Implementation of a chest pain management service improves patient care and reduces length of stay

Objective Chest pain is one of the most common complaints in patients presenting to an emergency department. Delays in management due to a lack of readily available objective tests to risk stratify patients with possible acute coronary syndromes can lead to an unnecessarily lengthy admission placing pressure on hospital beds or inappropriate discharge. The need for a co-ordinated system of clinical management based on enhanced communication between departments, timely and appropriate triage, clinical investigation, diagnosis, and treatment was identified. Methods An evidence-based Chest Pain Management Service and clinical pathway were developed and implemented, including the introduction of after-hours exercise stress testing. Results Between November 2005 and March 2013, 5662 patients were managed according to a Chest Pain Management pathway resulting in a reduction of 5181 admission nights by more timely identification of patients at low risk who could then be discharged. In addition, 1360 days were avoided in high-risk patients who received earlier diagnosis and treatment. Conclusions The creation of a Chest Pain Management pathway and the extended exercise stress testing service resulted in earlier discharge for low-risk patients; and timely treatment for patients with positive and equivocal exercise stress test results. This service demonstrated a significant saving in overnight admissions.

Effect of water management practice on pesticide behavior in paddy water

The fate and transport of three herbicides commonly used in rice production in Japan were compared using two water management practices. The herbicides were simetryn, thiobencarb and mefenacet. The first management practice was an intermittent irrigation scheme using an automatic irrigation system (AI) with a high drainage gate and the second one was a continuous irrigation and overflow drainage scheme (CI) in experimental paddy fields. Dissipation of the herbicides appeared to follow first order kinetics with the half-lives (DT₅₀) of 1.6-3.4 days and the DT₉₀ (90% dissipation) of 7.4-9.8 days. The AI scheme had little drainage even during large rainfall events thus resulting in losses of less than 4% of each applied herbicide through runoff. Meanwhile the CI scheme resulted in losses of about 37%, 12% and 35% of the applied masses of simetryn, thiobencarb and mefenacet, respectively. The intermittent irrigation scheme using an automatic irrigation system with a high drainage gate saved irrigation water and prevented herbicide runoff whereas the continuous irrigation and overflow scheme resulted in significant losses of water as well as the herbicides. Maintaining the excess water storage is important for preventing paddy water runoff during significant rainfall events. The organic carbon partition coefficient K_oc seems to be a strong indicator of the aquatic fate of the herbicide as compared to the water solubility (S_W). However, further investigations are required to understand the relation between K_oc and the agricultural practices upon the pesticide fate and transport. An extension of the water holding period up to 10 days after herbicide application based on the DT₉₀ from the currently specified period of 3-4 days in Japan is recommended to be a good agricultural practice for controlling the herbicide runoff from paddy fields. Also, the best water management practice, which can be recommended for use during the water holding period, is the intermittent irrigation scheme using an automatic irrigation system with a high drainage gate. © 2006 Elsevier B.V. All rights reserved.

Pesticide discharge and water management in a paddy catchment in Japan

Concentrations of several pesticides were monitored in a paddy block and in the Kose river, which drains a paddy catchment in Fukuoka prefecture, Japan. Detailed water management in the block was also monitored to evaluate its effect on the pesticide contamination. The concentrations of applied pesticides in both block irrigation channel and drainage canal increased to tens of μg/L shortly after their applications. The increase in pesticide concentrations was well correlated with the open of irrigation and drainage gates in the pesticide-applied paddy plots only 1–3 days after pesticide application. High concentration of other pesticides, mainly herbicides, was also observed in the inflow irrigation and drainage waters, confirming the popularity of early irrigation and drainage after pesticide application in the area. The requirement of holding water after pesticide application (as a best management practice) issued by the authority was thus not properly followed. In a larger scale of the paddy catchment, the concentration of pesticides also increased significantly to several μg/L in the water of the Kose river shortly after the start of the pesticide application period either in downstream or mid–upstream areas, confirming the effect of current water management to the water quality. More extension and enforcement on water management should be done in order to control pesticide pollution from rice cultivation in Japan.

