Hospital in the Nursing Home program reduces emergency department presentations and hospital admissions from residential aged care facilities in Queensland, Australia: A quasi-experimental study

Background There has been considerable publicity regarding population ageing and hospital emergency department (ED) overcrowding. Our study aims to investigate impact of one intervention piloted in Queensland Australia, the Hospital in the Nursing Home (HiNH) program, on reducing ED and hospital attendances from residential aged care facilities (RACFs). Methods A quasi-experimental study was conducted at an intervention hospital undertaking the program and a control hospital with normal practice. Routine Queensland health information system data were extracted for analysis. Results Significant reductions in the number of ED presentations per 1000 RACF beds (rate ratio (95 % CI): 0.78 (0.67–0.92); p = 0.002), number of hospital admissions per 1000 RACF beds (0.62 (0.50–0.76); p < 0.0001), and number of hospital admissions per 100 ED presentations (0.61 (0.43–0.85); p = 0.004) were noticed in the experimental hospital after the intervention; while there were no significant differences between intervention and control hospitals before the intervention. Pre-test and post-test comparison in the intervention hospital also presented significant decreases in ED presentation rate (0.75 (0.65–0.86); p < 0.0001) and hospital admission rate per RACF bed (0.66 (0.54–0.79); p < 0.0001), and a non-significant reduction in hospital admission rate per ED presentation (0.82 (0.61–1.11); p = 0.196). Conclusions Hospital in the Nursing Home program could be effective in reducing ED presentations and hospital admissions from RACF residents. Implementation of the program across a variety of settings is preferred to fully assess the ongoing benefits for patients and any possible cost-savings.

The architecture of the psychiatric milieu

The last time a peer-reviewed volume on the future of mental health facilities was produced was in 1959, following a symposium organised by the American Psychological Association. The consensus was easy enough to follow and still resonates today: the best spaces to treat psychiatric illness will be in smaller, less restrictive units that offer more privacy and allow greater personalisation of space – possibly a converted hotel (Goshen, 1959). In some way, all those ideals have come to pass. An ideal typology was never established, but even so, units have shrunk from thousands of beds to units that typically house no more than 50 patients. Patients are generally more independent and are free to wander (within a unit) as they please. But the trend toward smaller and freer is reversing. This change is not driven by a desire to find the ideal building nor better models of care, but by growing concerns about budgets, self-harm and psychiatric violence. This issue of the Facilities comes at a time when the healthcare design is increasingly dominated by codes, statutes and guidelines. But the articles herein are a call to stop and think. We are not at the point where guidelines can be helpful, because they do not embody any depth of knowledge nor wisdom. These articles are intended to inject some new research on psychiatric/environmental interactions and also to remind planners and managers that guidelines might not tackle a core misunderstanding: fear-management about patient safety and the safety of society is not the purpose of the psychiatric facility. It is purpose is to create spaces that are suitable for improving the well-being of the mentally ill.

Are diverse factors proxies for architectural influences? A case for architecture in the aetiology of schizophrenia

Introduction The last half-century of epidemiological enquiry into schizophrenia can be characterized by the search for neurological imbalances and lesions for genetic factors. The growing consensus is that these directions have failed, and there is now a growing interest in psychosocial and developmental models. Another area of recent interest is in epigenetics – the multiplication of genetic influences by environmental factors. Methods This integrative review comparatively maps current psychosocial, developmental and epigenetic models for schizophrenia epidemiology to identify crossover and theoretical gaps. Results In the flood of data that is being produced around the schizophrenia epidemiology, one of the most consistent findings is that schizophrenia is an urban syndrome. Once demographic factors have been discounted, between one-quarter and one-third of all incidence is repeatedly traced back to urbanicity – potentially threatening more established models, such as the psychosocial, genetic and developmental hypotheses. Conclusions Close analysis demonstrates how current models for schizophrenia epidemiology appear to miss the mark. Furthermore, the built environment appears to be an inextricable factor in all current models and indeed may be a valid epidemiological factor on its own. The reason the built environment hasn’t already become a de rigueur area of epidemiological research is possibly trivial – it just doesn’t attract enough science, and lacks a hero to promote it alongside other hypotheses.

