Medication errors in ED: do patient characteristics and the environment influence the nature and frequency of medication errors?

Background: Medication safety is of increasing importance and understanding the nature and frequency of medication errors in the Emergency Department (ED) will assist in tailoring interventions which will make patient care safer. The challenge with the literature to date is the wide variability in the frequency of errors reported and the reliance on incident reporting practices of busy ED staff. Methods: A prospective, exploratory descriptive design using point prevalence surveys was used to establish the frequency of observed medication errors in the ED. In addition, data related to contextual factors such as ED patients, staffing and workload were also collected during the point prevalence surveys to enable the analysis of relationships between the frequency and nature of specific error types and patient and ED characteristics at the time of data collection. Results: A total of 172 patients were included in the study: 125 of whom patients had a medication chart. The prevalence of medication errors in the ED studied was 41.2% for failure to apply patient ID bands, 12.2% for failure to document allergy status and 38.4% for errors of omission. The proportion of older patients in the ED did not affect the frequency of medication errors. There was a relationship between high numbers of ATS 1, 2 and 3 patients (indicating high levels of clinical urgency) and increased rates of failure to document allergy status. Medication errors were affected by ED occupancy, when cubicles in the ED were over 50% occupied, medication errors occurred more frequently. ED staffing affects the frequency of medication errors, there was an increase in failure to apply ID bands and errors of omission when there were unfilled nursing deficits and lower levels of senior medical staff were associated with increased errors of omission. Conclusions: Medication errors related to patient identification, allergy status and medication omissions occur more frequently in the ED when the ED is busy, has sicker patients and when the staffing is not at the minimum required staffing levels.

Park proximity, quality and recreational physical activity among mid-older aged adults: moderating effects of individual factors and area of residence

The transition from active employment to retirement is a potentially critical period for promoting maintenance or development of recreational physical activity in older age. Park proximity and quality might be important correlates of recreational physical activity in this age group. However, research on park-physical activity relationships among mid-older aged adults is limited and inconclusive. Furthermore, while knowledge of individual moderators of park-physical activity relationships is crucial for tailoring interventions, this knowledge is also limited. We investigated relationships between perceived park proximity, park quality and recreational physical activity among mid-older aged adults. Additionally, we examined the potential moderating effects of gender, education level, retirement status, functional limitations and area of residence on these relationships.

Tracking of maternal self-efficacy for limiting young children's television viewing and associations with children's television viewing time: a longitudinal analysis over 15-months

BACKGROUND: Mothers' self-efficacy for limiting their children's television viewing is an important correlate of this behaviour in young children. However, no studies have examined how maternal self-efficacy changes over time, which is potentially important during periods of rapid child development. This study examined tracking of maternal self-efficacy for limiting young children's television viewing over 15-months and associations with children's television viewing time. METHODS: In 2008 and 2010, mothers (n = 404) from the Melbourne InFANT Program self-reported their self-efficacy for limiting their child's television viewing at 4- and 19-months of age. Tertiles of self-efficacy were created at each time and categorised into: persistently high, persistently low, increasing or decreasing self-efficacy. Weighted kappa and multinomial logistic regression examined tracking and demographic and behavioural predictors of change in self-efficacy. A linear regression model examined associations between tracking categories and children's television viewing time. RESULTS: Tracking of maternal self-efficacy for limiting children's television viewing was low (kappa = 0.23, p < 0.001). Mothers who had persistently high or increasing self-efficacy had children with lower television viewing time at 19-months (β = -35.5; 95 % CI = -54.4,-16.6 and β = 37.0; 95 % CI = -54.4,-19.7, respectively). Mothers of children with difficult temperaments were less likely to have persistently high self-efficacy. Mothers who met adult physical activity guidelines had 2.5 greater odds of increasing self-efficacy. CONCLUSIONS: Interventions to increase and maintain maternal self-efficacy for limiting children's television viewing time may result in lower rates of this behaviour amongst toddlers. Maternal and child characteristics may need to be considered when tailoring interventions.

Just another meeting?: Investigating mentoring for early childhood teachers in Victoria

IN A TIME OF REFORM FOR children’s services in Australia, this paper explores the currentmentoring programs on offer to the early childhood sector in the state of Victoria. Thecommissioned research involved the mapping of existing mentoring programs, supported byan extensive literature review. A thematic analysis of the data identified the following aspectsas impacting on the success of the programs: the value placed on mentoring; the mentor’s role;the level of support and training for mentors; the availability of resources; the divisions betweenmentoring and other management functions; tailoring of mentoring to individual professionaldesires and needs; and the presence or absence of formal evaluations to inform the futuresuccess of programs. The questions raised by this research prompt further consideration as towhat mentoring for early childhood practitioners should look like in the future, especially relatedto collaborative practice and the balance between autonomy and guidance.

