Implementation of individualised medication administration guides for patients with dysphagia: Results from a pilot controlled trial

Introduction Patients with dysphagia (PWDs) have been shown to be four times more likely to suffer medication administration errors (MAEs).1 2 Individualised medication administration guides (I-MAGs) which outline how each formulation should be administered, have been developed to standardise medication administration by nurses on the ward and reduce the likelihood of errors. This pilot study aimed to determine the recruitment rates, estimate effect on errors and develop the intervention to design a future full scale randomised controlled trial to determine the costs and effects of I-MAG implementation. Ethical approval was granted by local ethics committee. Method Software was developed to enable I-MAG production (based on current best practice)3 4 for all PWDs on two care of the older person wards admitted during a six month period from January to July 2011. I-MAGs were attached to the medication administration record charts to be utilised by nurses when administering medicines. Staff training was provided for all staff on the intervention wards. Two care of the older person wards in the same hospital were used for control purposes. All patients with dysphagia were recruited for follow up purposes at discharge. Four ward rounds at each intervention and control ward were observed pre and post I-MAG implementation to determine the level of medication administration errors. NHS ethical approval for the study was obtained. Results 164 I-MAGs were provided for 75 patients with dysphagia (PWDs) in the two intervention wards. At discharge, 23 patients in the intervention wards and 7 patients in the control wards were approached for recruitment of which 17 (74%) & 5 (71.5%) respectively consented. Discussion Recruitment rates were low on discharge due to the dysphagia remitting during hospitalisation. The introduction of the I-MAG demonstrated no effect on the quality of administration on the intervention ward and interestingly practice improved on the control ward. The observation of medication rounds at least one month post I-MAG removal may have identified a reversal to normal practice and ideally observations should have been undertaken with I-MAGs in place. Identification of the reason for the improvement in the control ward is warranted.

Wood density : a tool to find complementary species for the design of mixed species plantations

The successful establishment and growth of mixed-species forest plantations requires that complementary or facilitatory species be identified. This can be difficult in many tropical areas because the growth characteristics of endemic species are often unknown, particularly when grown at potentially higher densities in plantations than in natural forests. Here, we investigate whether wood density is a useful and readily accessible trait for choosing complementary species for mixed species plantations. Wood density represents the carbon investment per unit volume of stem with a trade-off generally found between fast (low wood density) and slow (high wood density) growing species. To do this, we use data collected from 18 highly diverse mixed species plantations (4–23 mostly native species) aged from 6 to 11 years at the time of data collection located on Leyte Island, Philippines. We found significant negative correlations between wood densities and the height of the most abundant species, as well as with measures of overall stand growth and tree diameter size distribution. Not only do species with denser woods have slower growth rates, but also mixed-species plantations with higher average wood density and higher stem density were also less productive, at least in these young plantations. Similarly, stands with a high diversity in wood densities were less productive. There is growing interest in making greater use of native multi-species mixtures in smallholder and community planting programs in the tropics, and our results show databases of wood density values may help improve their design. In the early development stages of plantations, canopy closure and rapid height growth are usually key silvicultural targets, and wood density values can predict the rapid height development of species. If plantations are being grown for the livelihood of small landholders then the best target is to choose some species with different wood densities. This allows an early harvest of low-wood density species for early income, and will also reduce competition for slower growing trees with higher wood densities for later income generation.

Comparing the effectiveness of education and technology in reducing wood smoke pollution: A field experiment

This study describes a field experiment assessing the effectiveness of education and technological innovation in reducing air pollution generated by domestic wood heaters. Two-hundred and twenty four households from a small regional center in Australia were randomly assigned to one of four experimental conditions: (1) Education only – households received a wood smoke reduction education pack containing information about the negative health impacts of wood smoke pollution, and advice about wood heater operation and firewood management; (2) SmartBurn only – households received a SmartBurn canister designed to improve combustion and help wood fires burn more efficiently, (3) Education and SmartBurn, and (4) neither Education nor SmartBurn (control). Analysis of covariance, controlling for pre-intervention household wood smoke emissions, wood moisture content, and wood heater age, revealed that education and SmartBurn were both associated with significant reduction in wood smoke emissions during the post-intervention period. Follow-up mediation analyses indicated that education reduced emissions by improving wood heater operation practices, but not by increasing health risk perceptions. As predicted, SmartBurn exerted a direct effect on emission levels, unmediated by wood heater operation practices or health risk perceptions.

