Change to costs and lengths of stay in the emergency department and the Brisbane protocol: An observational study

- Objective To compare health service cost and length of stay between a traditional and an accelerated diagnostic approach to assess acute coronary syndromes (ACS) among patients who presented to the emergency department (ED) of a large tertiary hospital in Australia. - Design, setting and participants This historically controlled study analysed data collected from two independent patient cohorts presenting to the ED with potential ACS. The first cohort of 938 patients was recruited in 2008–2010, and these patients were assessed using the traditional diagnostic approach detailed in the national guideline. The second cohort of 921 patients was recruited in 2011–2013 and was assessed with the accelerated diagnostic approach named the Brisbane protocol. The Brisbane protocol applied early serial troponin testing for patients at 0 and 2 h after presentation to ED, in comparison with 0 and 6 h testing in traditional assessment process. The Brisbane protocol also defined a low-risk group of patients in whom no objective testing was performed. A decision tree model was used to compare the expected cost and length of stay in hospital between two approaches. Probabilistic sensitivity analysis was used to account for model uncertainty. - Results Compared with the traditional diagnostic approach, the Brisbane protocol was associated with reduced expected cost of $1229 (95% CI −$1266 to $5122) and reduced expected length of stay of 26 h (95% CI −14 to 136 h). The Brisbane protocol allowed physicians to discharge a higher proportion of low-risk and intermediate-risk patients from ED within 4 h (72% vs 51%). Results from sensitivity analysis suggested the Brisbane protocol had a high chance of being cost-saving and time-saving. - Conclusions This study provides some evidence of cost savings from a decision to adopt the Brisbane protocol. Benefits would arise for the hospital and for patients and their families.

The social tasks of learning to become a physical education teacher: Considering the HPE subject department as a community of practice

Initial teacher education (ITE) students participate in various workplaces within schools and in doing so, form understandings about the numerous, and at times competing, expectations of teachers’ work. Through these experiences they form understandings about themselves as health and physical education (HPE) teachers. This paper examines the ways communities of practice within HPE subject department offices function as sites of workplace learning for student teachers. In particular this research focused on how ITE students negotiate tacit and contradictory expectations as well as social tasks during the practicum and the ways in which their understandings are mediated through participation in the workspace. Qualitative methods of survey and semi-structured interview were used to collect data on a cohort of student teachers during and following their major (10 week) practicum experience. Analysis was informed by theories of communities of practice (Wenger, 1998), workplace learning (Billett, 2001), and social task systems (Doyle, 1977). It was evident that considerable effort, attention, and energy was expended on various interrelated social tasks aimed at building positive relationships with their supervisor and other HPE teachers at the school. The social dynamics were highly nuanced and required a game-like approach. In our view the complexity that student teachers must negotiate in striving for an excellent evaluation warrants specific attention in physical education teacher education (PETE) programs. This study raises questions regarding our responsibilities in sending student teachers into contexts that might even be described as toxic. We offer some suggestions for how PETE might better support students going into practicum contexts that might be regarded as problematic workplaces.

Becoming a health and physical education teacher: Student teacher ‘performances’ in the HPE subject department office

This study considered how physical education teacher education students ‘perform’ their ‘selves’ within subject department offices during the practicum or ‘teaching practice’. The research was framed by a conceptual framework informed by the work of Goffman on ‘performance’ and ‘front’. The findings revealed three common performances across the whole group across all sites. These were: performance of sports talk, bodily performances, and performance of masculine repertoires. Such performances were considered to be inconsistent with the coursework ideals and principles within the teacher education programme but in step with the general ethos of most PE department offices.