New insights into the thermal behaviour of organic ionic plastic crystals: magnetic resonance imaging of polycrystalline morphology alterations induced by solid-solid phase transitions

Organic ionic plastic crystals (OIPCs) show strong potential as solid-state electrolytes for lithium battery applications, demonstrating promising electrochemical performance and eliminating the need for a volatile and flammable liquid electrolyte. The ionic conductivity (σ) in these systems has recently been shown to depend strongly on polycrystalline morphology, which is largely determined by the sample's thermal history. [K. Romanenko et al., J. Am. Chem. Soc., 2014, 136, 15638]. Tailoring this morphology could lead to conductivities sufficiently high for battery applications, so a more complete understanding of how phenomena such as solid-solid phase transitions can affect the sample morphology is of significant interest. Anisotropic relaxation of nuclear spin magnetisation provides a new MRI based approach for studies of polycrystalline materials at both a macroscopic and molecular level. In this contribution, morphology alterations induced by solid-solid phase transitions in triisobutyl(methyl)phosphonium bis(fluorosulfonyl)imide (P1444FSI) and diethyl(methyl)(isobutyl)phosphonium hexafluorophosphate (P1224PF6) are examined using magnetic resonance imaging (MRI), alongside nuclear magnetic resonance (NMR) spectroscopy, diffusion measurements and conductivity data. These observations are linked to molecular dynamics and structural behaviour crucial for the conductive properties of OIPCs. A distinct correlation is established between the conductivity at a given temperature, σ(T), and the intensity of the narrow NMR signal that is attributed to a mobile fraction, fm(T), of ions in the OIPC. To explain these findings we propose an analogy with the well-studied relationship between permeability (k) and void fraction (θ) in porous media, with k(θ) commonly quantified by a power-law dependence that can also be employed to describe σ(fm).

Prosecutors’ perceptions of how to improve the quality of evidence in domestic violence cases

Limited evidence in domestic violence prosecutions is a persistent problem. Focus groups with 13 prosecutors from across Australia and New Zealand were used to explore how to improve the quality of evidence collected and presented in these cases. A thematic analysis identified three main strategies: improving the quality of investigations by initial police responders, supporting the complainant and tailoring the trial process to the domestic violence context. The most discussed strategy within these categories has previously received little attention– police video recording the complainant's initial account and using that video as the basis for the complainant's courtroom testimony.

Implementing novel models of posttreatment care for cancer survivors: Enablers, challenges and recommendations

AIM: The American Society of Clinical Oncology and US Institute of Medicine emphasize the need to trial novel models of posttreatment care, and disseminate findings. In 2011, the Victorian State Government (Australia) established the Victorian Cancer Survivorship Program (VCSP), funding six 2-year demonstration projects, targeting end of initial cancer treatment. Projects considered various models, enrolling people of differing cancer types, age and residential areas. We sought to determine common enablers of success, as well as challenges/barriers. METHODS: Throughout the duration of the projects, a formal "community of practice" met regularly to share experiences. Projects provided regular formal progress reports. An analysis framework was developed to synthesize key themes and identify critical enablers and challenges. Two external reviewers examined final project reports. Discussion with project teams clarified content. RESULTS: Survivors reported interventions to be acceptable, appropriate and effective. Strong clinical leadership was identified as a critical success factor. Workforce education was recognized as important. Partnerships with consumers, primary care and community organizations; risk stratified pathways with rapid re-access to specialist care; and early preparation for survivorship, self-management and shared care models supported positive project outcomes. Tailoring care to individual needs and predicted risks was supported. Challenges included: lack of valid assessment and prediction tools; limited evidence to support novel care models; workforce redesign; and effective engagement with community-based care and issues around survivorship terminology. CONCLUSION: The VCSP project outcomes have added to growing evidence around posttreatment care. Future projects should consider the identified enablers and challenges when designing and implementing survivorship care.

Clustering of attitudes towards obesity: a mixed methods study of Australian parents and children

