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.

Extinction risk in cloud forest fragments under climate change and habitat loss

Aim: To quantify the consequences of major threats to biodiversity, such as climate and land-use change, it is important to use explicit measures of species persistence, such as extinction risk. The extinction risk of metapopulations can be approximated through simple models, providing a regional snapshot of the extinction probability of a species. We evaluated the extinction risk of three species under different climate change scenarios in three different regions of the Mexican cloud forest, a highly fragmented habitat that is particularly vulnerable to climate change. Location: Cloud forests in Mexico. Methods: Using Maxent, we estimated the potential distribution of cloud forest for three different time horizons (2030, 2050 and 2080) and their overlap with protected areas. Then, we calculated the extinction risk of three contrasting vertebrate species for two scenarios: (1) climate change only (all suitable areas of cloud forest through time) and (2) climate and land-use change (only suitable areas within a currently protected area), using an explicit patch-occupancy approximation model and calculating the joint probability of all populations becoming extinct when the number of remaining patches was less than five. Results: Our results show that the extent of environmentally suitable areas for cloud forest in Mexico will sharply decline in the next 70 years. We discovered that if all habitat outside protected areas is transformed, then only species with small area requirements are likely to persist. With habitat loss through climate change only, high dispersal rates are sufficient for persistence, but this requires protection of all remaining cloud forest areas. Main conclusions: Even if high dispersal rates mitigate the extinction risk of species due to climate change, the synergistic impacts of changing climate and land use further threaten the persistence of species with higher area requirements. Our approach for assessing the impacts of threats on biodiversity is particularly useful when there is little time or data for detailed population viability analyses. © 2013 John Wiley & Sons Ltd.

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.

The potential impact of climate change and ultraviolet radiation on vaccine preventable infectious diseases and immunisation service delivery system

Climate change and solar ultraviolet radiation may affect vaccine-preventable infectious diseases (VPID), the human immune response process and the immunization service delivery system. We systematically reviewed the scientific literature and identified 37 relevant publications. Our study shows that climate variability and ultraviolet radiation may potentially affect VPID and the immunization delivery system through modulating vector reproduction and vaccination effectiveness, possibly influencing human immune response systems to the vaccination, and disturbing immunization service delivery. Further research is needed to determine these affects on climate-sensitive VPID and on human immune response to common vaccines. Such research will facilitate the development and delivery of optimal vaccination programs for target populations, to meet the goal of disease control and elimination.

An introduction to education research methods: Exploring the learning journey of pre-service teachers in a transnational programme

Internationally there is interest in developing the research skills of pre-service teachers as a means of ongoing professional renewal with a distinct need for systematic and longitudinal investigation of student learning. The current study takes a unique perspective by exploring the research learning journey of pre-service teachers participating in a transnational degree programme. Using a case-study design that includes both a self-reported and direct measure of research knowledge, the results indicate a progression in learning, as well as evidence that this research knowledge is continued or maintained when the pre-service teachers return to their home university. The findings of this study have implications for both pre-service teacher research training and transnational programmes.

Oncology service initiatives and research in regional Australia

Objective: This paper reflects on the recent growth of cancer research being conducted through some of Australia’s rural centres. It encompasses work being done across the fields of clinical, translational and health services research. Design: This is a collaborative piece with contributions from rural health researchers, clinical and cancer services staff from several different regions. Conclusion: The past decade has seen an expansion in cancer research in rural and regional Australia driven in part by the recognition that cancer patients in remote areas experience poorer outcomes than their metropolitan counterparts. This work has led to the development of more effective cancer networks and new models of care designed to meet the particular needs of the rural cancer patient. It is hoped that the growth of cancer research in regional centres will, in time, reduce the disparity between rural and urban communities and improve outcomes for cancer patients across both populations.

Performance evaluation of cloud-based parallel computing

As computational models in fields such as medicine and engineering get more refined, resource requirements are increased. In a first instance, these needs have been satisfied using parallel computing and HPC clusters. However, such systems are often costly and lack flexibility. HPC users are therefore tempted to move to elastic HPC using cloud services. One difficulty in making this transition is that HPC and cloud systems are different, and performance may vary. The purpose of this study is to evaluate cloud services as a means to minimise both cost and computation time for large-scale simulations, and to identify which system properties have the most significant impact on performance. Our simulation results show that, while the performance of Virtual CPU (VCPU) is satisfactory, network throughput may lead to difficulties.

Achieving service quality through service innovation exploration-exploitation: The critical role of employee empowerment and slack resources

Purpose This study investigates the effects of service innovation exploration-exploitation on financial performance through the delivery of quality services. Additional emphasis is also given to examining the extent to which employee empowerment and slack resources enhance or suppress the performance benefits of service firms engaging in service innovation exploration versus exploitation. Design/methodology/approach Data were drawn from a multi-informant survey of service firms using a drop-and-collect approach. The survey gathered data from managers, customer service employees and customers to test the hypotheses. Findings The results show that excelling at both exploitative and exploratory innovation helps enhance the quality of services, which in turn yield superior financial performance. Further, empowering employees enhances the relationship between exploratory and exploitative service innovation and service quality. We also show that the extent managers’ perceived their market to be competitive influences in the pursuit of high levels of both service innovation exploration and exploitation and that this relationship is impacted by the extent they believe they have available slack resources. Practical implications The findings suggest that service firms need to pursue both exploitation and exploration at high levels simultaneously and empower their employees to stay ahead of competitors in delivering quality services, which ultimately contribute to the achievement of superior financial outcomes. Also, the findings highlight the importance of employee empowerment, market competitiveness and slack resources in the pursuit of high levels of both service innovation exploration and exploitation. Originality/value These findings and our theory indicate that this study is the first to empirically examine organizational ambidexterity in the context of service innovation exploration – exploitation adopting the principles of combined and balanced innovation. The study provides insights into the critical role of customers’ perceptions of service quality in contributing to firms’ financial performance. Our insights are unique in that the study incorporates managers, employees and customers in an integrated service innovation model.

