The effect of implementing a modified early warning scoring (MEWS) system on the adequacy of vital sign documentation

Introduction and objectives Early recognition of deteriorating patients results in better patient outcomes. Modified early warning scores (MEWS) attempt to identify deteriorating patients early so timely interventions can occur thus reducing serious adverse events. We compared frequencies of vital sign recording 24 h post-ICU discharge and 24 h preceding unplanned ICU admission before and after a new observation chart using MEWS and an associated educational programme was implemented into an Australian Tertiary referral hospital in Brisbane. Design Prospective before-and-after intervention study, using a convenience sample of ICU patients who have been discharged to the hospital wards, and in patients with an unplanned ICU admission, during November 2009 (before implementation; n = 69) and February 2010 (after implementation; n = 70). Main outcome measures Any change in a full set or individual vital sign frequency before-and-after the new MEWS observation chart and associated education programme was implemented. A full set of vital signs included Blood pressure (BP), heart rate (HR), temperature (T°), oxygen saturation (SaO2) respiratory rate (RR) and urine output (UO). Results After the MEWS observation chart implementation, we identified a statistically significant increase (210%) in overall frequency of full vital sign set documentation during the first 24 h post-ICU discharge (95% CI 148, 288%, p value <0.001). Frequency of all individual vital sign recordings increased after the MEWS observation chart was implemented. In particular, T° recordings increased by 26% (95% CI 8, 46%, p value = 0.003). An increased frequency of full vital sign set recordings for unplanned ICU admissions were found (44%, 95% CI 2, 102%, p value = 0.035). The only statistically significant improvement in individual vital sign recordings was urine output, demonstrating a 27% increase (95% CI 3, 57%, p value = 0.029). Conclusions The implementation of a new MEWS observation chart plus a supporting educational programme was associated with statistically significant increases in frequency of combined and individual vital sign set recordings during the first 24 h post-ICU discharge. There were no significant changes to frequency of individual vital sign recordings in unplanned admissions to ICU after the MEWS observation chart was implemented, except for urine output. Overall increases in the frequency of full vital sign sets were seen.

Provincialising Perth? : Satellite television and the Chinese in Perth

Relocated people habitually seek the familiar within their new social milieus as a means of easing their transition into ways strange and alien. However, from networks and food to everyday customs, efforts to hold on to such home comforts are often viewed with a measure of hostile disdain and regarded as preludes to the formation of ethnic enclaves. Through a pilot study on the access of satellite television by mainland Chinese migrants in Perth, Western Australia, this chapter seeks to shed some light on how migrants understand and employ these comforting strategies and how Chinese-Australians are using technology to achieve a sense of sanctuary from the views and habits of Australians while (re)constructing and articulating multiple belongings in their new homes.

Introduction : creative industries and cities

The 2000s were marked by a resurgence of interest in creativity and cities. If the rapid global proliferation of the Internet and digital media technologies in the 1990s had set off enthusiasm for a post-industrial ‘new economy’, where the significance of location would be in decline, the 2000s saw an energetic search by artists, entrepreneurs, investors, policy-makers, journalists and many others to uncover the well-springs of creativity and its relationship to place (Flew 2012a). This chapter begins with a discussion of the discourses or ‘scripts’ that have emerged to try and conceptualise the relationship between creativity and cities, notably theories of creative clusters, creative cities and creative class theories. Such work can be seen as representing a growth in the field of cultural economic geography although – as is noted in the chapter – it possesses some significant gaps. Among the issues that are drawn out in this book, and discussed in this chapter, are: the need to move beyond ‘imagined geographies’ of creative inner cities and come to terms with empirical evidence that suggests significant concentrations of the creative workforce in suburbs and regional cities; the relevance of urban cultural policy as a variable in the rise of cities as creative hubs or, in a different model, media capitals; and the challenges of bringing together cultural research with economic discourses in ways that get beyond caricatured representations of the ‘other’, as found, for instance, in some of the most influential framings of the concept of neo-liberalism.

Confronting consensus : the art and politics of Christopher Howlett

The article discusses the art career and works of Brisbane artist Christopher Howlett. Howlett has engaged with a number of political issues in a range of media. Issues include the artist as 'labourer', art in the age of tabloid media, art and celebrity culture in media such as performance, installation, sound works, and digital frameworks.