Exposure risk assessment and evaluation of the best management practice for controlling pesticide runoff from paddy fields. Part 2: Model simulation for the herbicide pretilachlor

BACKGROUND: Monitoring studies revealed high concentrations of pesticides in the drainage canal of paddy fields. It is important to have a way to predict these concentrations in different management scenarios as an assessment tool. A simulation model for predicting the pesticide concentration in a paddy block (PCPF-B) was evaluated and then used to assess the effect of water management practices for controlling pesticide runoff from paddy fields. RESULTS: The PCPF-B model achieved an acceptable performance. The model was applied to a constrained probabilistic approach using the Monte Carlo technique to evaluate the best management practices for reducing runoff of pretilachlor into the canal. The probabilistic model predictions using actual data of pesticide use and hydrological data in the canal showed that the water holding period (WHP) and the excess water storage depth (EWSD) effectively reduced the loss and concentration of pretilachlor from paddy fields to the drainage canal. The WHP also reduced the timespan of pesticide exposure in the drainage canal. CONCLUSIONS: It is recommended that: (1) the WHP be applied for as long as possible, but for at least 7 days, depending on the pesticide and field conditions; (2) an EWSD greater than 2 cm be maintained to store substantial rainfall in order to prevent paddy runoff, especially during the WHP.

Consensus statement on the investigation and management of non-radiographic axial spondyloarthritis (nr-axSpA)

Aim Non-radiographic axial spondyloarthritis (nr-axSpA) is axial inflammatory arthritis where plain radiographic damage is not evident. An unknown proportion of these patients will progress to ankylosing spondylitis (AS). The increasing recognition of nr-axSpA has been greatly assisted by the widespread use of magnetic resonance imaging. The aim of this article was to construct a set of consensus statements based on a literature review to guide investigation and promote best management of nr-axSpA. Methods A literature review using Medline was conducted covering the major investigation modalities and treatment options available. A group of rheumatologists and a radiologist with expertise in investigation and management of SpA reviewed the literature and formulated a set of consensus statements. The Grade system encompassing the level of evidence and strength of recommendation was used. The opinion of a patient with nr-axSpA and a nurse experienced in the care of SpA patients was also sought and included. Results The literature review found few studies specifically addressing nr-axSpA, or if these patients were included, their results were often not separately reported. Fourteen consensus statements covering investigation and management of nr-axSpA were formulated. The level of agreement was high and ranged from 8.1 to 9.8. Treatment recommendations vary little with established AS, but this is primarily due to the lack of available evidence on the specific treatment of nr-axSpA. Conclusion The consensus statements aim to improve the diagnosis and management of nr-axSpA. We aim to raise awareness of this condition by the public and doctors and promote appropriate investigation and management.

Teacher Education for High Poverty Schools

This volume captures the innovative, theory-based, and grounded work being done by established scholars who are interrogating how teacher education can prepare teachers to work in challenging and diverse high-poverty settings. It offers articles from the US, Australia, Canada, the UK and Chile by some of the most significant scholars in the field. Internationally, research suggests that effective teachers for high poverty schools require deep theoretical understanding as well as the capacity to function across three well-substantiated areas: deep content knowledge, well-tuned pedagogical skills, and demonstrated attributes that prove their understanding and commitment to social justice. Schools in low socioeconomic communities need quality teachers most, however, they are often staffed by the least experienced and least prepared teachers. The chapters in this volume examine how pre-service teachers are taught to understand the social contexts of education. Drawing on the individual expertise of the authors, the topics covered include unpacking poverty for pre-service teachers, issues related to urban schooling as well as remote and regional area schooling.