“This is not a burning issue for me”: How citizens justify their use of wood heaters in a city with a severe air pollution problem

Although wood smoke pollution has been linked to health problems, wood burning remains a popular form of domestic heating in many countries across the world. In this paper, we describe the rhetoric of resistance to wood heater regulation amongst citizens in the regional Australian town of Armidale, where wood smoke levels regularly exceed national health advisory limits. We discuss how this is related to particular sources of resistance, such as affective attachment to wood heating and socio-cultural norms. The research draws on six focus groups with participants from households with and without wood heating. With reference to practice theory, we argue that citizen discourses favouring wood burning draw upon a rich suite of justifications and present this activity as a natural and traditional activity promoting comfort and cohesion. Such discourses also emphasise the identity of the town as a rural community and the supposed gemeinschaft qualities of such places. We show that, in this domain of energy policy, it is not enough to present ‘facts’ which have little emotional association or meaning for the populace. Rather, we need understand how social scripts, often localised, inform identity and practice.

The affect heuristic and public support for three types of wood smoke mitigation policies

This study applied the affect heuristic model to investigate key psychological factors (affective associations, perceived benefits, and costs of wood heating) contributing to public support for three distinct types of wood smoke mitigation policies: education, incentives, and regulation. The sample comprised 265 residents of Armidale, an Australian regional community adversely affected by winter wood smoke pollution. Our results indicate that residents with stronger positive affective associations with wood heating expressed less support for wood smoke mitigation policies involving regulation. This relationship was fully mediated by expected benefits and costs associated with wood heating. Affective associations were unrelated to public support for policies involving education and incentives, which were broadly endorsed by all segments of the community, and were more strongly associated with rational considerations. Latent profile analysis revealed no evidence to support the proposition that some community members experience internal “heart versus head” conflicts in which their positive affective associations with wood heating would be at odds with their risk judgments about the dangers of wood smoke pollution. Affective associations and cost/benefit judgments were very consistent with each other.

Particle number and mass emission factors from combustion of wood samples collected from Queensland forest

Knowledge of particle emission characteristics associated with forest fires and in general, biomass burning, is becoming increasingly important due to the impact of these emissions on human health. Of particular importance is developing a better understanding of the size distribution of particles generated from forest combustion under different environmental conditions, as well as provision of emission factors for different particle size ranges. This study was aimed at quantifying particle emission factors from four types of wood found in South East Queensland forests: Spotted Gum (Corymbia citriodora), Red Gum (Eucalypt tereticornis), Blood Gum (Eucalypt intermedia), and Iron bark (Eucalypt decorticans); under controlled laboratory conditions. The experimental set up included a modified commercial stove connected to a dilution system designed for the conditions of the study. Measurements of particle number size distribution and concentration resulting from the burning of woods with a relatively homogenous moisture content (in the range of 15 to 26 %) and for different rates of burning were performed using a TSI Scanning Mobility Particle Sizer (SMPS) in the size range from 10 to 600 nm and a TSI Dust Trak for PM2.5. The results of the study in terms of the relationship between particle number size distribution and different condition of burning for different species show that particle number emission factors and PM2.5 mass emission factors depend on the type of wood and the burning rate; fast burning or slow burning. The average particle number emission factors for fast burning conditions are in the range of 3.3 x 1015 to 5.7 x 1015 particles/kg, and for PM2.5 are in the range of 139 to 217 mg/kg.

John Frazer

John Frazer, Professor, trained at the Architectural Association, taught first at Cambridge University and then the AA in the 1970s and again in the '90s. He was Head of School of Design Research History and Criticism at the University of Ulster in the 1980s, he also ran a systems and design consultancy with his wife Julia (including projects for Cedric Price and Walter Segal) and was founder and chairman of Autographics software. He is currently Swire Chair Professor and Head of School of Design in Hong Kong.----- This is a very personal perspective on a concept of universal and future significance. It is personal, both is the sense that it is an unashamedly biased view of both the significance of the project, and the nature of that significance and because the author was personally involved as one of the consultants on GENERATOR and subsequently involved Cedric Price in its educational application at the Architectural Association. GENERATOR is still very much alive and was still developing whilst this chapter was being written.

