Effectiveness of an emergency nurse practitioner service for adults presenting to rural hospitals with chest pain : Protocol for a multicentre, longitudinal nested cohort study

Introduction Chest pain is common in emergency department (ED) patients and represents a considerable burden for rural health services. Health services reforms to improve access to care need appropriately skilled and supported clinicians in the delivery of safe and effective care, including the use of emergency nurse practitioners (ENPs). Despite increasing use of ENPs, little is known about the safety and quality of the service in the rural ED context. The aims of this study are (1) to examine the safety and quality of the ENP service model in the provision of care in the rural environment and (2) to evaluate the effectiveness of the service in the management of patients presenting with undifferentiated chest pain. Methods and analysis This is the protocol for a prospective longitudinal nested cohort study to compare the effectiveness of ENP service with that of standard care. Adults presenting to three rural EDs in Queensland, Australia with a primary presenting complaint of atraumatic chest pain will be eligible for enrolment. We will measure (1) clinician's use of evidence-based guidelines (2) diagnostic accuracy of ECG interpretation for the management of patients with suspected or confirmed ACS (3) service indicators of waiting times, length-of-stay and did-not-wait rates and (4) clinician's diagnostic accuracy as measured by rates of unplanned representation within 7 days (5) satisfaction with care, (6) quality-of-life and (7) functional status. To assess these outcomes we will use a combination of measures collected from routinely collected data, medical record review and questionnaires (with 30-day follow-up). Ethics and dissemination Queensland Health Human Research Ethics Committee (HREC) has approved this protocol. The results will be published in peer-reviewed scientific journals and presented at one or more scientific conferences.

Emerging water treatment technologies for decentralised systems : an overview of selected systems suited for application in towns and settlements in remote and very remote regions of Australia and vulnerable and lagging rural regions in Sri Lanka

The primary purpose of this paper is to overview a selection of advanced water treatment technology systems that are suited for application in towns and settlements in remote and very remote regions of Australia and vulnerable and lagging rural regions in Sri Lanka. This recognises that sanitation and water treatment are inextricably linked and both are needed to reduce risks to environment and population health from contaminated water sources. For both Australia and Sri Lanka only a small fraction of the settlements in rural and remote regions are connected to water treatment facilities and town water supplies. In Australia’s remote/very remote regions raw water is drawn from underground sources and rainwater capture. Most settlements in rural Sri Lanka rely on rivers, reservoirs, wells, springs or carted water. Furthermore, Sri Lanka has more than 25,000 hand pumped tube wells which saved the communities during recent droughts. Decentralised water supply systems offer the opportunity to provide safe drinking water to these remote/very remote and rural regions where centralised systems are not feasible due to socio-cultural, economic, political, technological reasons. These systems reduce health risks from contaminated water supplies. In remote areas centralized systems fail due to low population density and less affordability. Globally, a new generation of advanced water treatment technologies are positioned to make a major impact on the provision of safe potable water in remote/very remote regions in Australia and rural regions in Sri Lanka. Some of these systems were developed for higher income countries. However, with careful selection and further research they can be tailored to match local socio-economic conditions and technical capacity. As such, they can equally be used to provide decentralised water supply in communities in developed and developing countries such as Australia and Sri Lanka.

The private problem with public service: Rural teachers in educational markets

Staffing rural and remote schools is an important policy issue for the public good. This paper examines the private issues it also poses for teachers with families working in these communities, as they seek to reconcile careers with educational choices for children. The paper first considers historical responses to staffing rural and remote schools in Australia, and the emergence of neoliberal policy encouraging marketisation of the education sector. We report on interviews about considerations motivating household mobility with 11 teachers across regional, rural and remote communities in Queensland. Like other middle-class parents, these teachers prioritised their children’s educational opportunities over career opportunities. The analysis demonstrates how teachers in rural and remote communities constitute a special group of educational consumers with insider knowledge and unique dilemmas around school choice. Their heightened anxieties around school choice under neoliberal policy are shown to contribute to the public issue of staffing rural and remote schools.

Decentralised Communication in Autonomous Agent Swarms

Communication and information diffusion are typically difficult in situations where centralised structures may become unavailable. In this context, decentralised communication based on epidemic broadcast becomes essential. It can be seen as an opportunity-based flooding for message broadcasting within a swarm of autonomous agents, where each entity tries to share the information it possesses with its neighbours. As an example of applications for such a system, we present simulation results where agents have to coordinate to map an unknown area.