Change to costs and lengths of stay in the emergency department and the Brisbane protocol: An observational study

- Objective To compare health service cost and length of stay between a traditional and an accelerated diagnostic approach to assess acute coronary syndromes (ACS) among patients who presented to the emergency department (ED) of a large tertiary hospital in Australia. - Design, setting and participants This historically controlled study analysed data collected from two independent patient cohorts presenting to the ED with potential ACS. The first cohort of 938 patients was recruited in 2008–2010, and these patients were assessed using the traditional diagnostic approach detailed in the national guideline. The second cohort of 921 patients was recruited in 2011–2013 and was assessed with the accelerated diagnostic approach named the Brisbane protocol. The Brisbane protocol applied early serial troponin testing for patients at 0 and 2 h after presentation to ED, in comparison with 0 and 6 h testing in traditional assessment process. The Brisbane protocol also defined a low-risk group of patients in whom no objective testing was performed. A decision tree model was used to compare the expected cost and length of stay in hospital between two approaches. Probabilistic sensitivity analysis was used to account for model uncertainty. - Results Compared with the traditional diagnostic approach, the Brisbane protocol was associated with reduced expected cost of $1229 (95% CI −$1266 to $5122) and reduced expected length of stay of 26 h (95% CI −14 to 136 h). The Brisbane protocol allowed physicians to discharge a higher proportion of low-risk and intermediate-risk patients from ED within 4 h (72% vs 51%). Results from sensitivity analysis suggested the Brisbane protocol had a high chance of being cost-saving and time-saving. - Conclusions This study provides some evidence of cost savings from a decision to adopt the Brisbane protocol. Benefits would arise for the hospital and for patients and their families.

The social tasks of learning to become a physical education teacher: Considering the HPE subject department as a community of practice

Initial teacher education (ITE) students participate in various workplaces within schools and in doing so, form understandings about the numerous, and at times competing, expectations of teachers’ work. Through these experiences they form understandings about themselves as health and physical education (HPE) teachers. This paper examines the ways communities of practice within HPE subject department offices function as sites of workplace learning for student teachers. In particular this research focused on how ITE students negotiate tacit and contradictory expectations as well as social tasks during the practicum and the ways in which their understandings are mediated through participation in the workspace. Qualitative methods of survey and semi-structured interview were used to collect data on a cohort of student teachers during and following their major (10 week) practicum experience. Analysis was informed by theories of communities of practice (Wenger, 1998), workplace learning (Billett, 2001), and social task systems (Doyle, 1977). It was evident that considerable effort, attention, and energy was expended on various interrelated social tasks aimed at building positive relationships with their supervisor and other HPE teachers at the school. The social dynamics were highly nuanced and required a game-like approach. In our view the complexity that student teachers must negotiate in striving for an excellent evaluation warrants specific attention in physical education teacher education (PETE) programs. This study raises questions regarding our responsibilities in sending student teachers into contexts that might even be described as toxic. We offer some suggestions for how PETE might better support students going into practicum contexts that might be regarded as problematic workplaces.

Becoming a health and physical education teacher: Student teacher ‘performances’ in the HPE subject department office

This study considered how physical education teacher education students ‘perform’ their ‘selves’ within subject department offices during the practicum or ‘teaching practice’. The research was framed by a conceptual framework informed by the work of Goffman on ‘performance’ and ‘front’. The findings revealed three common performances across the whole group across all sites. These were: performance of sports talk, bodily performances, and performance of masculine repertoires. Such performances were considered to be inconsistent with the coursework ideals and principles within the teacher education programme but in step with the general ethos of most PE department offices.

A hybrid agent architecture for modeling autonomous agents in SAGE

This paper highlights the Hybrid agent construction model being developed that allows the description and development of autonomous agents in SAGE (Scalable, fault Tolerant Agent Grooming Environment) - a second generation FIPA-Compliant Multi-Agent system. We aim to provide the programmer with a generic and well defined agent architecture enabling the development of sophisticated agents on SAGE, possessing the desired properties of autonomous agents - reactivity, pro-activity, social ability and knowledge based reasoning. © Springer-Verlag Berlin Heidelberg 2005.