Concerning the house museum and the picturesque landscape in the work of Sir John Soane : with raw hints for post-heritage museum space

The picturesque aesthetic in the work of Sir John Soane, architect and collector, resonates in the major work of his very personal practice – the development of his house museum, now the Soane Museum in Lincoln’s Inn Fields in London. Soane was actively involved with the debates, practices and proponents of picturesque and classical practices in architecture and landscape and his lectures reveal these influences in the making of The Soane, which was built to contain and present diverse collections of classical and contemporary art and architecture alongside scavenged curiosities. The Soane Museum has been described as a picturesque landscape, where a pictorial style, together with a carefully defined itinerary, has resulted in the ‘apotheosis of the Picturesque interior’. Soane also experimented with making mock ruinscapes within gardens, which led him to construct faux architectures alluding to archaeological practices based upon the ruin and the fragment. These ideas framed the making of interior landscapes expressed through spatial juxtapositions of room and corridor furnished with the collected object that characterise The Soane Museum. This paper is a personal journey through the Museum which describes and then reviews aspects of Soane’s work in the context of contemporary theories on ‘new’ museology. It describes the underpinning picturesque practices that Soane employed to exceed the boundaries between interior and exterior landscapes and the collection. It then applies particular picturesque principles drawn from visiting The Soane to a speculative project for a house/landscape museum for the Oratunga historic property in outback South Australia, where the often, normalising effects of conservation practices are reviewed using minimal architectural intervention through a celebration of ruinous states.

Management

Building on the strengths of its popular previous editions, Management 4th Australasian edition has been thoroughly revised and updated to both reflect contemporarymanagement thinking and to highlight the issues facing managers of the21st century. A solid foundation of theory provides the background to a wealth ofillustrative examples, highlighting organisations operating inAustralia, New Zealand and the Asia-Pacific region. A balance of small-to medium- size enterprises and larger multinational corporations arefeatured. A critical thinking perspective is integrated throughout thebook, asking and encouraging student to analyse research and theory inthe light of contemporary management practice. Each copy of the printed textbook comes with a free copy of the Wiley Desktop Edition:a full electronic version of the text that allows students to easilysearch for key concepts, create their own colour-coded highlights andmake electronic notes in the text for revision. Key themes of the text include: The importance of ethical and socially responsible management Recognition of the continuing need to cater for the increasing diversity of the workforce The importance of managing people, technology, knowledge and quality in achieving organisational goals An appreciation of the challenges and opportunities presented bythe ever changing environment in which contemporary managers operate.

Management: Core concepts and applications

Building on the strengths of its popular previous edition Management: Core Concepts and Applications, 2nd Australasian edition has been thoroughly revised and updated to reflect the three keyaspects of contemporary undergraduate introductory management education: Management theory Concept application Skills development. The text's 16 chapters are presented in a lively and concise mannerideal for the typical 12 or 13 teaching weeks of a semester. Itsflexible framework allows instructors to teach students through the useof interactive tools such as case studies, exercises and projects.These action-oriented learning activities complement the text's solidfoundation of knowledge-based theory material. There is a balanced coverage of both small to medium sizedenterprises and larger multinational organisations operating inAustralia, New Zealand and the Asia-Pacific region. A critical thinkingperspective is integrated throughout the book, asking and encouragingstudents to analyse the theory in light of real-world examples. Each copy of the printed textbook comes with a free copy of the Wiley Desktop Edition:a full electronic version of the text that allows students to easilysearch for key concepts, create their own colour-coded highlights andmake electronic notes in the text for revision. Key themes of the text include: The importance of ethical and socially responsible management Recognition of the continuing need to cater for the increasing diversity of the workforce The importance of managing people, technology, knowledge and quality in achieving organisational goals An appreciation of the challenges and opportunities presented bythe ever changing environment in which contemporary managers operate.

Art, popular culture and cultural policy: variations on a theme of John Carey

The article presents a criticism of the accounts of John Carey in his book entitled "The Intellectuals and the Masses." The author focuses on Carey's argument that the art is not an eternal category but an invention of the late eighteenth century and it no longer has any intellectual legitimacy other than that of provoking feelings which are no more and no less valuable than those provoked by any other form of entertainment or physical activity