Development and validation of the Emergency Department Assessment of Chest pain Score and 2h accelerated diagnostic protocol

Objective Risk scores and accelerated diagnostic protocols can identify chest pain patients with low risk of major adverse cardiac event who could be discharged early from the ED, saving time and costs. We aimed to derive and validate a chest pain score and accelerated diagnostic protocol (ADP) that could safely increase the proportion of patients suitable for early discharge. Methods Logistic regression identified statistical predictors for major adverse cardiac events in a derivation cohort. Statistical coefficients were converted to whole numbers to create a score. Clinician feedback was used to improve the clinical plausibility and the usability of the final score (Emergency Department Assessment of Chest pain Score [EDACS]). EDACS was combined with electrocardiogram results and troponin results at 0 and 2 h to develop an ADP (EDACS-ADP). The score and EDACS-ADP were validated and tested for reproducibility in separate cohorts of patients. Results In the derivation (n = 1974) and validation (n = 608) cohorts, the EDACS-ADP classified 42.2% (sensitivity 99.0%, specificity 49.9%) and 51.3% (sensitivity 100.0%, specificity 59.0%) as low risk of major adverse cardiac events, respectively. The intra-class correlation coefficient for categorisation of patients as low risk was 0.87. Conclusion The EDACS-ADP identified approximately half of the patients presenting to the ED with possible cardiac chest pain as having low risk of short-term major adverse cardiac events, with high sensitivity. This is a significant improvement on similar, previously reported protocols. The EDACS-ADP is reproducible and has the potential to make considerable cost reductions to health systems.

Critically deconstructing race through a multimodal analysis of iPad Tellagami videos

Drawing on multimodal texts produced by an Indigenous school community in Australia, I apply critical race theory and multimodal analysis (Jewitt, 2011) to decolonise digital heritage practices for Indigenous students. This study focuses on the particular ways in which students’ counter-narratives about race were embedded in multimodal and digital design in the development of a digital cultural heritage (Giaccardi, 2012). Data analysis involved applying multimodal analysis to the students’ Gamis, following social semiotic categories and principles theorised by Kress and Bezemer (2008), and Jewitt (2006, 2011). This includes attending to the following semiotic elements: visual design, movement and gesture, gaze, and recorded speech, and their interrelationships. The analysis also draws on critical race theory to interpret the students’ representations of race. In particular, the multimodal texts were analysed as a site for students’ views of Indigenous oppression in relation to the colonial powers and ownership of the land in Australian history (Ladson-Billings, 2009). Pedagogies that explore counter-narratives of cultural heritage in the official curriculum can encourage students to reframe their own racial identity, while challenging dominant white, historical narratives of colonial conquest, race, and power (Gutierrez, 2008). The children’s multimodal “Gami” videos, created with the iPad application, Tellagami, enabled the students to imagine hybrid, digital social identities and perspectives of Australian history that were tied to their Indigenous cultural heritage (Kamberelis, 2001).

Predicting the performance of LSF walls made of hollow flange channel sections in fire

Fire resistance of load bearing Light Gauge Steel Frame (LSF) wall systems is important to protect lives and properties in fire accidents. Recent fire tests of LSF walls made of the new cold-formed and welded hollow flange channel (HFC) section studs and the commonly used lipped channel section (LCS) studs have shown the influence of stud sections on the fire resistance rating (FRR) of LSF walls. To advance the use of HFC section studs and to verify the outcomes from the fire tests, finite element models were developed to predict the structural fire performance of LSF walls made of welded HFC section studs. The developed models incorporated the measured non-uniform temperature distributions in LSF wall studs due to the exposure of standard fire on one side, and accurate elevated temperature mechanical properties of steel used in the stud sections. These models simulated the various complexities involved such as thermal bowing and neutral axis shift caused by the non-uniform temperature distribution in the studs. The finite element analysis (FEA) results agreed well with the full scale fire test results including the FRR, outer hot and cold flange temperatures at failure and axial deformation and lateral displacement profiles. They also confirmed the superior fire performance of LSF walls made of HFC section studs. The applicability of both transient and steady state FEA of LSF walls under fire conditions was verified in this study, which also investigated the effects of using various temperature distribution patterns across the cross-section of HFC section studs on the FRR of LSF walls. This paper presents the details of this numerical study and the results.

