Factors affecting emergency department length of stay of patients admitted to telemetry and critical care units

The purpose of this study was to determine the emergency department (ED) length of stay (LOS) of patients admitted to inpatient telemetry and critical care units and to identify the factors that contribute to a prolonged ED LOS. It also examined whether there was a difference in ED LOS between clients evaluated by an ED physician, an Advanced Registered Nurse Practitioner (ARNP) or a Physician's Assistant (PA).^ A data collection tool was devised and used to record data obtained by retrospectively reviewing 110 charts of patients from this sample. The mean ED LOS was 286.75 minutes. Multiple factors were recorded as affecting the ED LOS of this sample, including: age, diagnosis, consultations, multiple radiographs, pending admission orders, nurse unable to call report/busy, relatives at bedside, observation or stabilization necessary, bed not ready and infusion in progress. No significant difference in ED LOS was noted between subjects initially evaluated by a physician, an ARNP or a PA. ^

A systems model for community injury prevention

The purpose of this study was to develop, explicate, and validate a comprehensive model in order to more effectively assess community injury prevention needs, plan and target efforts, identify potential interventions, and provide a framework for an outcome-based evaluation of the effectiveness of interventions. A systems model approach was developed to conceptualize the major components of inputs, efforts, outcomes and feedback within a community setting. Profiling of multiple data sources demonstrated a community feedback mechanism that increased awareness of priority issues and elicited support from traditional as well as non-traditional injury prevention partners. Injury countermeasures including education, enforcement, engineering, and economic incentives were presented for their potential synergistic effect impacting on knowledge, attitudes, or behaviors of a targeted population. Levels of outcome data were classified into ultimate, intermediate and immediate indicators to assist with determining the effectiveness of intervention efforts. A collaboration between business and health care was successful in achieving data access and use of an emergency department level of injury data for monitoring of the impact of community interventions. Evaluation of injury events and preventive efforts within the context of a dynamic community systems environment was applied to a study community with examples detailing actual profiling and trending of injuries. The resulting model of community injury prevention was validated using a community focus group, community injury prevention coordinators, and injury prevention national experts. ^

Ten Year Study on Water Flushing Times and Water Quality in Southern Taylor Slough, Everglades National Park, FL

The purpose of this research was to investigate the effects of wetland restoration on the water balance, flushing time, and water chemistry of southern Taylor Slough, a major water way in Everglades National Park. Water balance and flushing time equations were calculated on a monthly time step from 2001 – 2011. Water chemistry of major ions and nutrients were analyzed and correlated with water flushing times. Results showed that evapotranspiration followed by water volume had the greatest influence on flushing time. The flushing times varied between 3 and 78 days, with longer times observed between October and December, and the shorter times between March and May. Ion concentrations at the coastal areas decreased with increased flushing times. Increased surface water inflow that resulted from restoration projects and water management changes were productive in the rainy season and should result in increased flushing times and decreased ion concentrations in Taylor Slough.

A historical study of selected documents from the period 1890--1920 with implications for understanding success in school

During the years 1890–1920, the public school education system established itself as the medium to transmit American values, knowledge and culture. This study described and explained why some individuals were destined to fail, and others succeed in America's public schools. The exploratory questions guiding this study were: What elements constitute society's perspective of whom it should educate during the years 1890–1920? What variables influenced society's perspective of whom it should educate during the years 1890–1920? ^ After explaining these issues, educators will then have a better understanding and awareness of why certain educational practices are currently implemented and will be able to critically evaluate which ones should be continued. The methodology chosen was historical. The approach for analyzing the data was coding. The information was coded in order to determine themes, concepts and ideas amongst the documents and as portrayed in the literature. The first step was to seek out patterns and then to write out words and phrases to represent these topics. Then, these phrases were attributed to networks. ^ The data indicated that public schools during this era were designed to conform and assimilate the new immigrants and factory workers in an efficient and standardized manner. Efficiency and standardization in production became the American way for government, commerce, personal, lives and the school. Many different approaches to education emerged during this time period, specifically those, which emphasized individuality; but only those, which paralleled the ideology of efficiency, standardization and conformity were adopted. Those students who were unable to conform to society's criteria for success were penalized in the classroom, on IQ examinations and national standardized exams. ^ This study was illuminative in that it explained the root cause as to why some individuals are meant to succeed while others are penalized in the classroom. Future studies connecting standardized assessments and learning styles are suggested. ^

Water Quality and Wet Season Diatom Assemblage Characteristics from the Tamiami Trail Pilot Swales Sites (Everglades National Park, Florida, USA)

A pivotal component of hydrological restoration of the Florida Everglades is the improvement of water conveyance to Everglades National Park by the degradation of the current network of canals, roadways and levees. The Tamiami Trail (L29) road/canal complex represents a major barrier to natural water flows into the park and a variety of modification options for flow improvement are currently being explored, including the installation of spreader swales immediately downstream of culverts conveying water under Tamiami Trail from the L29 canal into Everglades National Park. In this study, we evaluated water column chemistry and wet-season diatom community structure to provide baseline information for use in future monitoring activities related to the proposed Tamiami Trail modifications. Water chemistry showed pronounced fluctuations in response to precipitation and anthropogenically mediated hydrological events. Differences in water quality variables among sites were dampened during periods of inundation, and became more pronounced during periods of low canal stage, suggesting the importance of small-scale mechanisms related to isolation of habitat patches. Diatom assemblages were unexpectedly speciose (127 taxa in 40 samples) compared to typical Everglades assemblages, and spatially heterogeneous in sites associated with concentric areas of dense vegetation immediately downstream of culverts. We also observed significant compositional dissimilarities among transects, indicating that culvert pool and north transect assemblages were substantially influenced by propagule input from the canal and areas to the north, while south transect sites were compositionally similar to typical sawgrass prairie diatom communities. Central transect sites were compositionally intermediate to their north and south counterparts. We propose that the position and spatial extent of this “transitional assemblage” is a sensitive indicator of subtle environmental change related to Tamiami Trail modifications.