The role of phosphorus as a regulator of bloom-forming diazotrophic cyanobacteria in the Baltic Sea

Eutrophication favours harmful algal blooms worldwide. The blooms cause toxic outbreaks and deteriorated recreational and aesthetic values, causing both economic loss and illness or death of humans and animals. The Baltic Sea is the world s only large brackish water habitat with recurrent blooms of toxic cyanobacteria capable of biological fixation of atmospheric nitrogen gas. Phosphorus is assumed to be the main limiting factor, along with temperature and light, for the growth of these cyanobacteria. This thesis evaluated the role of phosphorus nutrition as a regulating factor for the occurrence of nitrogen-fixing cyanobacteria blooms in the Baltic Sea, utilising experimental laboratory and field studies and surveys on varying spatial scales. Cellular phosphorus sources were found to be able to support substantial growth of the two main bloom forming species Aphanizomenon sp. and Nodularia spumigena. However, N. spumigena growth seemed independent of phosphorus source, whereas, Aphanizomenon sp. grew best in a phosphate enriched environment. Apparent discrepancies with field observations and experiments are explained by the typical seasonal temperature dependent development of Aphanizomenon sp. and N. spumigena biomass allowing the two species to store ambient pre-bloom excess phosphorus in different ways. Field experiments revealed natural cyanobacteria bloom communities to be predominantly phosphorus deficient during blooms. Phosphate additions were found to increase the accumulation of phosphorus relatively most in the planktonic size fraction dominated by the nitrogen-fixing cyanobacteria. Aphanizomenon sp. responded to phosphate additions whereas the phosphorus nutritive status of N. spumigena seemed independent of phosphate addition. The seasonal development of phosphorus deficiency is different for the two species with N. spumigena showing indications of phosphorus deficiency during a longer time period in the open sea. Coastal upwelling introduces phosphorus to the surface layer during nutrient deficient conditions in summer. The species-specific ability of Aphanizomenon sp. and N. spumigena to utilise phosphate enrichment of the surface layer caused by coastal upwelling was clarified. Typical bloom time vertical distributions of biomass maxima were found to render N. spumigena more susceptible to advection by surface currents caused by coastal upwellings. Aphanizomenon sp. populations residing in the seasonal thermocline were observed to be able to utilise the phosphate enrichment and a bloom was produced with a two to three week time lag subsequent to the relaxation of upwelling. Consistent high concentrations of dissolved inorganic phosphorus, caused by persistent internal loading of phosphorus, was found to be the main source of phosphorus for large-scale pelagic blooms. External loads were estimated to contribute with only a fraction of available phosphorus for open sea blooms. Remineralization of organic forms of phosphorus along with vertical mixing to the permanent halocline during winter set the level of available phosphorus for the next growth season. Events such as upwelling are important in replenishing phosphate concentrations during the nutrient deplete growth season. Autecological characteristics of the two main bloom forming species favour Aphanizomenon sp. populations in utilising the abundant excess phosphate concentrations and phosphate pulses mediated through upwelling. Whilst, N. spumigena displays predominant phosphorus limited growth mode and relies on more scarce cellular phosphorus stores and presumably dissolved organic phosphorus compounds for growth. The Baltic Sea is hypothesised to be in an inhibited state of recovery due to the extensive historical external nutrient loading, extensive internal phosphorus loading and the substantial nitrogen load caused by cyanobacteria nitrogen fixation. This state of the sea is characterised as a vicious circle .

Social work in a hospital emergency department

This paper describes how a Hospital Social Work Department's Emergency Team has attempted to provide a crisis and out-of-hours service to its Emergency Department. Through a staffing commitment to extensive evening and weekend cover, the Emergency Team's social worker is able to provide an immediate intervention and assessment service to problems. This has resulted in early detection and treatment of the non-medical aspects of a patient's problem and appropriate referral to other agencies for longer-term follow-up.

