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 is a city of orphans. People arrive temporarily for work, but stay on because they discover unanticipated promise and opportunity in a city that the rest of the country loathes but can’t ...really do without. Daley’s Canberra begins and ends at the lake and its forgotten suburbs, traces of which can still be found on Burley Griffin’s banks. It meanders through the cultural institutions that chronicle the unsavoury early life of Canberra, the graveyard at St John’s where the pioneers rest and the mountains that surround the city. In Canberra people don’t ask you where you went to school, as they do in Melbourne, or where your house is and how much you paid for it, as they do in Sydney. They ask you where you’ve come from. And how long you’re going to stay.
•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.
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.
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