Planning, development and management of sustainable cities: A commentary from the guest editors

Cities are the most dramatic manifestations of human activities on the surface of the earth. These human-dominated organisms—i.e., cities—degrade natural habitats, simplify species composition, disrupt hydrological systems, and modify energy flow and nutrient cycling. Today, these consequential impacts of human activities, originated from population increase, rapid urbanization, high private motor vehicle dependency, deregulated industrialization and mass livestock production, are increasing exponentially and causing great deal of environmental, social, and economic challenges both at global and local scales. In such a situation, establishment of sustainable cities, through sustainable urban development practices, is seen as a potential panacea to combat these challenges responsibly, effectively, and efficiently. This paper offers a critical review of the key literature on the issues relating to planning, development and management of sustainable cities, introduces the contributions from the Special Issue, and speculates on the prospective research directions to place necessary mechanisms to secure a sustainable urban future for all.

A critical appraisal of the relational management paradigm in an international setting: A future research agenda

Purpose In the mainstream relationship management literature, critical appraisal of the relationship paradigm in an international setting is virtually non-existent. The extant literature reveals a gap in terms of linking relationship management theories with international management. Furthermore, little research attention has been paid to synthesise the existing theories in a cohesive manner towards developing a theoretical paradigm in the interface of the importer-supplier relationship dyad. Thus, the purpose of this paper is to strengthen the theoretical grounds of relationship marketing in an international setting in an importer-exporter relationship context. Design/methodology/approach The paper follows a comprehensive review approach and applies the fundamental theory of trust and commitment to identify the relational factors. More precisely, the paper identifies and applies other relevant theories such as internationalisation process theory, resource-based theory of the firm, dependence theory and transaction cost theory in developing an innovative theoretical paradigm. Findings Based on the integration of extant theories, this paper proposes a new direction in the theoretical realm of the trust and commitment building process within an importer and supplier relationship management paradigm. The research concludes that trust and commitment are the focal factors within the international relational paradigm. Research limitations/implications The proposed research direction suggests an emerging framework integrating mainstream theoretical variables of trust and commitment in importer and foreign-supplier context. This novel framework has the potential for use in further research. Originality/value This paper advances a grounded theoretical exploration within an international management domain in the context of importers and foreign-suppliers.

Standardised antibacterial Manuka honey in the management of persistent post-operative corneal oedema: A case series

Background Corneal oedema is a common post-operative problem that delays or prevents visual recovery from ocular surgery. Honey is a supersaturated solution of sugars with an acidic pH, high osmolarity and low water content. These characteristics inhibit the growth of micro-organisms, reduce oedema and promote epithelialisation. This clinical case series describes the use of a regulatory approved Leptospermum species honey ophthalmic product, in the management of post-operative corneal oedema and bullous keratopathy. Methods A retrospective review of 18 consecutive cases (30 eyes) with corneal oedema persisting beyond one month after single or multiple ocular surgical procedures (phacoemulsification cataract surgery and additional procedures) treated with Optimel Antibacterial Manuka Eye Drops twice to three times daily as an adjunctive therapy to conventional topical management with corticosteroid, aqueous suppressants, hypertonic sodium chloride five per cent, eyelid hygiene and artificial tears. Visual acuity and central corneal thickness were measured before and at the conclusion of Optimel treatment. Results A temporary reduction in corneal epithelial oedema lasting up to several hours was observed after the initial Optimel instillation and was associated with a reduction in central corneal thickness, resolution of epithelial microcysts, collapse of epithelial bullae, improved corneal clarity, improved visualisation of the intraocular structures and improved visual acuity. Additionally, with chronic use, reduction in punctate epitheliopathy, reduction in central corneal thickness and improvement in visual acuity were achieved. Temporary stinging after Optimel instillation was experienced. No adverse infectious or inflammatory events occurred during treatment with Optimel. Conclusions Optimel was a safe and effective adjunctive therapeutic strategy in the management of persistent post-operative corneal oedema and warrants further investigation in clinical trials.

