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Context: Machine learning (ML) software systems are permeating many aspects of our life, such as healthcare, transportation, banking, and recruitment. These systems are trained with data that is often biased, resulting in biased behaviour. To address this issue, fairness testing approaches have been proposed to test ML systems for fairness, which predominantly focus on assessing classification-based ML systems. These methods are not applicable to regression-based systems, for example, they do not quantify the magnitude of the disparity in predicted outcomes, which we identify as important in the context of regression-based ML systems. Method: We conduct this study as design science research. We identify the problem instance in the context of emergency department (ED) wait-time prediction. In this paper, we develop an effective and efficient fairness testing approach to evaluate the fairness of regression-based ML systems. We propose fairness degree, which is a new fairness measure for regression-based ML systems, and a novel search-based fairness testing (SBFT) approach for testing regression-based machine learning systems. We apply the proposed solutions to ED wait-time prediction software. Results: We experimentally evaluate the effectiveness and efficiency of the proposed approach with ML systems trained on real observational data from the healthcare domain. We demonstrate that SBFT significantly outperforms existing fairness testing approaches, with up to 111% and 190% increase in effectiveness and efficiency of SBFT compared to the best performing existing approaches. Conclusion: These findings indicate that our novel fairness measure and the new approach for fairness testing of regression-based ML systems can identify the degree of fairness in predictions, which can help software teams to make data-informed decisions about whether such software systems are ready to deploy. The scientific knowledge gained from our work can be phrased as a technological

OBJECTIVE: To estimate the total economic impact of peripheral intravenous catheter (PIVC) or cannula insertion and use in adult Australian EDs, including those cannulas that remain unused for therapeutic purposes. METHODS: Searches on Australian government websites were conducted to find rates of insertion, complications and cost of cannula; following this, gaps in national data sets were filled with MEDLINE and PubMed searches to estimate the total cost of cannula use in Australian EDs. Once the data were collected, totals were combined to establish an estimated cost for the listed categories. RESULTS: The estimated cost of cannulation in Australia may be up to A$594 million per year, including the cost of insertion (equipment and staff), cost of complications such as Staphylococcus aureus bacteraemia and phlebitis, and patient-centred costs (lost patient productivity, infiltration, occlusion and dislodgement). Approximately A$305.9 million is attributed to unused cannulas and approximately 11 790 days of clinician time is spent annually inserting cannula that remains idle. CONCLUSION: The figures developed in the present study represent an important educational opportunity to encourage thoughtful consideration of all interventions, no matter how small. ED cannula insertion represents a large economic and health cost to Australia's health system, many of which remain unused. There are no national data sets that record complications associated with PIVCs and we highlight the urgent need for improved data.

Personal protective equipment (PPE) is essential for healthcare worker (HCW) safety. Conservation of PPE for clinical use during the COVID-19 pandemic reduced its availability for training, necessitating an innovative approach to sourcing high physical resemblance PPE (HPR-PPE). We present a case study of crowd-sourcing of HPR-PPE to train HCWs. Survey results indicated that HPR-PPE enabled high-fidelity practise of PPE application and removal, aided procedure recall, improved user confidence and was sufficiently similar to medical-grade PPE. HPR-PPE provided a novel and cost-effective alternative. We also demonstrated that medical-grade PPE can be sourced from non-medical institutions and businesses during a pandemic.Copyright © 2021 The Healthcare Infection Society