Acceptability of a rice-based oral rehydration solution in Port Moresby General Hospital's Children's Outpatient Department

The guardians of children brought to the Port Moresby General Hospital's Children's Outpatient Department with a chief complaint of diarrhoeal disease were questioned regarding their preference of glucose-based vs rice-based oral rehydration solution (ORS) in order to determine the acceptability of a rice-based ORS. Of the 93 guardians interviewed, greater than 60% preferred the glucose-based solution in its mixability, appearance and taste, and 65% initially reported that their children preferred the taste of the glucose solution. However, after a 30-minute trial, only 58% of children still preferred the glucose solution. In a country where diarrhoeal disease is a leading cause of child death and guardians are the primary health care providers, the acceptability of an ORS is critical to the morbidity and mortality of Papua New Guinea's children. Killing an estimated 2.9 million children annually, diarrheal disease is the second leading cause of child mortality worldwide. Diarrheal disease is also the second leading cause of child mortality in Papua New Guinea (PNG), killing an average 193 inpatient children per year over the period 1984-90. However, despite the high level of diarrhea-related mortality and the proven efficacy of oral rehydration therapy (ORT) in managing diarrhea-related dehydration, standardized ORT has been underutilized in PNG. The current glucose-based oral rehydration solution (ORS) does not reduce the frequency or volume of a child's diarrhea, the most immediate concern of caregivers during episodes of illness. Cereal-based ORS, made from cereals which are commonly available as food staples in most countries, better address the short-term concerns of caregivers while offering a superior nutritional profile. A sample of guardians of children brought to the Port Moresby General Hospital's Children's Outpatient Department complaining of child diarrhea were asked about their preferences on glucose-based versus rice-based ORS in order to determine the acceptability of a rice-based ORS. More than 60% of the 93 guardians interviewed preferred the glucose-based solution for its mixability, appearance, and taste. 65% initially reported that their children preferred the taste of the glucose solution. However, after a 30-minute trial, only 58% of children still preferred the glucose solution.

Infant product-related injuries: comparing specialised injury surveillance and routine emergency department data

- Objective To explore the potential for using a basic text search of routine emergency department data to identify product-related injury in infants and to compare the patterns from routine ED data and specialised injury surveillance data. - Methods Data was sourced from the Emergency Department Information System (EDIS) and the Queensland Injury Surveillance Unit (QISU) for all injured infants between 2009 and 2011. A basic text search was developed to identify the top five infant products in QISU. Sensitivity, specificity, and positive predictive value were calculated and a refined search was used with EDIS. Results were manually reviewed to assess validity. Descriptive analysis was conducted to examine patterns between datasets. - Results The basic text search for all products showed high sensitivity and specificity, and most searches showed high positive predictive value. EDIS patterns were similar to QISU patterns with strikingly similar month-of-age injury peaks, admission proportions and types of injuries. - Conclusions This study demonstrated a capacity to identify a sample of valid cases of product-related injuries for specified products using simple text searching of routine ED data. - Implications As the capacity for large datasets grows and the capability to reliably mine text improves, opportunities for expanded sources of injury surveillance data increase. This will ultimately assist stakeholders such as consumer product safety regulators and child safety advocates to appropriately target prevention initiatives.

Mechanical performances of track-shaped rebar stiffened concrete-filled steel tubular (SCFRT) stub columns under axial compression

This paper presents a combined experimental, numerical, and theoretical study on the mechanical behaviors of track-shaped concrete-filled steel tubular (SCFRT) stub columns stiffened by rebars under compressive load. A total of 18 track-shaped concrete-filled steel tubular specimens including 12 specimens stiffened by rebars and 6 non-stiffened counterparts are tested, with consideration of parameters including flakiness ratio, concrete strength, and stiffeners. Failure pattern, bearing capacity, and ductility are all analyzed and discussed based on the experimental results. The numerical simulation by finite element (FE) software ABAQUS is also conducted. Based on both experimental and numerical results, theoretical formula to predict the load-bearing capacity of SCFRT stub columns subjected to axial compression loading is established according to the superposition principle of ultimate load-bearing capacity with rational simplification. The proposed theoretical method provides accurate predictions on the load bearing capacity by comparing with experimental results from 18 groups of specimens.

