The impact of nurse practitioner services on cost, quality of care, satisfaction and wait times in the emergency department: A systematic review

Aims To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. Background The delivery of quality care in the emergency department is one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. Data A comprehensive search of four electronic databases from 2006-­‐2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. Methods A three step approach was used. Following a comprehensive search, two reviewers assessed identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data extracted using standardised tools. Results Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-­‐analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding impact on costs. Conclusion Synthesis of the available research attempts to provide an evidence base for emergency nurse practitioner service to guide healthcare leaders, policy makers and clinicians in reforming emergency department service provision. The findings suggest that further quality research is required for comparative measures of clinical and service effectiveness of emergency nurse practitioner service. In the context of increased health service demand and the need to provide timely and effective care to patients, such measures will assist in delivering quality patient care.

Determination of battery storage capacity in energy buffer for wind farm

Design of a battery energy storage system (BESS) in a buffer scheme is examined for the purpose of attenuating the effects of unsteady input power from wind farms. The design problem is formulated as maximization of an objective function that measures the economic benefit obtainable from the dispatched power from the wind farm against the cost of the BESS. Solution to the problem results in the determination of the capacity of the BESS to ensure constant dispatched power to the connected grid, while the voltage level across the dc-link of the buffer is kept within preset limits. A computational procedure to determine the BESS capacity and the evaluation of the dc voltage is shown. Illustrative examples using the proposed design method are included.

Buffer scheme with battery energy storage capability for enhancement of network transient stability and load ride-through

This paper examines a buffer scheme to mitigate the negative impacts of power-conditioned loads on network voltage and transient stabilities. The scheme is based on the use of battery energy-storage systems in the buffers. The storage systems ensure that protected loads downstream of the buffers can ride through upstream voltage sags and swells. Also, by controlling the buffers to operate in either constant impedance or constant power modes, power is absorbed or injected by the storage systems. The scheme thereby regulates the rotor-angle deviations of generators and enhances network transient stability. A computational method is described in which the capacity of the storage systems is determined to achieve simultaneously the above dual objectives of load ride-through and stability enhancement. The efficacy of the resulting scheme is demonstrated through numerical examples.

Department of Social Services Options Paper : Options for Replacement Arrangements Following the Abolition of the Australian Charities and Not-for-profits Commission : Response

Submission in response to government options paper regarding arrangements for regulation of charities following abolition of the Australian Charities and Not-for-profits Commission.

The outsourcing of accounting services and the subsequent accounting education implications

This paper examines the outsourcing of accounting services by Australian accounting firms. It considers what, if any, impact the outsourcing of accounting services may have on accounting graduates if entry level tasks normally completed by graduates are sent to offshore processing centres. This paper categorises the most important prerequisite skills requirements of new junior employees identified by accounting firms in Australia.

Contactless and replaceable modularized battery energy storage system for electric vehicles

A novel replaceable, modularized energy storage system with wireless interface is proposed for a battery operated electric vehicle (EV). The operation of the proposed system is explained and analyzed with an equivalent circuit and an averaged state-space model. A non-linear feedback linearization based controller is developed and implemented to regulate the DC link voltage by modulating the phase shift ratio. The working and control of the proposed system is verified through simulation and some preliminary results are presented.

Effective responses to offenders with intellectual disabilities : generalist and specialist services working together

Despite policies of deinstitutionalisation, many people with intellectual disabilities in developed western countries continue to live in mainstream institutional settings, such as correctional facilities, rather than in the community with support from disability services. This paper reports on the life stories of 10 people with intellectual disabilities, who had been imprisoned in adult correctional facilities in Queensland. The pathways taken by these 10 people into and out of prison are marked by significant abuse, neglect, and poverty. Significant disparity and disconnection is also displayed between the policies and service approaches, particularly between the disability, mental health, and correctional systems in Queensland. Based on these findings, a framework for practice, which spans both generic and specialist services, is suggested.

A unique battery/supercapacitor direct integration scheme for hybrid electric vehicles

Battery/supercapacitor hybrid energy storage systems have been gaining popularity in electric vehicles due to their excellent power and energy performances. Conventional designs of such systems require interfacing dc-dc converters. These additional dc-dc converters increase power loss, complexity, weight and cost. Therefore, this paper proposes a new direct integration scheme for battery/supercapacitor hybrid energy storage systems using a double ended inverter system. This unique approach eliminates the need for interfacing converters and thus it is free from aforementioned drawbacks. Furthermore, the proposed system offers seven operating modes to improve the effective use of available energy in a typical drive cycle of a hybrid electric vehicle. Simulation results are presented to verify the efficacy of the proposed system and control techniques.

Battery clamped three-level inverter for renewable energy systems

This paper presents a novel battery direct integration scheme for renewable energy systems. The idea is to replace ordinary capacitors of a three-level flying-capacitor inverter by three battery banks to alleviate power fluctuations in renewable generation. This approach eliminates the need for interfacing dc-dc converters and thus considerably improves the overall efficiency. However, the major problem with this approach is the uneven distribution of space vectors which is due to unavoidable unbalance in clamping voltages. A detailed analysis on the effects of this issue and a novel carrier based pulse width modulation method, which can generate undistorted currents even in the presence of unevenly distributed space vectors, are presented in this paper. A charge/discharge controller is also proposed for power sharing and state of charge balancing of battery banks. Simulation results are presented to verify the efficacy of the proposed system, modulation method and power sharing controller.