The impacts of policy change on collaborative governance networks

For many complex natural resources problems, planning and management efforts involve groups of organizations working collaboratively through networks (Agranoff, 2007; Booher & Innes, 2010). These networks sometimes involve formal roles and relationships, but often include informal elements (Edelenbos & Klijn, 2007). All of these roles and relationships undergo change in response to changes in personnel, priorities and policy. There has been considerable focus in the planning and public policy literature on describing and characterizing these networks (Mandell & Keast, 2008; Provan & Kenis, 2007). However, there has been far less research assessing how networks change and adjust in response to policy and political change. In the Australian state of Queensland, Natural Resource Management (NRM) organizations were created as lead organizations to address land and water management issues on a regional basis with Commonwealth funding and state support. In 2012, a change in state government signaled a dramatic change in policy that resulted in a significant reduction of state support and commitment. In response to this change, NRM organizations have had to adapt their networks and relationships. In this study, we examine the issues of network relationships, capacity and changing relationships over time using written surveys and focus groups with NRM CEOs, managers and planners (note: data collection events scheduled for March and April 2015). The research team will meet with each of these three groups separately, conduct an in-person survey followed by a facilitated focus group discussion. The NRM participant focus groups will also be subdivided by region, which correlates with capacity (inland/low capacity; coastal/high capacity). The findings focus on how changes in state government commitment have affected NRM networks and their relationships with state agencies. We also examine how these changes vary according to the level within the organization and the capacity of the organization. We hypothesize that: (1) NRM organizations have struggled to maintain capacity in the wake of state agency withdrawal of support; (2) NRM organizations with the lowest capacity have been most adversely affected, while some high capacity NRM organizations may have become more resilient as they have sought out other partners; (3) Network relationships at the highest levels of the organization have been affected the most by state policy change; (4) NRM relationships at the lowest levels of the organizations have changed the least, as formal relationships are replaced by informal networks and relationships.

A lifespan perspective on psychological contracts and their relations with organizational commitment

The current study investigated the influence of age-related constructs on the psychological contract and its relationships with continuance and normative commitment. It was proposed that as people age, their future time perspective (FTP) decreases. Consequently, it was expected that contract fulfilment would be positively related to continuance commitment for workers with short FTP, while it would be positively related to normative commitment for workers with long FTP. Conversely, it was argued that, with age, workers’ perceived work-related expertise increases, resulting in stronger reactions to obligation fulfilment on normative commitment. A study among 334 employees showed that FTP and work-related expertise indeed moderated the relationships between contract fulfilment and organizational commitment. The results showed that the influence of age on the relations between contract fulfilment with outcomes is dependent upon FTP and occupational expertise. The study shows the value of a lifespan perspective on psychological contracts and their relations with organizational commitment.

Shared perceptions of supervisor conflict management style

- Purpose This study aims to investigate the extent to which employee outcomes (anxiety/depression, bullying and workers’ compensation claims thoughts) are affected by shared perceptions of supervisor conflict management style (CMS). Further, this study aims to assess cross-level moderating effects of supervisor CMS climate on the positive association between relationship conflict and these outcomes. - Design/methodology/approach Multilevel modeling was conducted using a sample of 401 employees nested in 69 workgroups. - Findings High collaborating, low yielding and low forcing climates (positive supervisor climates) were associated with lower anxiety/depression, bullying and claim thoughts. Unexpectedly, the direction of moderation showed that the positive association between relationship conflict and anxiety/depression and bullying was stronger for positive supervisor CMS climates than for negative supervisor CMS climates (low collaborating, high yielding and high forcing). Nevertheless, these interactions revealed that positive supervisor climates were the most effective at reducing anxiety/depression and bullying when relationship conflict was low. For claim thoughts, positive supervisor CMS climates had the predicted stress-buffering effects. - Research limitations/implications Employees benefit from supervisors creating positive CMS climates when dealing with conflict as a third party, and intervening when conflict is low, when their intervention is more likely to minimize anxiety/depression and bullying. - Originality/value By considering the unique perspective of employees’ shared perceptions of supervisor CMS, important implications for the span of influence of supervisor behavior on employee well-being have been indicated.