A submission to the Tasmanian Department of Health and Human Services consultation “Healthy Tasmania Five Year Strategic Plan”

This submission will address a number of questions raised in section 5.2, “Potential Future Initiatives to target smoking”, of the Healthy Tasmania Five Year Strategic Plan – Community Consultation Draft. Each question has been answered within this submission. This submission will also address the possibility of legal challenges to these proposed changes, a pivotal consideration when implementing any tobacco control laws. This is due to the aggressive nature of the tobacco industry, as illustrated by their attempts to challenge plain packaging laws in the country and through international treaties. The evidence provided in my submission illustrates that prevention of initiation of smoking during adolescence has various benefits in terms of reduction of negative smoking behaviors in later life. I argue that increasing the minimum legal age of purchasing for tobacco to 21 will benefit both the levels of underage smoking as well as the age of onset of initiation of smoking, due to the greater difficulties that those who are underage would experience in accessing tobacco products. I will also address the question of whether the minimum smoking age should be increased to 25.

Fast in-memory XPath search using compressed indexes

A large fraction of an XML document typically consists of text data. The XPath query language allows text search via the equal, contains, and starts-with predicates. Such predicates can be efficiently implemented using a compressed self-index of the document's text nodes. Most queries, however, contain some parts querying the text of the document, plus some parts querying the tree structure. It is therefore a challenge to choose an appropriate evaluation order for a given query, which optimally leverages the execution speeds of the text and tree indexes. Here the SXSI system is introduced. It stores the tree structure of an XML document using a bit array of opening and closing brackets plus a sequence of labels, and stores the text nodes of the document using a global compressed self-index. On top of these indexes sits an XPath query engine that is based on tree automata. The engine uses fast counting queries of the text index in order to dynamically determine whether to evaluate top-down or bottom-up with respect to the tree structure. The resulting system has several advantages over existing systems: (1) on pure tree queries (without text search) such as the XPathMark queries, the SXSI system performs on par or better than the fastest known systems MonetDB and Qizx, (2) on queries that use text search, SXSI outperforms the existing systems by 1-3 orders of magnitude (depending on the size of the result set), and (3) with respect to memory consumption, SXSI outperforms all other systems for counting-only queries.

Developing Peer-To-Peer Web Applications

As the virtual world grows more complex, finding a standard way for storing data becomes increasingly important. Ideally, each data item would be brought into the computer system only once. References for data items need to be cryptographically verifiable, so the data can maintain its identity while being passed around. This way there will be only one copy of the users family photo album, while the user can use multiple tools to show or manipulate the album. Copies of users data could be stored on some of his family members computer, some of his computers, but also at some online services which he uses. When all actors operate over one replicated copy of the data, the system automatically avoids a single point of failure. Thus the data will not disappear with one computer breaking, or one service provider going out of business. One shared copy also makes it possible to delete a piece of data from all systems at once, on users request. In our research we tried to find a model that would make data manageable to users, and make it possible to have the same data stored at various locations. We studied three systems, Persona, Freenet, and GNUnet, that suggest different models for protecting user data. The main application areas of the systems studied include securing online social networks, providing anonymous web, and preventing censorship in file-sharing. Each of the systems studied store user data on machines belonging to third parties. The systems differ in measures they take to protect their users from data loss, forged information, censorship, and being monitored. All of the systems use cryptography to secure names used for the content, and to protect the data from outsiders. Based on the gained knowledge, we built a prototype platform called Peerscape, which stores user data in a synchronized, protected database. Data items themselves are protected with cryptography against forgery, but not encrypted as the focus has been disseminating the data directly among family and friends instead of letting third parties store the information. We turned the synchronizing database into peer-to-peer web by revealing its contents through an integrated http server. The REST-like http API supports development of applications in javascript. To evaluate the platform’s suitability for application development we wrote some simple applications, including a public chat room, bittorrent site, and a flower growing game. During our early tests we came to the conclusion that using the platform for simple applications works well. As web standards develop further, writing applications for the platform should become easier. Any system this complex will have its problems, and we are not expecting our platform to replace the existing web, but are fairly impressed with the results and consider our work important from the perspective of managing user data.