Developing knowledge and leadership in pre-service teacher education systems

Pre-service teacher education institutions are large and complex organizations, which are notoriously difficult to change. One factor is that many change efforts focus largely on individual pre-service teacher educators altering their practice. We report here on our experience using a model for effecting change, which views pre-service teacher education institutions and educators as a part of a much broader system. We identified numerous possibilities for, and constraints on, embedding change, but focus only on two in this paper: participants’ knowledge of change strategies and their leadership capacities. As a result of our study findings and researcher reflections, we argue that being a leader in an academic area within pre-service teacher education does not equate to leadership knowledge or skills to initiate and enact systems-wide change. Furthermore, such leadership capacities must be explicitly developed if education for sustainability is to become embedded in pre-service teacher education.

Professional spaces for pre-service teachers: sites of reality, imagination and resistance

Questions about the practicum within teacher education tend to focus on the amount of time allocated to it in programs. In this research, we were interested in the quality of the experience rather than assuming ‘more is better’. To understand what is going on and where, this study focussed on the school and specially the departmental office of room as a site for workplace learning. Using qualitative methods we constructed narratives from the data provided by a cohort of four-year bachelor degree pre-service teachers during and following their final major (10 week)practicum experience. Using theories of spatiality to make sense of the data, we found that the narratives revealed stories of spaces where compliance, disappointment were the key features of the practicum, and where resistance through absence (from the departmental office) was an important strategy to manage the experience. This research challenges the ‘more is better’ argument.

Life storytelling at the ABC: Challenges of 'giving the audience a voice' in the context of public service media

Life storytelling projects have become an important means through which public service media institutions such as the Australian Broadcasting Corporation are seeking to foster audience participation and involve particular cohorts in the creation and distribution of broadcast content. This paper contributes to the wider conversation on audience participation within public service media intuitions (PSMs), and focuses on the opportunities and challenges that arise within life storytelling projects that are facilitated by these institutions, and that aim to ‘give voice’ to members of ‘the audience’. In particular, it focuses on two of the Australian Broadcasting Corporation’s current life storytelling projects: ABC Open and Heywire.

Evaluation of ANPR trials for traffic policing in Queensland. Report to the Queensland Police Service, State Traffic Support Branch

In response to the Travelsafe Committee Report No. 51 – report on the inquiry into Automatic Plate Recognition Technology – it was recommended that the Queensland Police Service continue to trial the deployment of ANPR technology for traffic enforcement work and to evaluate the road safety impacts and operational effectiveness of the technology. As such, the purpose of this report is to provide an independent evaluation of a trial of ANPR that was conducted by a project team within the State Traffic Support Branch of the Queensland Police Service (QPS) and provide recommendations as to the applicability and usability of the technology for use throughout Queensland...

Rubbing shoulders with mobile service robots

This paper is not about the details of yet another robot control system, but rather the issues surrounding realworld robotic implementation. It is a fact that in order to realise a future where robots co-exist with people in everyday places, we have to pass through a developmental phase that involves some risk. Putting a “Keep Out, Experiment in Progress” sign on the door is no longer possible since we are now at a level of capability that requires testing over long periods of time in complex realistic environments that contain people. We all know that controlling the risk is important – a serious accident could set the field back globally – but just as important is convincing others that the risks are known and controlled. In this article, we describe our experience going down this path and we show that mobile robotics research health and safety assessment is still unexplored territory in universities and is often ignored. We hope that the article will make robotics research labs in universities around the world take note of these issues rather than operating under the radar to prevent any catastrophic accidents.

Service Interface Synthesis in Business Networks

Mismatches between services needing to interoperate have been addressed through the adaptation of structural and behavioural interfaces of services, which in practice incur long lead time through manual, coding effort. We propose a framework, complementary to con- ventional service adaptation, to synthesise service interfaces in the open setting of business networks, allowing consumers to introspect service interfaces and formulate service invocations. The framework also allows evolved service requests, as new features of service capabilities are discov- ered, through interactions with other, similar services. Finally the frame- work fosters reuse of adaptation efforts through normalisation of struc- tural and behavioural interfaces of similar services. This paper provides a first exposition of the service interface synthesis framework, describing patterns containing novel requirements for unilateral service adaptation and detailing the interface synthesis technique. Complex examples of ser- vices drawn from commercial logistic systems are then used to validate the synthesis technique and identify open challenges and future research directions.

A randomised controlled trial evaluating outcomes of emergency nurse practitioner service

The emergency nurse practitioner role was developed as an innovative and cost effective approach to meet increasing patient demand for health care. This thesis is the first contemporary study to evaluate clinical outcomes of the role within a complex systems-intervention framework. Emergency nurse practitioner service effectiveness was demonstrated through superior performance in delivery of timely analgesia for emergency department patients. The results validate nurse practitioner service as being able to demonstrate comparable outcomes. This research provides a much-needed evidence base supporting nurse practitioner service and its role in the changing health system and the reform agenda for service innovation.