A Companion to New Media Dynamics

A Companion to New Media Dynamics presents a state-of-the-art collection of multidisciplinary readings that examine the origins, evolution, and cultural underpinnings of the media of the digital age in terms of dynamic change Presents a state-of-the-art collection of original readings relating to new media in terms of dynamic change. - Features interdisciplinary contributions encompassing the sciences, social sciences, humanities and creative arts - Addresses a wide range of issues from the ownership and regulation of new media to their form and cultural uses - Provides readers with a glimpse of new media dynamics at three levels of scale: the ‘macro’ or system level; the ‘meso’ or institutional level; and ‘micro’ or agency level

Are insect frugivores always plant pests? The impact of fruit fly (Diptera: Tephritidae) larvae on host plant fitness

Herbivory is generally regarded as negatively impacting on host plant fitness. Frugivorous insects, which feed directly on plant reproductive tissues, are predicted to be particularly damaging to hosts. We tested this prediction with the fruit fly, Bactrocera tryoni, by recording the impact of larval feeding on two direct (seed number and germination) and two indirect (fruit decay rate and attraction/deterrence of vertebrate frugivores) measures of host plant fitness. Experiments were done in the laboratory, glasshouse and tropical rainforest. We found no negative impact of larval feeding on seed number or germination for three test plants: tomato, capsicum and eggplant. Further, larval feeding accelerated the initiation of decay and increased the final level of fruit decay in tomatoes, apples, pawpaw and pear, a result considered to be beneficial to the fruit. In rainforest studies, native rodents preferred infested apple and pears compared to uninfested control fruit; however, there were no differences observed between treatments for tomato and pawpaw. For our study fruits, these results demonstrate that fruit fly larval infestation has neutral or beneficial impacts on the host plant, an outcome which may be largely influenced by the physical properties of the host. These results may contribute to explaining why fruit flies have not evolved the same level of host specialization generally observed for other herbivore groups.

Agronomic and economic evaluation of irrigation strategies on cotton lint yield in Australia

Cotton is one of the most important irrigated crops in subtropical Australia. In recent years, cotton production has been severely affected by the worst drought in recorded history, with the 2007–08 growing season recording the lowest average cotton yield in 30 years. The use of a crop simulation model to simulate the long-term temporal distribution of cotton yields under different levels of irrigation and the marginal value for each unit of water applied is important in determining the economic feasibility of current irrigation practices. The objectives of this study were to: (i) evaluate the CROPGRO-Cotton simulation model for studying crop growth under deficit irrigation scenarios across ten locations in New South Wales (NSW) and Queensland (Qld); (ii) evaluate agronomic and economic responses to water inputs across the ten locations; and (iii) determine the economically optimal irrigation level. The CROPGRO-Cotton simulation model was evaluated using 2 years of experimental data collected at Kingsthorpe, Qld. The model was further evaluated using data from nine locations between northern NSW and southern Qld. Long-term simulations were based on the prevalent furrowirrigation practice of refilling the soil profile when the plant -available soil water content is<50%. The model closely estimated lint yield for all locations evaluated. Our results showed that the amounts of water needed to maximise profit and maximise yield are different, which has economic and environmental implications. Irrigation needed to maximise profits varied with both agronomic and economic factors, which can be quite variable with season and location. Therefore, better tools and information that consider the agronomic and economic implications of irrigation decisions need to be developed and made available to growers.

Encouraging learners to drive using game elements and smartphones

Young drivers aged 17-24 years are at a risk of death and injury from road crashes primarily due to their age and inexperience on the road. Our research aims to investigate if a gamified mobile tracking and intervention tool can help to address this issue. We aim to build a smartphone application to support the current process of logging driving hours using a physical logbook and pen in Queensland. This provides an easier way to log driving hours than recording them in a logbook. In an attempt to engage Learners and encourage them to undertake more diverse driving practice we will explore how game elements can be integrated into the experience to motivate Learners. Previous research in other domains has shown that framing tasks as game-like can help engage and motivate users, however the addition of game elements to this space provides some interesting design challenges. This paper presents an overview of the research and presents these challenges for further discussion.