Investigation of pedestrian crashes on two-way two-lane rural roads in Ethiopia

Understanding pedestrian crash causes and contributing factors in developing countries is critically important as they account for about 55% of all traffic crashes. Not surprisingly, considerable attention in the literature has been paid to road traffic crash prediction models and methodologies in developing countries of late. Despite this interest, there are significant challenges confronting safety managers in developing countries. For example, in spite of the prominence of pedestrian crashes occurring on two-way two-lane rural roads, it has proven difficult to develop pedestrian crash prediction models due to a lack of both traffic and pedestrian exposure data. This general lack of available data has further hampered identification of pedestrian crash causes and subsequent estimation of pedestrian safety performance functions. The challenges are similar across developing nations, where little is known about the relationship between pedestrian crashes, traffic flow, and road environment variables on rural two-way roads, and where unique predictor variables may be needed to capture the unique crash risk circumstances. This paper describes pedestrian crash safety performance functions for two-way two-lane rural roads in Ethiopia as a function of traffic flow, pedestrian flows, and road geometry characteristics. In particular, random parameter negative binomial model was used to investigate pedestrian crashes. The models and their interpretations make important contributions to road crash analysis and prevention in developing countries. They also assist in the identification of the contributing factors to pedestrian crashes, with the intent to identify potential design and operational improvements.

Communication and essentialism: Grounding the shared reality of a social category

Essentialism is an ontological belief that there exists an underlying essence to a category. This article advances and tests in three studies the hypothesis that communication about a social category, and expected or actual mutual validation, promotes essentialism about a social category. In Study 1, people who wrote communications about a social category to their ingroup audiences essentialized it more strongly than those who simply memorized about it. In Study 2, communicators whose messages about a novel social category were more elaborately discussed with a confederate showed a stronger tendency to essentialize it. In Study 3, communicators who elaborately talked about a social category with a naive conversant also essentialized the social category. A meta-analysis of the results supported the hypothesis that communication promotes essentialism. Although essentialism has been discussed primarily in perceptual and cognitive domains, the role of social processes as its antecedent deserves greater attention.

Enterprise-related crisis communication on Twitter

The rise of social media as communication channels has enabled customers to provide feedback or to ask for assistance quickly and easily. In the context of brand crises, the microblogging platform Twitter is highly relevant because of its ability to support information sharing. By investigating communication on Twitter, the authors examine Twitter activity patterns based on a dataset of some 240,000 tweets during two major brand crises affecting the Australian airline Qantas – the volcanic ash cloud caused by the eruption of Chilean volcano Puyehue in June 2011, and the global grounding of Qantas flights by management in the course of an industrial dispute in October/November 2011. Through this case study we find that characteristics of communication change significantly during different stages of the crisis. Further, we demonstrate that different kinds of crisis result in different communication patterns on Twitter.

Exploring factors influencing adherence to lifestyle modifications in Chinese people with hypertension: The role of concordance during health communication

This study investigated the factors influencing the conduct of modifying unhealthy lifestyles in Chinese people with high blood pressure, and examined the effect of health communication between health professionals and patients on their health behaviours. The thesis proposes a new theoretical framework to explain and predict individuals' behaviours which can be used to design interventions to improve their health behaviours.

Establishing and maintaining social connectivity: An understanding of the lived experiences of older adults residing in regional and rural communities

- Objective To better understand how to plan for an ageing demographic that resides in ever-changing community typologies. Design: Semi-structured in-depth interviews. - Setting Community settings in rural and regional towns in Queensland. - Participants Twenty-two people aged over 65 years living in regional and rural Australia. - Interventions Qualitative study of social connectedness. - Main outcome measure(s) Thematic qualitative analysis. - Results Formal and informal social contact, through family, friends and social groups, was found to be important to the everyday lives of the participants. - Conclusions Social connections for older adults are important in maintaining independence and community engagement.

Reliable, cloud-based communication for multi-robot systems

In contrast to single robotic agent, multi-robot systems are highly dependent on reliable communication. Robots have to synchronize tasks or to share poses and sensor readings with other agents, especially for co-operative mapping task where local sensor readings are incorporated into a global map. The drawback of existing communication frameworks is that most are based on a central component which has to be constantly within reach. Additionally, they do not prevent data loss between robots if a failure occurs in the communication link. During a distributed mapping task, loss of data is critical because it will corrupt the global map. In this work, we propose a cloud-based publish/subscribe mechanism which enables reliable communication between agents during a cooperative mission using the Data Distribution Service (DDS) as a transport layer. The usability of our approach is verified by several experiments taking into account complete temporary communication loss.