Developing Peer-To-Peer Web Applications

As the virtual world grows more complex, finding a standard way for storing data becomes increasingly important. Ideally, each data item would be brought into the computer system only once. References for data items need to be cryptographically verifiable, so the data can maintain its identity while being passed around. This way there will be only one copy of the users family photo album, while the user can use multiple tools to show or manipulate the album. Copies of users data could be stored on some of his family members computer, some of his computers, but also at some online services which he uses. When all actors operate over one replicated copy of the data, the system automatically avoids a single point of failure. Thus the data will not disappear with one computer breaking, or one service provider going out of business. One shared copy also makes it possible to delete a piece of data from all systems at once, on users request. In our research we tried to find a model that would make data manageable to users, and make it possible to have the same data stored at various locations. We studied three systems, Persona, Freenet, and GNUnet, that suggest different models for protecting user data. The main application areas of the systems studied include securing online social networks, providing anonymous web, and preventing censorship in file-sharing. Each of the systems studied store user data on machines belonging to third parties. The systems differ in measures they take to protect their users from data loss, forged information, censorship, and being monitored. All of the systems use cryptography to secure names used for the content, and to protect the data from outsiders. Based on the gained knowledge, we built a prototype platform called Peerscape, which stores user data in a synchronized, protected database. Data items themselves are protected with cryptography against forgery, but not encrypted as the focus has been disseminating the data directly among family and friends instead of letting third parties store the information. We turned the synchronizing database into peer-to-peer web by revealing its contents through an integrated http server. The REST-like http API supports development of applications in javascript. To evaluate the platform s suitability for application development we wrote some simple applications, including a public chat room, bittorrent site, and a flower growing game. During our early tests we came to the conclusion that using the platform for simple applications works well. As web standards develop further, writing applications for the platform should become easier. Any system this complex will have its problems, and we are not expecting our platform to replace the existing web, but are fairly impressed with the results and consider our work important from the perspective of managing user data.

Swedish advertising language in Finland mirrored by the newspaper advertisements of the Stockmanns department store during the 20th century

The advertising business is often said to favour a modern, innovative language use. This is a statement not easily verified. Newspaper ads are in fact the genre of written language that linguists have paid the least attention to. People writing texts for newspaper ads are individuals representing contemporary language use. Advertisements representing different periods therefore diverge not only regarding the change of style and form advertising undergoes over time, but changes in the language itself also reflect the continuous process of alteration in a speech community. Advertisements and marketing material on the whole, are also read by many individuals who otherwise are not accustomed to reading at all. The marketing manager, the copywriter and the Art Director, in other words, produce texts that unconsciously function as language models. Changes are not created by, or urged on by linguistic expertise, but by ordinary users confronting other ordinary users. From a sociolinguistic perspective the widely diffused advertising language is therefore a most influential factor.

Reklamsvenska i Finland speglad genom varuhuset Stockmanns tidningsannonser under det 20e seklet - Swedish Advertising Language in Finland Mirrored by the Newspaper Advertisements of the Stockmanns Department Store during the 20th Century

Reklam sägs använda ett modernt, gärna ett nyskapande språk. Detta är ett påstående som inte så lätt kan verifieras. Tidningsannonsen är troligen den skriftspråksgenre som har fått minst uppmärksamhet av språkforskare. De som skriver texten i en tidningsannons är personer som representerar det samtida språkbruket. Annonser som representerar olika tidsepoker skiljer sig därför från varandra inte bara genom att annonsen förändras i fråga om stil och form. Annonsens språk avspeglar också den språkliga förändringsprocess som kontinuerligt pågår i varje språksamhälle. Annonser, och marknadsföringsmaterial över huvud taget, läses också av många människor som i övrigt läser mycket litet eller kanske inte alls. Marknadsföraren, reklamskribenten (copywriter) och AD:n producerar m.a.o. texter som på ett omedvetet sätt kommer att vara språkmodeller för sina läsare. Förändringar i språket kreeras inte och drivs inte på av språkforskare, utan av vanliga språkbrukare i interaktion med andra språkbrukare. Sett ur ett sociolingvistiskt perspektiv har det vitt spridda reklamspråket därför inflytande på språket i samhället. Syftet med det reklamspråksprojekt som presenteras i föreliggande rapport är att analysera hur och när förändringar i svenskan som uppträder i Sverige dyker upp i annonser som skrivs på svenska i Finland. Reklam på svenska Finland under 1900-talet står i fokus, och tidningsannonser för Stockmanns varuhus i Helsingfors utgör primärmaterialet. Tidningsannonser för varuhuset Nordiska Kompaniet (NK) i Stockholm under motsvarande tid tjänar som jämförelsematerial. I denna rapport presenteras projektets syfte, de uppställda forskningsfrågorna, och resonemanget illustreras med exempel ur projektmaterialet. Rapporten innehåller också en beskrivning av projektets reklamdatabas och basfakta om material och metoder. -