Literacy teacher research in high poverty schools: Why it matters

Teachers who work in contexts in which their students’ lives are affected by poverty take up the challenge of learning to teach diverse students in ways that teachers in other contexts may not be required to do. And they do this work in contexts of immense change. Students’ communities change, neighborhoods change, educational policies change, literate practices and the specific effects of what it means to be poor in particular places also change. What cannot change is a commitment to high-equity, high-quality education for the students in these schools. Teachers need to analyze situations and make ongoing ethical decisions about pedagogy and curriculum. To do this, they must be able to continuously gauge the effects of their practices on different students. Hence, we argue that building teacher-researcher dispositions and repertoires is a key goal for teacher education across the teaching life-span. Drawing on a range of recent and ongoing collaborative research projects in schools situated in areas of high poverty, we draw out some principles for literacy teachers’ education.

Improved wound management at lower costs: A sensible goal for Australia

Chronic wounds cost the Australian health system at least US$2·85 billion per year. Wound care services in Australia involve a complex mix of treatment options, health care sectors and funding mechanisms. It is clear that implementation of evidence-based wound care coincides with large health improvements and cost savings, yet the majority of Australians with chronic wounds do not receive evidence-based treatment. High initial treatment costs, inadequate reimbursement, poor financial incentives to invest in optimal care and limitations in clinical skills are major barriers to the adoption of evidence-based wound care. Enhanced education and appropriate financial incentives in primary care will improve uptake of evidence-based practice. Secondary-level wound specialty clinics to fill referral gaps in the community, boosted by appropriate credentialing, will improve access to specialist care. In order to secure funding for better services in a competitive environment, evidence of cost-effectiveness is required. Future effort to generate evidence on the cost-effectiveness of wound management interventions should provide evidence that decision makers find easy to interpret. If this happens, and it will require a large effort of health services research, it could be used to inform future policy and decision-making activities, reduce health care costs and improve patient outcomes.

Disease control and management

Globally, the main contributors to morbidity and mortality are chronic conditions, including cardiovascular disease and diabetes. Chronic disease is costly and partially avoidable, with around 60% of deaths and nearly 50% of the global disease burden attributable to these conditions. By 2020, chronic illnesses will likely be the leading cause of disability worldwide. Existing healthcare systems that focus on acute episodic health conditions, both national and international, cannot address the worldwide transition to chronic illness; nor are they appropriate for the ongoing care and management of those already dealing with chronic diseases. As such, chronic disease management requires integrated approaches that incorporate interventions targeted at both individuals and populations, and emphasise the shared risk factors of different conditions. International and Australian strategic planning documents articulate similar elements to manage chronic disease, including the need for aligning sectoral policies for health, forming partnerships, and engaging communities in decision-making. Infectious diseases are also a common and significant contributor to ill health throughout the world. In many countries, this impact has been minimised by the combined efforts of preventative health measures and improved treatment methods. However, in low-income countries, infectious diseases remain the dominant cause of death and disability. The World Health Organization (WHO) estimates that infectious diseases (including respiratory infections) still account for around 23% (or around 14 million) of all deaths each year, and result in over 4.6 billion episodes of diarrhoeal disease and 243 million cases of malaria each year (Lozano et al. 2012, WHO 2009). In addition to the high level of mortality, infectious diseases disable many hundreds of millions of people each year, mainly in developing countries, with the global burden of disease from infectious diseases estimated to be around 300 million DALYs (disability-adjusted life years) (WHO 2012). The aim of this chapter is to outline the impact that infectious diseases and chronic diseases have on the health of the community, describe the public health strategies used to reduce the burden of those diseases, and discuss the historic and emerging disease risks to public health. This chapter examines the comprehensive approaches implemented to prevent both chronic and infectious diseases, and to manage and care for communities with these conditions.