Performance analysis of IEC 61850 sampled value process bus networks

Process bus networks are the next stage in the evolution of substation design, bringing digital technology to the high voltage switchyard. Benefits of process buses include facilitating the use of Non-Conventional Instrument Transformers, improved disturbance recording and phasor measurement and the removal of costly, and potentially hazardous, copper cabling from substation switchyards and control rooms. This paper examines the role a process bus plays in an IEC 61850 based Substation Automation System. Measurements taken from a process bus substation are used to develop an understanding of the network characteristics of "whole of substation" process buses. The concept of "coherent transmission" is presented and the impact of this on Ethernet switches is examined. Experiments based on substation observations are used to investigate in detail the behavior of Ethernet switches with sampled value traffic. Test methods that can be used to assess the adequacy of a network are proposed, and examples of the application and interpretation of these tests are provided. Once sampled value frames are queued by an Ethernet switch the additional delay incurred by subsequent switches is minimal, and this allows their use in switchyards to further reduce communications cabling, without significantly impacting operation. The performance and reliability of a process bus network operating with close to the theoretical maximum number of digital sampling units (merging units or electronic instrument transformers) was investigated with networking equipment from several vendors, and has been demonstrated to be acceptable.

Heart beats and economic decisions : Observing mental stress in the ultimatum bargaining game

One aim of experimental economics is to try to better understand human economic decision making. Early research of the ultimatum bargaining game (Gueth et al., 1982) revealed that other motives than pure monetary reward play a role. Neuroeconomic research has introduced the recording of physiological observations as signals of emotional responses. In this study, we apply heart rate variability (HRV) measuring technology to explore the behaviour and physiological reactions of proposers and responders in the ultimatum bargaining game. Since this technology is small and non-intrusive, we are able to run the experiment in a standard experimental economic setup. We show that low o�ers by a proposer cause signs of mental stress in both the proposer and the responder, as both exhibit high ratios of low to high frequency activity in the HRV spectrum.

Narrative : family trauma or challenge and resilience in the Galapagos Archipelago

The chapter is a "here and now" narration in the first person as witnessed and experienced by the author during field work in the Galapagos Islands in 1976-79. The story begins on the most remote volcanic island of Fernandina where the breeding biology of Flightless cormorants was being studied. A small selection of the many potentially life threatening situations and challenges is described including stories related to the birth of their son.

Is there a place for pixels in our practice? Dietitians' attitudes towards the use of photographic dietary records within the nutrition care process

Photographic records of dietary intake (PhDRs) are an innovative method for the dietary assessment and may alleviate the burden of recording intake compared to traditional methods of recording intake. While the performance of PhDRs has been evaluated, no investigation into the application of this method had occurre within dietetic practice. This study examined the attitudes of dietitians towards the use of PhDRs in the provision of nutrition care. A web-based survey on the practices and beliefs with regards to technology use among Dietitians Association of Australia members was conducted in August 2011. Of the 87 dietitians who responded, 86% assessed the intakes of clients as part of individualised medical nutrition therapy, with the diet history the most common method used. The majority (91%) of dietitians surveyed believed that a PhDR would be of use in their current practice to estimate intake. Information contained in the PhDR would primarily be used to obtain a qualitative evaluation of diet (84%) or to supplement an existing assessment method (69%), as opposed to deriving an absolute measure of nutrient intake (31%). Most (87%) indicated that a PhDR would also be beneficial in both the delivery of the intervention and to evaluate and monitor goals and outcomes, while only 46% felt that a PhDR would assist in determining the nutrition diagnosis. This survey highlights the potential for the use of PhDRs within practice. Future endeavours lie in establishing resources which support the inclusion of PhDRs within the nutrition care process.

From homepages to network profiles : balancing personal and social identity

The World Wide Web constitutes one of the most important inventions of the late 20th century: it has changed culture, society, business, communication, politics, and many other fields of human endeavour, not least also by providing a more user-friendly pathway of access to its major underlying technology, the Internet itself. Key phases in its development can be charted, especially by how it has been used to present and share information – and here, the personal or professional, private or official homepage stands in as a useful representation of wider Web trends overall. From hand-coded beginnings through several successive stages of experimentation and standardisation, to the shifting balance between personal sites and social networks, the homepage demonstrates how the Web itself, and its place in our lives, have changed.