Effective communication during disasters: What effects community decision making & action?

Study/Objective This paper describes a program of research examining emergency messaging during the response and early recovery phases of natural disasters. The objective of this suite of studies is to develop message construction frameworks and channels that maximise community compliance with instructional messaging. The research has adopted a multi-hazard approach and considers the impact of formal emergency messages, as well as informal messages (e.g., social media posts), on community compliance. Background In recent years, media reports have consistently demonstrated highly variable community compliance to instructional messaging during natural disasters. Footage of individuals watching a tsunami approaching from the beach or being over-run by floodwaters are disturbing and indicate the need for a clearer understanding of decision making under stress. This project’s multi-hazard approach considers the time lag between knowledge of the event and desired action, as well as how factors such as message fatigue, message ambiguity, and the interplay of messaging from multiple media sources are likely to play a role in an individual’s compliance with an emergency instruction. Methods To examine effective messaging strategy, we conduct a critical analysis of the literature to develop a framework for community consultation and design experiments to test the potential for compliance improvement. Results Preliminary results indicate that there is, as yet, little published evidence on which to base decisions about emergency instructional messages to threatened communities. Conclusion The research described here will contribute improvements in emergency instructional message compliance by generating an evidence-based framework that takes into account behavioural compliance theory, the psychology of decision making under stress, and multiple channels of communication including social media.

Effective communication during disasters

This paper describes a program of research examining emergency messaging during the response and early recovery phases of natural disasters. The objective of this suite of studies is to develop message construction frameworks and channels that maximise community compliance with instructional messaging. The research has adopted a multi-hazard approach and considers the impact of formal emergency messages, as well as informal messages (e.g., social media posts), on community compliance. In recent years, media reports have consistently demonstrated highly variable community compliance to instructional messaging during natural disasters. Footage of individuals watching a tsunami approaching from the beach or being over-run by floodwaters are disturbing and indicate the need for a clearer understanding of decision making under stress. This project’s multi-hazard approach considers the time lag between knowledge of the event and desired action, as well as how factors such as message fatigue, message ambiguity, and the interplay of messaging from multiple media sources are likely to play a role in an individual’s compliance with an emergency instruction. To examine effective messaging strategy, we conduct a critical analysis of the literature to develop a framework for community consultation and design experiments to test the potential for compliance improvement. Preliminary results indicate that there is, as yet, little published evidence on which to base decisions about emergency instructional messages to threatened communities. The research described here will contribute improvements in emergency instructional message compliance by generating an evidence-based framework that takes into account behavioural compliance theory, the psychology of decision making under stress, and multiple channels of communication including social media.

Seasonal variations of outdoor air pollution and factors driving them in the school environment in rural Bhutan

A quantitative understanding of outdoor air quality in school environments is crucial given that air pollution levels inside classrooms are significantly influenced by outdoor pollution sources. To date, only a handful of studies have been conducted on this important topic in developing countries. The aim of this study was to quantify pollutant levels in the outdoor environment of a school in Bhutan and assess the factors driving them. Measurements were conducted for 16 weeks, spanning the wet and dry seasons, in a rural school in Bhutan. PM10, PM2.5, particle number (PN) and CO were measured daily using real-time instruments, while weekly samples for volatile organic compounds (VOCs), carbonyls and NO2 were collected using a passive sampling method. Overall mean PM10 and PM2.5 concentrations (µg/m3) were 27 and 13 for the wet, and 36 and 29 for the dry season, respectively. Only wet season data were available for PN concentrations, with a mean of 2.56 × 103 particles/cm3. Mean CO concentrations were below the detection limit of the instrumentation for the entire measurement period. Only low levels of eight VOCs were detected in both the wet and dry seasons, which presented different seasonal patterns in terms of the concentration of different compounds. The notable carbonyls were formaldehyde and hexaldehyde, with mean concentrations (µg/m3) of 2.37 and 2.41 for the wet, and 6.22 and 0.34 for the dry season, respectively. Mean NO2 cocentration for the dry season was 1.7 µg/m3, while it was below the detection limit of the instrumentation for the wet season. The pollutant concentrations were associated with a number of factors, such as cleaning and combustion activities in and around the school. A comparison with other school studies showed comparable results with a few of the studies, but in general, we found lower pollutant concentrations in the present study.