BACKGROUND: High-sensitivity cardiac troponin I (hs-cTnI) assays promise high diagnostic accuracy for myocardial infarction (MI). In an ED where conventional cTnI was in use, we evaluated an assessment pathway using the new Access hsTnI assay. METHOD(S): This retrospective analysis recruited ED patients with suspected MI between June and September 2019. All patients received routine care with a conventional cTnI assay (AccuTnI +3: limit of detection (LoD) 10ng/L, 99th centile upper reference limit (URL) 40ng/L, abnormal elevation cut-point 80ng/L). Arrival, then 90-minute or 360-minute cTnI levels for low and non-low risk patients, respectively (ED Assessment of Chest pain score) guided diagnosis and disposition which was at treating physician discretion. The same patients had arrival and 90-minute or 180-minute samples drawn for hs-cTnI levels (Access hsTnI: LoD 2ng/L, 99th centile URL 10ng/L (females) and 20ng/L (males); abnormal elevation above the URL and delta >30%). Treating physicians were blinded to the hs-cTnI results. Using the hs-cTnI values, investigators retrospectively assigned likely diagnosis, disposition and likelihood of a 30-day major adverse cardiac event (MACE). Admission was recommended for significantly rising hs-cTnI elevations. The primary objective was to demonstrate an acceptable unexpected 30-day post-discharge MACE rate of <1%. cTnI elevation rates, diagnostic outcomes and ED disposition were also compared between pathways. RESULT(S): For the 935 patients, unexpected 30-day post-discharge MACE rates were 0/935 (0%, 95% CI 0% to 0.4%) with the conventional or novel pathway. For the high-sensitivity and conventional assays, respectively, abnormal elevation rates were 29% (95% CI 26% to 32%) and 19% (95% CI 17% to 22%), for MI were 9% (95% CI 8% to 11%) and 8% (95% CI 6% to 10%), and for hospital admission were 42% (95% CI 39% to 45%) and 43% (95% CI 40% to 47%). CONCLUSION(S): The novel pathway using the Access hsTnI assay has an acceptabl

Women have generally worse outcomes after myocardial infarction (MI) compared to men. The reasons for these disparities are multifactorial. At the beginning is the notion-widespread in the community and health care providers-that women are at low risk for MI. This can impact on primary prevention of cardiovascular disease in women, with lower use of preventative therapies and lifestyle counselling. It can also lead to delays in presentation in the event of an acute MI, both at the patient and health care provider level. This is of particular concern in the case of ST elevation MI (STEMI), where "time is muscle". Even after first medical contact, women with acute MI experience delays to diagnosis with less timely reperfusion and percutaneous coronary intervention (PCI). Compared to men, women are less likely to undergo invasive diagnostic testing or PCI. After being diagnosed with a STEMI, women receive less guideline-directed medical therapy and potent antiplatelets than men. The consequences of these discrepancies are significant-with higher mortality, major cardiovascular events and bleeding after MI in women compared to men. We review the sex disparities in pathophysiology, risk factors, presentation, diagnosis, treatment, and outcomes for acute MI, to answer the question: are they due to biology or bias, or both?Copyright © 2020

Personal protective equipment (PPE) is essential for health care worker (HCW) safety. Conservation of PPE for clinical use during the COVID-19 pandemic reduced its availability for training, necessitating an innovative approach to sourcing high physical resemblance PPE (HPR-PPE). We present a case study of crowd-sourcing HPR-PPE to train HCW. Survey results indicated that HPR-PPE enabled high-fidelity practice of PPE application and removal, aided procedure recall, improved user confidence and was sufficiently similar to medical-grade PPE. HPR-PPE provided a novel and cost-effective alternative. We also demonstrated that medical-grade PPE can be sourced from non-medical institutions and businesses during a pandemic.Copyright © 2021 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

BACKGROUND: 'Gold standard' sepsis care encompasses the recognition and treatment of sepsis within one hour of emergency department (ED) presentation. Early treatment of patients with sepsis reduces mortality. The aim of this study was to examine the effect that the nurse allocated Australasian Triage Scale (ATS) Category allocation had on ED patient treatment for severe sepsis and septic shock. METHOD(S): A two-year retrospective observational cohort study from a single major metropolitan ED, including all patients with severe sepsis or septic shock. RESULT(S): Sixty patients were included in this study. Sepsis was recognised at triage for the majority of patients (n=38, 63%), and most were allocated an ATS Category Two (n=39). Almost half of the patients received all elements of the sepsis bundle within one hour of arrival (n=27,45%). Patients allocated an ATS Category One or Two had a shorter time to lactate collection (p=0.003), blood culture procurement (p=0.009) and intravenous antibiotic administration (p=0.021) compared with patients who were allocated ATS Category Three or Four. CONCLUSION(S): Most patients presenting with sepsis were recognised by the triage nurse and allocated a high acuity ATS category accordingly. As sepsis is a time-critical condition and a high acuity triage allocation reduces time to treatment, we recommend all Australian EDs should implement a standard approach to sepsis triage by allocating an ATS Category of One or Two to all patients suspected of having sepsis, thus reflecting the urgency of their disease.Copyright © 2020 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