BACKGROUND: Current population-based anti-obesity campaigns often target individuals based on either weight or socio-demographic characteristics, and give a 'mass' message about personal responsibility. There is a recognition that attempts to influence attitudes and opinions may be more effective if they resonate with the beliefs that different groups have about the causes of, and solutions for, obesity. Limited research has explored how attitudinal factors may inform the development of both upstream and downstream social marketing initiatives. METHODS: Computer-assisted face-to-face interviews were conducted with 159 parents and 184 of their children (aged 9-18 years old) in two Australian states. A mixed methods approach was used to assess attitudes towards obesity, and elucidate why different groups held various attitudes towards obesity. Participants were quantitatively assessed on eight dimensions relating to the severity and extent, causes and responsibility, possible remedies, and messaging strategies. Cluster analysis was used to determine attitudinal clusters. Participants were also able to qualify each answer. Qualitative responses were analysed both within and across attitudinal clusters using a constant comparative method. RESULTS: Three clusters were identified. Concerned Internalisers (27% of the sample) judged that obesity was a serious health problem, that Australia had among the highest levels of obesity in the world and that prevalence was rapidly increasing. They situated the causes and remedies for the obesity crisis in individual choices. Concerned Externalisers (38% of the sample) held similar views about the severity and extent of the obesity crisis. However, they saw responsibility and remedies as a societal rather than an individual issue. The final cluster, the Moderates, which contained significantly more children and males, believed that obesity was not such an important public health issue, and judged the extent of obesity to be less extreme than the other clusters. CONCLUSION: Attitudinal clusters provide new information and insights which may be useful in tailoring anti-obesity social marketing initiatives.

Sensitivity of the final properties of tailored hot stamping components to the process and material parameters

The final mechanical properties of hot stamped components are affected by many process and material parameters due to the multidisciplinary nature of this thermal-mechanical-metallurgical process. The phase transformation, which depends on the temperature field and history, determines the final microstructure and consequently the final mechanical properties. Tailored hot stamping parts - where the cooling rates are locally chosen to achieve structures with graded properties - has been increasingly adopted in the automotive industry. In this case, the robustness of final part properties is more critical than in the conventional hot stamping parts, where the part is fully quenched. In this study, a wide range of input parameters in a generalized hot stamping model have been investigated, examining the effect on the temperature history and resulting final material properties. A generic thermo-mechanical finite element model of hot stamping was created and a modified phase transformation model, based on Scheil's additive principle, has been applied. The comparison between modeling and experiments shows that the modified phase transformation model coupled with the incubation time provides higher accuracy on the simulation of transformation kinetics history. The robustness of four conditions relevant to tailored hot stamping was investigated: heated tooling (with low and high tool conductance), air cooling, and conventional hot stamping. The results show the high robustness of the conventional hot stamping compared to tailored hot stamping, with respect to the stamped component's final material properties (i.e. phase fraction and hardness). Furthermore, tailored hot stamping showed higher robustness when low conductivity tools are used relative to high conductivity tools.

An exercise programme for smoking cessation: perceptions of the Fit2quit trial intervention

Introduction: Few trials of exercise interventions for smoking cessation have included a qualitative evaluation of the intervention from the participants' perspective. Aims: To determine the perceptions of participants who received a 6-month telephone counselling exercise intervention to aid smoking cessation. Methods: Participants in the Fit2Quit study intervention group were asked to take part in a semi-structured phone interview. All interviews were digitally recorded and transcribed verbatim, and a general inductive approach to data analysis was followed. Results/Findings: Twenty participants from the intervention group completed an interview. The following themes emerged from the analyses: (1) The support people were genuinely interested in what I was achieving, (2) new awareness, new attitude, new lifestyle: I could see the benefits, (3) lack of time, willpower and money stopped me from changing and (4) I would have preferred a more hands on approach: Recommendations for future programmes. Conclusions: A telephone counselling intervention to enhance exercise for smoking cessation was well received. Aspects of the intervention, particularly the provision of support and encouragement from the participant support person, were beneficial. Suggested improvements were greater tailoring of the call schedule, greater face-to-face contact and provision of a buddy system or support group. Such improvements may increase adherence and, therefore, effectiveness of exercise interventions for smoking cessation.

Synthesis of a porous sheet-like V₂O₅-CNT nanocomposite using an ice-templating 'bricks-and-mortar' assembly approach as a high-capacity, long cyclelife cathode material for lithium-ion batteries

Tailoring the nanostructures of electrode materials is an effective way to enhance their electrochemical performance for energy storage. Herein, an ice-templating "bricks-and-mortar" assembly approach is reported to make ribbon-like V2O5 nanoparticles and CNTs integrated into a two-dimensional (2D) porous sheet-like V2O5-CNT nanocomposite. The obtained sheet-like V2O5-CNT nanocomposite possesses unique structural characteristics, including a hierarchical porous structure, 2D morphology, large specific surface area and internal conducting networks, which lead to superior electrochemical performances in terms of long-term cyclability and significantly enhanced rate capability when used as a cathode material for LIBs. The sheet-like V2O5-CNT nanocomposite can charge/discharge at high rates of 5C, 10C and 20C, with discharge capacities of approximately 240 mA h g-1, 180 mA h g-1, and 160 mA h g-1, respectively. It also retains 71% of the initial discharge capacity after 300 cycles at a high rate of 5C, with only 0.097% capacity loss per cycle. The rate capability and cycling performance of the sheet-like V2O5-CNT nanocomposite are significantly better than those of commercial V2O5 and most of the reported V2O5 nanocomposite.