A direct integration scheme for battery-supercapacitor hybrid energy storage systems with the use of grid side inverter

Battery-supercapacitor hybrid energy storage systems are becoming popular in the renewable energy sector due to their improved power and energy performances. These hybrid systems require separate dc-dc converters, or at least one dc-dc converter for the supercapacitor bank, to connect them to the dc-link of the grid interfacing inverter. These additional dc-dc converters increase power losses, complexity and cost. Therefore, possibility of their direct connection is investigated in this paper. The inverter system used in this study is formed by cascading two 3-level inverters, named as the “main inverter” and the “auxiliary inverter”, through a coupling transformer. In the test system the main inverter is connected with the rectified output of a wind generator while the auxiliary inverter is directly attached to a battery and a supercapacitor bank. The major issues with this approach are the dynamic changes in dc-link voltages and inevitable imbalances in the auxiliary inverter voltages, which results in unevenly distributed space vectors. A modified SVM technique is proposed to solve this issue. A PWM based time sharing method is proposed for power sharing between the battery and the supercapacitor. Simulation results are presented to verify the efficacy of the proposed modulation and control techniques.

A Battery Energy Storage interface for wind power systems with the use of grid side inverter

This paper presents a novel concept of Energy Storage System (ESS) interfacing with the grid side inverter in wind energy conversion systems. The inverter system used here is formed by cascading a 2-level inverter and a three level inverter through a coupling transformer. The constituent inverters are named as the “main inverter” and the “auxiliary inverter” respectively. The main inverter is connected with the rectified output of the wind generator while the auxiliary inverter is attached to a Battery Energy Storage System (BESS). The BESS ensures constant power dispatch to the grid irrespective of change in wind condition. Furthermore, this unique combination of BESS and inverter eliminates the need of additional dc-dc converters. Novel modulation and control techniques are proposed to address the problem of non-integer, dynamically-changing dc-link voltage ratio, which is due to random wind changes. Strategies used to handle auxiliary inverter dc-link voltage imbalances and controllers used to charge batteries at different rates are explained in detail. Simulation results are presented to verify the efficacy of the proposed modulation and control techniques in suppressing random wind power fluctuations.

What parents value from formal support services in the context of identified child abuse

Parents whose children are identified as having experienced or being at risk of experiencing significant harm potentially provide an invaluable dimension to our understanding of the circumstances that result in child abuse or neglect and how best to respond to these invariably complex situations. This paper reports findings from a study of the experiences of six parents. In-depth interviews were conducted with four mothers and two fathers who had been referred to an intensive family support services by the Queensland statutory child protection authority. Using a critical ecological perspective, the study focused on identifying and understanding the experiences of the parents in using formal family support services, including aspects of service delivery that were helpful or unhelpful. Parents also commented on their experiences of statutory child protection services. Service components and worker qualities that parents identified as being helpful included being accessible, targeted and integrated and being able to meet a continuum of needs, from a micro to a broader level. Their reports provide invaluable insight into how formal family support services, including child protection services, can better meet the needs of parents in addressing the recurring problem of child maltreatment.

A new method of interfacing battery/supercapacitor energy storage systems for distributed energy sources

Battery-supercapacitor hybrid energy storage systems can achieve better power and energy performances compared to their individual use. These hybrid systems require separate dc-dc converters, or at least one dc-dc converter for the supercapacitor bank, to connect them to the dc-link of the grid connecting inverter. However, the use of such dc-dc converters introduces additional cost and power losses. Therefore, the possibility of direct connection of energy storage systems, to the dc-link of a diode clamped 3-level inverter is investigated in this paper. Even though the proposed topology does not use dc-dc converters, a vector selection method is proposed to produce a similar control flexibility that is found in the separate dc-dc converter topology. The major issue with the proposed system is the imminent imbalance of the neutral point potential. A PWM technique with modified carriers is used to solve this problem. Simulations are carried out using MATLAB/SIMULINK to verify the efficacy of the proposed system.

Public preferences for biodiversity conservation and climate-change mitigation: A choice experiment using ecosystem services indicators

Potential conflicts exist between biodiversity conservation and climate-change mitigation as trade-offs in multiple-use land management. This study aims to evaluate public preferences for biodiversity conservation and climate-change mitigation policy considering respondents’ uncertainty on their choice. We conducted a choice experiment using land-use scenarios in the rural Kushiro watershed in northern Japan. The results showed that the public strongly wish to avoid the extinction of endangered species in preference to climate-change mitigation in the form of carbon sequestration by increasing the area of managed forest. Knowledge of the site and the respondents’ awareness of the personal benefits associated with supporting and regulating services had a positive effect on their preference for conservation plans. Thus, decision-makers should be careful about how they provide ecological information for informed choices concerning ecosystem services tradeoffs. Suggesting targets with explicit indicators will affect public preferences, as well as the willingness of the public to pay for such measures. Furthermore, the elicited-choice probabilities approach is useful for revealing the distribution of relative preferences for incomplete scenarios, thus verifying the effectiveness of indicators introduced in the experiment.

Design of a wind turbine - battery energy storage scheme to achieve power dispatchability

Battery energy storage system (BESS) is to be incorporated in a wind farm to achieve constant power dispatch. The design of the BESS is based on the forecasted wind speed, and the technique assumes the distribution of the error between the forecasted and actual wind speeds is Gaussian. It is then shown that although the error between the predicted and actual wind powers can be evaluated, it is non-Gaussian. With the known distribution in the error of the predicted wind power, the capacity of the BESS can be determined in terms of the confident level in meeting specified constant power dispatch commitment. Furthermore, a short-term power dispatch strategy is also developed which takes into account the state of charge (SOC) of the BESS. The proposed approach is useful in the planning of the wind farm-BESS scheme and in the operational planning of the wind power generating station.