been disappointing. Importantly, diastolic dysfunction is consistently associated with higher mortality, which emphasizes the importance of early recognition and initiation of appropriate preventative treatments.
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•Epidemiological studies provide insight into the natural history, risk factors, and pathophysiology of diastolic dysfunction.•Key prognostic parameters are left atrial volume index and E/e′, which are feasible and reliably assessed.•Hypertension, diabetes, and obesity are consistently associated with diastolic dysfunction.
Designed as an 'ideal city' and emblem of the nation, Canberra has long been a source of ambivalence for many Australians. In this charming and concise book, Nicholas Brown challenges these ideas and ...looks beyond the clichés to illuminate the unique, layered and often colourful history of Australia's capital. Brown covers Canberra's selection as the site of the national capital, the turbulent path of Walter Burley Griffin's plan for the city and the many phases of its construction. He surveys citizens' diverse experiences of the city, the impact of the Second World War on Canberra's growth and explores the city's political history with insight and wit. A History of Canberra is informed by the interplay of three themes central to Canberra's identity: government, community and environment. Canberra's distinctive social and cultural history as a centre for the public service and national institutions is vividly rendered.
To quantify any relationship between emergency department (ED) overcrowding and 10-day patient mortality.
Retrospective stratified cohort analysis of three 48-week periods in a tertiary mixed ED in ...2002-2004. Mean "occupancy" (a measure of overcrowding based on number of patients receiving treatment) was calculated for 8-hour shifts and for 12-week periods. The shifts of each type in the highest quartile of occupancy were classified as overcrowded.
All presentations of patients (except those arriving by interstate ambulance) during "overcrowded" (OC) shifts and during an equivalent number of "not overcrowded" (NOC) shifts (same shift, weekday and period).
In-hospital death of a patient recorded within 10 days of the most recent ED presentation.
There were 34 377 OC and 32 231 NOC presentations (736 shifts each); the presenting patients were well matched for age and sex. Mean occupancy was 21.6 on OC shifts and 16.4 on NOC shifts. There were 144 deaths in the OC cohort and 101 in the NOC cohort (0.42% and 0.31%, respectively; P=0.025). The relative risk of death at 10 days was 1.34 (95% CI, 1.04-1.72). Subgroup analysis showed that, in the OC cohort, there were more presentations in more urgent triage categories, decreased treatment performance by standard measures, and a higher mortality rate by triage category.
In this hospital, presentation during high ED occupancy was associated with increased in-hospital mortality at 10 days, after controlling for seasonal, shift, and day of the week effects. The magnitude of the effect is about 13 deaths per year. Further studies are warranted.
Nowadays, Australian state and local governments consider Green Infrastructure (GI) planning as a mitigation and adaptation approach to make cities more resilient. Moreover, decision-makers have ...acknowledged and addressed social values, biodiversity, and habitat connectivity in policy documents. Canberra in the Australian Capital Territory (ACT), is a unique Australian city since it is totally designed as the National Capital of Australia and is built on a grassland plain, inspired by the Garden City concept. The green and open spaces have a symbolic value, representing Canberra as the national capital. However, Canberra is experiencing increasing urban development pressure, which threatens its green and open spaces. Thus, it is critical to explore the GI status in governance and decision-making in Canberra to guide its future planning. This research explores ten policy documents using a reflexive analysis to interpretatively critique policy documents and to diagnose the existing opportunities and constraints in Canberra’s GI planning. The documents were selected from 4 main defined scopes, Australian Government land-use responsibilities, ACT Government land-use planning and strategy, ACT Government greenspace planning, and Tree management regulations and mechanisms. This research identified dual governance (national/territory) and dual nature character (native/exotic) in the policy documents, which has intensified the complexity of GI planning. Another constraint was the lack of district level planning and a structured bottom-up approach. More flexibility in governance and collaboration between different governance levels and agencies is needed to make a more effective GI network, using the existing opportunities such as open space systems. Although GI principles have been addressed at Canberra’s strategic level, more comprehensive GI planning is needed to address all types of greenspaces.
Canberra's dual status as national capital and local city dramatically affected the rise of a unique contemporary arts scene. This complex story, informed by rich archival material and interviews, ...details the triumph of local arts practice and community over the insistent cultural nation-building of Australia's capital. It exposes local arts as a vital force in Canberra's development and uncovers the influence of women in the growth of its visual arts culture. A broad illumination of the city-wide development of arts and culture from the 1920s to 2001 is combined with the story of Bitumen River Gallery and its successor Canberra Contemporary Art Space from 1978 to 2001. This history traces the growth of the arts from a community-led endeavour, through a period of responses to social and cultural needs, and ultimately to a humanising local practice that transcended national and international boundaries.
•It is demonstrated that the difference of short-circuit current characteristics between renewable energy sources and synchronous generators.•The pilot protection based on Canberra distance is less ...affected by short-circuit current amplitude and abnormal data, and has good applicability in scenarios with the weak output of renewable energy sources.•The protection based on waveform differential breaks through the limitation of power frequency and solves the problems faced by traditional differential protection.
Affected by the control objectives of the inverter, the short-circuit characteristics of renewable energy sources are quite different from those of traditional synchronous generators. As a result, the performance of traditional protection is degraded, and may lead to mis-operation and rejection, posing hazards for the safety of the power grid. In this research, the fault characteristics of renewable energy sources and traditional synchronous generators are analyzed and compared. Then, according to the difference between the fault transient current waveforms of two power sources, a pilot protection principle based on Canberra distance is proposed. Considering the phase angle error and amplitude error during normal operation, the protection constant is theoretically set to 0.35. Simulations and field experiments show that the protection principle reliably distinguishes the faults inside and outside the zone in different scenarios. The protection is less affected by short-circuit current amplitude and abnormal data, because the numerator of Canberra distance signifies the difference between the transient current waveforms and denominator normalizes the difference. In addition, the Canberra distance is 1 when the output of renewable energy sources is 0, so the proposed protection is also applicable to the scenario where the renewable energy sources output is 0.
Background subtraction always remains an important and challenging task for different applications. Our previous work established the effectiveness of hybrid model by exploiting the oriented patterns ...present in a video sequences over other statistical method. To extend this approach further, we have proposed a novel approach herein by eliminating GLCM based features with an improved local Zernike moment and color components of intensity. These features are clubbed with the orientation based features extracted from angle co-occurrence matrices (ACMs) to model the background. Furthermore the Mahalanobis distance measure is replaced by Canberra distance to categorized foreground and background pixels, which significantly reduces the computational complexity of the proposed method due to the absence of covariance matrix measure. Comparative results have shown that our proposed method is effective than other competing method on different set of video sequences.
Summary Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective ...medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions ( r =0·83), and human resources for health per 1000 ( r =0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Funding Bill & Melinda Gates Foundation.
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