Providing mental health first aid in the workplace: a Delphi consensus study

BACKGROUND: Mental health problems are common in the workplace, but workers affected by such problems are not always well supported by managers and co-workers. Guidelines exist for the public on how to provide mental health first aid, but not specifically on how to tailor one's approach if the person of concern is a co-worker or employee. A Delphi consensus study was carried out to develop guidelines on additional considerations required when offering mental health first aid in a workplace context.

METHODS: A systematic search of websites, books and journal articles was conducted to develop a questionnaire with 246 items containing actions that someone may use to offer mental health first aid to a co-worker or employee. Three panels of experts from English-speaking countries were recruited (23 consumers, 26 managers and 38 workplace mental health professionals), who independently rated the items over three rounds for inclusion in the guidelines.

RESULTS: The retention rate of the expert panellists across the three rounds was 61.7 %. Of the 246 items, 201 items were agreed to be important or very important by at least 80 % of panellists. These 201 endorsed items included actions on how to approach and offer support to a co-worker, and additional considerations where the person assisting is a supervisor or manager, or is assisting in crisis situations such as acute distress.

CONCLUSIONS: The guidelines outline strategies for a worker to use when they are concerned about the mental health of a co-worker or employee. They will be used to inform future tailoring of Mental Health First Aid training when it is delivered in workplace settings and could influence organisational policies and procedures.

Intimate partner violence perpetrator subtypes and their developmental origins: implications for prevention and intervention

Intimate partner violence (IPV) is a major issue for many Australian families and yet progress towards the development of effective prevention and behaviour change programs has been relatively slow. In this paper, it is proposed that the tendency to treat perpetrators as a homogenous group has hampered progress, and that treatment outcomes can be improved by tailoring treatment responses to a small set of personal and offence-related characteristics. It explores the developmental origins and trajectories of these presentations and identifies some new directions for further research in this area.

Transition: improved literacy outcomes research study

This paper reports on the Transition: Improved Literacy Outcomes Research Study established by the Department of Education and Training (DET). The purpose of the study was to identify the most useful and usable data for educators to access in order to ensure that student literacy learning is maximised during the transition from Primary to Secondary school.1. The research followed a mixed-methods approach, combining a statistically defensible sample of schools selected to represent school types (primary, secondary, combined), locations (rural, regional, urban) and all regions with a survey and follow- up interviews.2. The results are presented as a mixture of statistics, case studies and discussion. The case studies were developed from both survey data and interview data.3. Leaders and teachers overwhelmingly valued teacher judgement (through AusVELS) as the most useful data in understanding students’ strengths and weaknesses, followed by On-Demand testing.4. NAPLAN results were frequently transferred between schools, but were found to be less useful than other data by teachers.5. School leaders and teachers are currently using data for ability streaming, or for tailoring curriculum for individual student needs. A number of schools use the Literacy data for achieving a balance of student abilities within classes.6. Support for access to, and use of, data is mainly manual, with some use of spreadsheets.7. As the number of feeder Primary schools to a single Secondary school increases, data management becomes a much larger burden on the Secondary staff concerned.8. In Secondary schools, there was a clear demand for Literacy data, but these data were not always those that were being provided by their feeder Priamary schools. This mis-match appears to lead to some frustration among Literacy transition staff at both levels of schooling.9. A gap that needs filling is around the nature of the pedagogies at the two school levels. Not knowing, or misunderstanding, the approaches and needs of each level of schooling leads to the passing on of irrelevant Literacy data in some instances.10. The need for a common template for transition data was expressed by many Transition staff, both Primary and Secondary. In some instances the secondary school had set up a local template for this11. It would be advantageous for data to be directly up-loaded or transferred into a system via electronic tools already in use, such as an Excel spreadsheet.12. We would recommend that the capacity to provide some visualisation of data, and the compilation of internal Literacy data such as teacher judgements and AusVELS levels, or additional testing carried out by the school.13. Student background data was seen by many Secondary transition staff as being equally as valuable as more formal Literacy data for determining student needs.

Advances in tailored hot stamping – innovations in material and local patchwork topology

Hot stamping is now commonplace in the automotive industry. The continuing need by automotive manufacturers to reduce weight while increasing crashworthiness has driven the industry to seek new hot stamping solutions. Tailored hot stamping can be thought to produce a part that has patchwork of hard and soft regions. In this context, patchwork means that there is a relational organization (topology) to the network of hard and soft regions. The next generation of tailored hot stamping will therefore combine new steel grades together into a single part, and secondly will be able to locally tailor material properties to meet detailed engineering targets. The key to meeting engineering demands will be how the patchwork material properties are organized on the part. This paper will briefly outline our latest research in tailoring parts.