Perceptions and experiences of intimate partner violence among Hispanic college students

Intimate partner violence (IPV) is recognized as a serious, growing problem on college campuses. IPV rates among college students exceed estimates reported for the general population. Few studies have examined the impact of IPV among the Hispanic college student (HCS) population or explored how HCSs perceive and experience IPV. Focusing on young adults (ages 18 to 25 years), this mixed methods study was designed to explore the perceptions and experiences of IPV focusing on levels of victimization and perpetration in relation to gender role attitudes and beliefs, exposure to parental IPV, acculturation, and religiosity. A sample of 120 HCSs was recruited from two south Florida universities. A subsample of 20 participants was randomly selected to provide qualitative responses. All participants completed a series of questionnaires including a demographic survey, the FPB, CTS2-CA, SASH, ERS and CTS2. Bivariate correlational techniques and multiple regressions were used to analyze data. Marked discrepancy between participants' perceived experience of IPV (N = 120) and their CTS2 responses (n = 116, 96.7%). Only 5% of the participants saw themselves as victims or perpetrators of IPV, yet 66% were victims or 67% were perpetrators of verbal aggression; and 31% were victims or 32.5% were perpetrators of sexual coercion based on their CTS2 scores. Qualitative responses elicited from the subsample of 20 students provided some insight regarding this disparity. There was rejection of traditional stratified gender roles. Few participants indicated that they were religious (20.8%, n = 25). Evidence for the theory of intergenerational transmission of violence was noted. Recall of parental IPV was a significant predictor of level of IPV victimization (β = 0.177, SE = 0.85, p = 0.041). Nursing and social service providers must be cognizant that contributing factors to either victimization and/or perpetration of IPV among college students must be addressed first (i.e., perceptions of IPV), both in acute (i.e., emergency department) and community (i.e., college and university) settings for optimum intervention outcome.

Analysis of global compliance and implementation of the goals of international environmental treaties: A case study of the Convention on Biodiversity (CBD)

The Convention on Biodiversity (CBD) was created in 1992 to coordinate global governments to protect biological resources. The CBD has three goals: protection of biodiversity, achievement of sustainable use of biodiversity and facilitation of equitable sharing of the benefits of biological resources. The goal of protecting biological resources has remained both controversial and difficult to implement. This study focused more on the goal of biodiversity protection. The research was designed to examine how globally constructed environmental policies get adapted by national governments and then passed down to local levels where actual implementation takes place. Effectiveness of such policies depends on the extent of actual implementation at local levels. Therefore, compliance was divided and examined at three levels: global, national and local. The study then developed various criteria to measure compliance at these levels. Both qualitative and quantitative methods were used to analyze compliance and implementation. The study was guided by three questions broadly examining critical factors that most influence the implementation of biodiversity protection policies at the global, national and local levels. Findings show that despite an overall biodiversity deficit of 0.9 hectares per person, global compliance with the CBD goals is currently at 35%. Compliance is lowest at local levels at 14%, it is slightly better at national level at 50%, and much better at the international level 64%. Compliance appears higher at both national and international levels because compliance here is paper work based and policy formulation. If implementation at local levels continues to produce this low compliance, overall conservation outcomes can only get worse than what it is at present. There are numerous weaknesses and capacity challenges countries are yet to address in their plans. In order to increase local level compliance, the study recommends a set of robust policies that build local capacity, incentivize local resource owners, and implement biodiversity protection programs that are akin to local needs and aspirations.^

Analysis of Global Compliance and Implementation of the Goals of International Environmental Treaties: A Case study of the Convention on Biodiversity (CBD)

The Convention on Biodiversity (CBD) was created in 1992 to coordinate global governments to protect biological resources. The CBD has three goals: protection of biodiversity, achievement of sustainable use of biodiversity and facilitation of equitable sharing of the benefits of biological resources. The goal of protecting biological resources has remained both controversial and difficult to implement. This study focused more on the goal of biodiversity protection. The research was designed to examine how globally constructed environmental policies get adapted by national governments and then passed down to local levels where actual implementation takes place. Effectiveness of such policies depends on the extent of actual implementation at local levels. Therefore, compliance was divided and examined at three levels: global, national and local. The study then developed various criteria to measure compliance at these levels. Both qualitative and quantitative methods were used to analyze compliance and implementation. The study was guided by three questions broadly examining critical factors that most influence the implementation of biodiversity protection policies at the global, national and local levels. Findings show that despite an overall biodiversity deficit of 0.9 hectares per person, global compliance with the CBD goals is currently at 35%. Compliance is lowest at local levels at 14%, it is slightly better at national level at 50%, and much better at the international level 64%. Compliance appears higher at both national and international levels because compliance here is paper work based and policy formulation. If implementation at local levels continues to produce this low compliance, overall conservation outcomes can only get worse than what it is at present. There are numerous weaknesses and capacity challenges countries are yet to address in their plans. In order to increase local level compliance, the study recommends a set of robust policies that build local capacity, incentivize local resource owners, and implement biodiversity protection programs that are akin to local needs and aspirations.