The politics of race, class and special education: The selected works of Sally Tomlinson

Upon reading this esteemed collection of Sally Tomlinson’s works, published in Routledge’s prestigious World Library of Educationalists series, I was struck by three things. First, Sally is one of only three women among the 26 scholars whose collections have been published in this series to date, and the only scholar researching questions relating to disability and special education. Second, her early work on the sociology of special education Tomlinson, 1982) is just as pertinent today as her most recent research on the political scapegoating of low-attainers in a global knowledge economy (Tomlinson, 2012). Third, I was reminded of the extent to which her research has both inspired and guided me as I now grapple with the same research problems, albeit in a different country and at a different time, but always from a similar sociological standpoint (Graham & Jahnukainen, 2011; Graham & Sweller, 2011; Graham, 2012; Graham, 2014; Graham, Van Bergen & Sweller, 2014). Not surprisingly, the phrase that kept echoing through my head as I read through the 11 chapters chronicling a rich and immensely productive academic career was: ‘history repeats’. And, throughout the book are numerous examples and observations as to why it does. To paraphrase, the answer is power, status and politics.

Fire resistance of light gauge steel frame wall systems lined with gypsum plasterboards

Light gauge steel frame (LSF) wall systems are increasingly used in residential and commercial buildings as load bearing and non-load bearing elements. Conventionally, the fire resistance ratings of such building elements are determined using approximate prescriptive methods based on limited standard fire tests. However, recent studies have shown that in some instances real building fire time-temperature curves could be more severe than the standard fire curve, in terms of maximum temperature and rate of temperature rise. This has caused problems for safe evacuation and rescue activities, and in some instances has also lead to the collapse of buildings earlier than the prescribed fire resistance. Therefore a detailed research study into the performance of LSF wall systems under both standard fire and realistic fire conditions was undertaken using full scale fire tests to understand the fire performance of different LSF wall configurations. Both load bearing and non-load bearing full scale fire tests were performed on LSF walls configurations which included single layer, double layer, externally insulated wall panels made up of different steel sections and thicknesses of gypsum plasterboards. The non-load bearing fire test results were utilized to understand the factors affecting the fire resistance of LSF walls, while loading bearing fire test results led to development of simplified methods to predict the fire resistance ratings of load bearing LSF walls exposed to both standard and realistic design fires. This paper presents the results of full scale experimental study and highlights the effects of standard and realistic fire conditions on fire performance of LSF walls.

Numerical studies of gypsum plasterboard and MGO board lined LSF walls exposed to fire

Fire resistance of cold-formed light gauge steel frame (LSF) wall systems is enhanced by lining them with single or multiple layers of wall boards with varying thermal properties. These wall boards are gypsum plasterboards or Magnesium Oxide (MgO) boards produced by different manufacturers. Thermal properties of these boards appear to show considerable variations and this can lead to varying fire resistance levels (FRL) for their wall systems. Currently FRLs of wall systems are determined using full scale fire tests, but they are time consuming and expensive. Recent research studies on the fire performance of LSF wall systems have used finite element studies to overcome this problem, but they were developed based on 1-D and 2-D finite element platform capable of performing either heat transfer or structural analysis separately. Hence in this research a 3-D finite element model was developed first for LSF walls lined with gypsum plasterboard and cavity insulation materials. Accurate thermal properties of these boards are essential for finite element modelling, and thus they were measured at both ambient and elevated temperatures. This experimental study included specific heat, relative density and thermal conductivity of boards. The developed 3-D finite element model was then validated using the available fire tests results of LSF walls lined with gypsum plasterboard, and is being used to investigate the fire performance of different LSF wall configurations. The tested MgO board exhibited significant variations in their thermal properties in comparison to gypsum plasterboards with about 50% loss of its initial mass at about 500 ºC compared to 16% for gypsum plasterboards. Hence the FRL of MgO board lined LSF wall systems is likely to be significantly reduced. This paper presents the details of this research study on the fire performance of LSF wall systems lined with gypsum plasterboard and MgO board including the developed 3-D finite element models, thermal property tests and the results.

Integrated lean six sigma approach for patient flow improvement in hospital emergency department

This research aims to develop an Integrated Lean Six Sigma approach to investigate and resolve the patient flow problems in hospital emergency departments. It was proposed that the voice of the customer and the voice of the process should be considered simultaneously to investigate the current process of patient flow. Statistical analysis, visual process mapping with A3 problem solving sheet, and cause and effect diagrams have been used to identify the major patient flow issues. This research found that engaged frontline workers, long-term leadership obligation, an understanding of patients' requirements and the implementation of a systematic integration of lean strategies could continuously improve patient flow, health care service and growth in the emergency departments.