BACKGROUND: With the increasing complexity of procedures being performed in the cardiac catheterisation laboratory, the multidisciplinary team has the challenge of providing safe care to patients who present with a multitude of healthcare needs. Although the use of a surgical safety checklist has become standard practice in operating theatres worldwide, the use of a pre-procedure checklist has not been routinely adopted into interventional cardiology. OBJECTIVE: The aim of this study was to design and evaluate a pre-procedure checklist specific to the cardiac catheterisation laboratory. METHOD: A descriptive, exploratory design was used to develop a specifically designed pre-procedure checklist for use in the cardiac catheterisation laboratory in a private hospital in Melbourne, Australia. The pre-procedure checklist was developed by exploring the multidisciplinary team's opinion regarding the organisation's previous surgical pre-procedure checklist through a pre-implementation survey and focus groups. Following an expert review, and implementation of the proposed pre-procedure checklist, a post-implementation survey was completed. RESULTS: Thirty-five (70%) cardiac catheterisation laboratory healthcare professionals completed the pre-implementation survey, with 31 (62%) completing the post-implementation survey. Ninety-one per cent of participants agreed that important clinical information required for interventional procedures was not documented on the previous surgical checklist. A specific checklist was developed from the results of the survey and six focus groups (N = 25) and implemented in the cardiac catheterisation laboratory. In the post-implementation survey, participants identified that the cardiac catheterisation laboratory specific pre-procedure checklist included all relevant clinical information and improved documentation of patient information. CONCLUSION: The development of a specific cardiac catheterisation laboratory pre-procedure checklist has le

The LSM-YSZ interactions along the cathode/electrolyte interface of solid oxide fuel cells operated at 750 °C with ambient air or oxygen as cathode gas are investigated. Secondary phase formation across the LSM/YSZ interface is examined by transmission electron microscopy (TEM), energy-dispersive x-ray spectroscopy (EDS), electron energy-loss spectroscopy (EELS) and energy-filtered TEM (EFTEM). Two substantially different LSM-YSZ reactions are observed. In the air-tested cell, Zr-rich phases are found to form inside the LSM which is in contact with YSZ. The Zr-rich phases are proposed to be a precursor phase of insulating zirconate and are probably responsible for aggravating cathode degradation by blocking the triple-phase boundary (TPB) active sites. In the oxygen-tested cell, no formation of Zr-rich phases occurs because the LSM could still maintain its A-site deficiency in higher oxygen partial pressure. Although formation of a Mn3O4 phase along the LSM/YSZ interface is observed, the absence of a zirconate phase allows the TPBs to remain unimpaired to a large extent and therefore, the cell exhibits milder cathode degradation. Theoretical calculations of the Mn solubility in the LSM and YSZ as a function of oxygen partial pressure and temperature is also performed, providing an explanation for the observed difference of LSM stability, LSM-YSZ interactions in air and in pure oxygen, respectively.

INTRODUCTION: High rates of mortality and morbidity result from disasters of all types, including armed conflicts. Overwhelming numbers of casualties with a myriad of illnesses and patterns of injuries are common in armed conflicts, leading to unpredictable workloads for hospital health care providers (HCPs). Identifying domains of hospital HCPs' core competency for armed conflicts is essential to inform standards of care, educational requirements, and to facilitate the translation of knowledge into safe and quality care. OBJECTIVE(S): The objective of this study is to identify the common domains of core competencies among HCPs working in hospitals in armed conflict areas. METHOD(S): A scoping review was conducted using the Joanna Briggs Institute framework. The review considered primary research and peer-reviewed literature from the following databases: Ovid Medline, Ovid EmCare, Embase, and CINAHL, as well as the reference lists of articles identified for full-text review. Eligibility criteria were outlined a priori to guide the literature selection. RESULT(S): Four articles met the inclusion criteria. The studies were conducted in different countries and were published from 2011 through 2017. The methods included three surveys and one Delphi study. CONCLUSION(S): This review maps the scope of knowledge, skills, and attitudes required by HCPs who are practicing in hospitals in areas of major armed conflict. Incorporation of identified core competency domains can improve the future planning, education, and training, and may enhance the HCPs' response in armed conflicts.