Suomalaisen alkuperäiskarjan liha – kuluttajien osto- ja maksuhalukkuus

Tutkielman tavoitteena on selvittää suomalaisen alkuperäiskarjan lihan potentiaalista kysyntää. Alkuperäiskarjan lihan erikoistuotemarkkinat voivat auttaa pitämään uhanalaiset, kotimaiset karjarodut tuotantokäytössä. Näin ollen erikoistuotemarkkinat voivat auttaa arvokkaiden suomalaisten eläingeenivarojen säilyttämisessä. Koska alkuperäiskarjan lihan tuotannon kannattavuus riippuu lihasta saatavasta lisähinnasta, tutkimuksen tavoitteena on myös tutkia, millainen kuluttajien maksuhalukkuus alkuperäiskarjan lihasta on verrattuna tavanomaiseen lihaan. Tutkimusaineisto kerättiin Maa- ja elintarviketalouden tutkimuskeskuksen ja Kuluttajatutkimuskeskuksen suunnittelemalla kyselytutkimuksella keväällä 2010. Tutkimuksessa käytettiin ehdollisen käyttäytymisen ja ehdollisen arvottamisen menetelmiä ja sen otoskoko on 1623. Kuluttajien ostohalukkuutta ja siihen vaikuttavia tekijöitä tutkittiin sekä binäärisen että ordinaalisen regression malleilla. Kuluttajien maksuhalukkuutta alkuperäiskarjan lihasta ja siihen vaikuttavia tekijöitä tutkittiin grouped data -mallin avulla. Malleissa käytettiin selittävinä muuttujina sosioekonomisten muuttujien lisäksi kuluttajien asenteita ja käyttäytymistä kuvaavia muuttujia. Tutkielman tulosten mukaan jopa 86 % vastaajista ostaisi alkuperäiskarjan lihaa, jos sitä olisi tarjolla kaupoissa. Ostohalukkuutta lisää muun muassa, jos vastaajalla on alle 18-vuotiaita lapsia ja vastaaja arvostaa lähellä tuotettua, paikallista ruokaa sekä ympäristöystävällisyyttä. Miehet ostaisivat alkuperäiskarjan lihaa todennäköisemmin kuin naiset. Suurin osa vastaajista ostaisi alkuperäiskarjan lihaa, jos se olisi samanhintaista kuin tavanomainen liha, mutta noin neljäsosa (23,5 %) vastaajista olisi valmis maksamaan alkuperäiskarjan lihasta korkeampaa hintaa kuin tavanomaisesta lihasta. Maksuhalukkuuteen vaikuttivat positiivisesti muun muassa kuuluminen ympäristöjärjestöön ja korkea tulotaso. Negatiivisesti vaikutti puolestaan esimerkiksi se, että vastaaja on nainen. Keskimääräinen maksuhalukkuus alkuperäiskarjan lihasta oli 6,25 % korkeampi kuin tavanomaisesta lihasta. Maksuhalukkuus alkuperäiskarjan lihasta oli selvästi yhteydessä siihen, kuinka usein vastaaja olisi halukas ostamaan sitä. Maksuhalukkuus oli korkein niillä vastaajilla, jotka haluaisivat ostaa lihaa säännöllisesti.