Cost and outcomes of assessing patients with chest pain in an Australian emergency department

Objectives: We sought to characterise the demographics, length of admission, final diagnoses, long-term outcome and costs associated with the population who presented to an Australian emergency department (ED) with symptoms of possible acute coronary syndrome (ACS). Design, setting and participants: Prospectively collected data on ED patients presenting with suspected ACS between November 2008 and February 2011 was used, including data on presentation and at 30 days after presentation. Information on patient disposition, length of stay and costs incurred was extracted from hospital administration records. Main outcome measures: Primary outcomes were mean and median cost and length of hospital stay. Secondary outcomes were diagnosis of ACS, other cardiovascular conditions or non-cardiovascular conditions within 30 days of presentation. Results: An ACS was diagnosed in 103 (11.1%) of the 926 patients recruited. 193 patients (20.8%) were diagnosed with other cardiovascular-related conditions and 622 patients (67.2%) had non-cardiac-related chest pain. ACS events occurred in 0 and 11 (1.9%) of the low-risk and intermediate-risk groups, respectively. Ninety-two (28.0%) of the 329 high-risk patients had an ACS event. Patients with a proven ACS, high-grade atrioventricular block, pulmonary embolism and other respiratory conditions had the longest length of stay. The mean cost was highest in the ACS group ($13 509; 95% CI, $11 794–$15 223) followed by other cardiovascular conditions ($7283; 95% CI, $6152–$8415) and non-cardiovascular conditions ($3331; 95% CI, $2976–$3685). Conclusions: Most ED patients with symptoms of possible ACS do not have a cardiac cause for their presentation. The current guideline-based process of assessment is lengthy, costly and consumes significant resources. Investigation of strategies to shorten this process or reduce the need for objective cardiac testing in patients at intermediate risk according to the National Heart Foundation and Cardiac Society of Australia and New Zealand guideline is required.

Low-frequency electrical stimulation combined with a cooling vest improves recovery of elite kayakers following a simulated 1000-m race in a hot environment

This study compared the effects of a low-frequency electrical stimulation (LFES; Veinoplus® Sport, Ad Rem Technology, Paris, France), a low-frequency electrical stimulation combined with a cooling vest (LFESCR) and an active recovery combined with a cooling vest (ACTCR) as recovery strategies on performance (racing time and pacing strategies), physiologic and perceptual responses between two sprint kayak simulated races, in a hot environment (∼32 wet-bulb-globe temperature). Eight elite male kayakers performed two successive 1000-m kayak time trials (TT1 and TT2), separated by a short-term recovery period, including a 30-min of the respective recovery intervention protocol, in a randomized crossover design. Racing time, power output, and stroke rate were recorded for each time trial. Blood lactate concentration, pH, core, skin and body temperatures were measured before and after both TT1 and TT2 and at mid- and post-recovery intervention. Perceptual ratings of thermal sensation were also collected. LFESCR was associated with a very likely effect in performance restoration compared with ACTCR (99/0/1%) and LFES conditions (98/0/2%). LFESCR induced a significant decrease in body temperature and thermal sensation at post-recovery intervention, which is not observed in ACTCR condition. In conclusion, the combination of LFES and wearing a cooling vest (LFESCR) improves performance restoration between two 1000-m kayak time trials achieved by elite athletes, in the heat.

What does the future hold for our traditional department stores?

Years of buy-outs, takeovers, mergers and rebranding have whittled a once plentiful landscape of department store competitors down to two major players, Myer and David Jones. Now, despite David Jones confirming it refused a potential A$3 billion merger proposal approach from its arch-competitor in October 2013, we must face the distinct possibility of there only being room for one, full line, up-market department store in Australia.

Down, down but not different: Australia’s supermarkets in a race to the bottom

For 25 years, Woolworths told shoppers they were “the fresh food people”. It was a very clear point of difference and delivered the group a sustainable competitive advantage. Any attempt by a competitor to replicate it would have been dismissed as lacking credence; a simple market-follower strategy.

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.