Architecture designed ZnO hollow microspheres with wide-range visible-light photoresponses

It is a challenge to increase the visible-light photoresponses of wide-gap metal oxides. In this study, we proposed a new strategy to enhance the visible-light photoresponses of wide-gap semiconductors by deliberately designing a multi-scale nanostructure with controlled architecture. Hollow ZnO microspheres with constituent units in the shape of one-dimensional (1D) nanowire networks, 2D nanosheet stacks, and 3D mesoporous nanoball blocks are synthesized via an approach of two-step assembly, where the oligomers or the constituent nanostructures with specially designed structures are first formed, and then further assembled into complex morphologies. Through deliberate designing of constituent architectures allowing multiple visible-light scattering, reflections, and dispersion inside the multiscale nanostructures, enhanced wide range visible-light photoresponses of the ZnO hollow microspheres were successfully achieved. Compared to the one-step synthesized ZnO hollow microspheres, where no nanostructured constituents were produced, the ZnO hollow microspheres with 2D nanosheet stacks presented a 50 times higher photocurrent in the visible-light range (λ > 420 nm). The nanostructure induced visible-light photoresponse enhancement gives a direction to the development of novel photosensitive materials.

DIY/DIWO media architecture: The InstaBooth

Building on previous discourse regarding the ability of media architecture to be more open and accessible for the purposes of community engagement (Caldwell & Foth, 2014), this chapter explores a particular case study that was designed, constructed and implemented with the intention of allowing city users to participate in the development and creation of media architecture, the InstaBooth. In this chapter, we first explore DIY (do it yourself) and DIWO (do it with others) phenomena to examine what motivates the DIY cultures, communities, and practices. Secondly, in this chapter, we define and discuss our implementation of a DIY / DIWO media architecture example, the InstaBooth. The InstaBooth project pro-vides an opportunity to question the effectiveness of a DIY driven media architec-ture artefact to see to what extent it impacts on the experience of its users and for what benefit.

Scopophobia/Scopophilia: electric light and the anxiety of the gaze in postwar American architecture

In the years of reconstruction and economic boom that followed the Second World War, the domestic sphere encountered new expectations regarding social behaviour, modes of living, and forms of dwelling. This book brings together an international group of scholars from architecture, design, urban planning, and interior design to reappraise mid-twentieth century modern life, offering a timely reassessment of culture and the economic and political effects on civilian life. This collection contains essays that examine the material of art, objects, and spaces in the context of practices of dwelling over the long span of the postwar period. It asks what role material objects, interior spaces, and architecture played in quelling or fanning the anxieties of modernism’s ordinary denizens, and how this role informs their legacy today. Table of Contents [Book] Introduction Robin Schuldenfrei Part 1: Psychological Constructions: Anxiety of Isolation and Exposure 1. Taking Comfort in the Age of Anxiety: Eero Saarinen’s Womb Chair Cammie McAtee 2. The Future is Possibly Past: The Anxious Spaces of Gaetano Pesce Jane Pavitt 3. Scopophobia/Scopophilia: Electric Light and the Anxiety of the Gaze in American Postwar Domestic Architecture Margaret Petty Part 2: Ideological Objects: Design and Representation 4. The Allegory of the Socialist Lifestyle: The Czechoslovak Pavilion at the Brussels Expo, its Gold Medal and the Politburo Ana Miljacki 5. Assimilating Unease: Moholy-Nagy and the Wartime-Postwar Bauhaus in Chicago Robin Schuldenfrei 6. The Anxieties of Autonomy: Peter Eisenman from Cambridge to House VI Sean Keller Part 3: Societies of Consumers: Materialist Ideologies and Postwar Goods 7. "But a home is not a laboratory": The Anxieties of Designing for the Socialist Home in the German Democratic Republic 1950—1965 Katharina Pfützner 8. Architect-designed Interiors for a Culturally Progressive Upper-Middle Class: The Implicit Political Presence of Knoll International in Belgium Fredie Floré 9. Domestic Environment: Italian Neo-Avant-Garde Design and the Politics of Post-Materialism Mary Louise Lobsinger Part 4: Class Concerns and Conflict: Dwelling and Politics 10. Dirt and Disorder: Taste and Anxiety in the Working Class Home Christine Atha 11. Upper West Side Stories: Race, Liberalism, and Narratives of Urban Renewal in Postwar New York Jennifer Hock 12. Pawns or Prophets? Postwar Architects and Utopian Designs for Southern Italy Anne Parmly Toxey. Coda: From Homelessness to Homelessness David Crowley

Heritability of the network architecture of intrinsic brain functional connectivity

The brain's functional network exhibits many features facilitating functional specialization, integration, and robustness to attack. Using graph theory to characterize brain networks, studies demonstrate their small-world, modular, and "rich-club" properties, with deviations reported in many common neuropathological conditions. Here we estimate the heritability of five widely used graph theoretical metrics (mean clustering coefficient (γ), modularity (Q), rich-club coefficient (ϕnorm), global efficiency (λ), small-worldness (σ)) over a range of connection densities (k=5-25%) in a large cohort of twins (N=592, 84 MZ and 89 DZ twin pairs, 246 single twins, age 23±2.5). We also considered the effects of global signal regression (GSR). We found that the graph metrics were moderately influenced by genetic factors h2 (γ=47-59%, Q=38-59%, ϕnorm=0-29%, λ=52-64%, σ=51-59%) at lower connection densities (≤15%), and when global signal regression was implemented, heritability estimates decreased substantially h2 (γ=0-26%, Q=0-28%, ϕnorm=0%, λ=23-30%, σ=0-27%). Distinct network features were phenotypically correlated (|r|=0.15-0.81), and γ, Q, and λ were found to be influenced by overlapping genetic factors. Our findings suggest that these metrics may be potential endophenotypes for psychiatric disease and suitable for genetic association studies, but that genetic effects must be interpreted with respect to methodological choices.

Blurring the physical boundaries of the city: Media architecture and urban informatics for community engagement

Architecture focuses on designing built environments in response to society’s needs, reflecting culture through materials and forms. The physical boundaries of the city have become blurred through the integration of digital media, connecting the physical environment with the digital. In the recent past the future was imagined as highly technological; 1982 Ridley Scott’s Blade Runner is set in 2019 and introduces a world where supersized screens inject advertisements in the cluttered urban space. Now, in 2015 screens are central to everyday life, but in a completely different way in respect to what had been imagined. Through ubiquitous computing and social media, information is abundant. Digital technologies have changed the way people relate to cities supporting discussion on multiple levels, allowing citizens to be more vocal than ever before. We question how architects can use the affordances of urban informatics to obtain and navigate useful social information to inform design. This chapter investigates different approaches to engage communities in the debate on cities, in particular it aims to capture citizens’ opinions on the use and design of public places. Physical and digital discussions have been initiated to capture citizens’ opinions on the use and design of public places. In addition to traditional consultation methods, Web 2.0 platforms, urban screens, and mobile apps are used in the context of Brisbane, Australia to explore contemporary strategies of engagement (Gray 2014).

Social work in a hospital emergency department

This paper describes how a Hospital Social Work Department's Emergency Team has attempted to provide a crisis and out-of-hours service to its Emergency Department. Through a staffing commitment to extensive evening and weekend cover, the Emergency Team's social worker is able to provide an immediate intervention and assessment service to problems. This has resulted in early detection and treatment of the non-medical aspects of a patient's problem and appropriate referral to other agencies for longer-term follow-up.

A submission to the Tasmanian Department of Health and Human Services consultation “Healthy Tasmania Five Year Strategic Plan”

This submission will address a number of questions raised in section 5.2, “Potential Future Initiatives to target smoking”, of the Healthy Tasmania Five Year Strategic Plan – Community Consultation Draft. Each question has been answered within this submission. This submission will also address the possibility of legal challenges to these proposed changes, a pivotal consideration when implementing any tobacco control laws. This is due to the aggressive nature of the tobacco industry, as illustrated by their attempts to challenge plain packaging laws in the country and through international treaties. The evidence provided in my submission illustrates that prevention of initiation of smoking during adolescence has various benefits in terms of reduction of negative smoking behaviors in later life. I argue that increasing the minimum legal age of purchasing for tobacco to 21 will benefit both the levels of underage smoking as well as the age of onset of initiation of smoking, due to the greater difficulties that those who are underage would experience in accessing tobacco products. I will also address the question of whether the minimum smoking age should be increased to 25.