Process quality indicators targeting cognitive impairment to support quality of care for older people with cognitive impairment in emergency departments

Objectives The objective of this study was to develop process quality indicators (PQIs) to support the improvement of care services for older people with cognitive impairment in emergency departments (ED). Methods A structured research approach was taken for the development of PQIs for the care of older people with cognitive impairment in EDs, including combining available evidence with expert opinion (phase 1), a field study (phase 2), and formal voting (phase 3). A systematic review of the literature identified ED processes targeting the specific care needs of older people with cognitive impairment. Existing relevant PQIs were also included. By integrating the scientific evidence and clinical expertise, new PQIs were drafted and, along with the existing PQIs, extensively discussed by an advisory panel. These indicators were field tested in eight hospitals using a cohort of older persons aged 70 years and older. After analysis of the field study data (indicator prevalence, variability across sites), in a second meeting, the advisory panel further defined the PQIs. The advisory panel formally voted for selection of those PQIs that were most appropriate for care evaluation. Results In addition to seven previously published PQIs relevant to the care of older persons, 15 new indicators were created. These 22 PQIs were then field tested. PQIs designed specifically for the older ED population with cognitive impairment were only scored for patients with identified cognitive impairment. Following formal voting, a total of 11 PQIs were included in the set. These PQIs targeted cognitive screening, delirium screening, delirium risk assessment, evaluation of acute change in mental status, delirium etiology, proxy notification, collateral history, involvement of a nominated support person, pain assessment, postdischarge follow-up, and ED length of stay. Conclusions This article presents a set of PQIs for the evaluation of the care for older people with cognitive impairment in EDs. The variation in indicator triggering across different ED sites suggests that there are opportunities for quality improvement in care for this vulnerable group. Applied PQIs will identify an emergency services' implementation of care strategies for cognitively impaired older ED patients. Awareness of the PQI triggers at an ED level enables implementation of targeted interventions to improve any suboptimal processes of care. Further validation and utility of the indicators in a wider population is now indicated.

Phenomenology and Extreme Sports in Natural Landscapes

Husserl reminded us of the imperative to return to the Lebensweldt, or life-world. He was preoccupied with the crisis of Western science which alienated the experiencing self from the world of immediate experience. Immediate experience provides a foundation for what it means to be human. Heidegger, building upon these ideas, foresaw a threat to human nature in the face of ‘technicity’. He argued for a return to a relationship between ‘authentic self’ and nature predicated upon the notion of ‘letting be’ in which humans are open to the mystery of being. Self and nature are not conceived as alienated entities but as aspects of a single entity. In modern times, separation between self and the world is further evidenced by scientific rational modes of being exemplified through consumerism and the incessant use of screen-based technology which dominate human experience. In contrast, extreme sports provide an opportunity for people to return to the life-world by living in relation to the natural world. Engagement in extreme sports enables a return to authenticity as we rediscover self as part of nature.

Social networking sites and participatory reluctance: A case study of Gaydar, user resistance and interface rejection

This article conceptualises ‘participatory reluctance’ as a particular orientation to social media that problematises binarised notions of connection and disconnection in social networking sites. It qualitatively examines how the concept has functioned within gay men’s social networking service, Gaydar, among 18- to 28-year-old users of the site in Brisbane, Australia. Participatory reluctance is shown to be a central aspect of the culture of this space, fostered among the studied demographic by the convergence of the growing global push for marriage equality and increasing normalisation of the kinds of gay male identities commonly adopted among this group, with three key factors rooted primarily in Gaydar’s design: (1) young users’ perceptions of the site as a space for procuring casual sex; (2) their perceptions of the imagined user as embodying existing stereotypes of gay masculinity, and; (3) a lack of genuine alternatives in terms of niche digital spaces for gay men’s social networking.

Customer-driven innovation: Digital channels and community

This study investigates the role of digital channels in community-led businesses by exploring two case study companies, Uber and Airbnb. At present, these community-led businesses are disrupting traditional industries by connecting with customers via digital channels and facilitating transactions between two parties. A deductive structured qualitative content analysis approach utilising a predetermined categorization matrix was implemented to decipher the digital channels used by both companies. The results discovered that both company’s digital channels push the customer to their core channel, allowing, customers to create their own physical, largely self-governed communities. However, little research exists which explores and analyses the role of digital channels in forming community-led businesses. Therefore, this paper aims to instigate future research and discussion in this emerging area by concluding with future research agendas.

Australians may get their own stop online piracy act #SOPA: Christmas time for copyright owners

Christmas has come early for copyright owners in Australia. The film company, Roadshow, the pay television company Foxtel, and Rupert Murdoch's News Corp and News Limited--as well as copyright industries--have been clamoring for new copyright powers and remedies. In the summer break, the Coalition Government has responded to such entreaties from its industry supporters and donors, with a new package of copyright laws and policies. There has been significant debate over the proposals between the odd couple of Attorney-General George Brandis and the Minister for Communications, Malcolm Turnbull. There have been deep, philosophical differences between the two Ministers over the copyright agenda. The Attorney-General George Brandis has supported a model of copyright maximalism, with strong rights and remedies for the copyright empires in film, television, and publishing. He has shown little empathy for the information technology companies of the digital economy. The Attorney-General has been impatient to press ahead with a copyright regime. The Minister for Communications, Malcolm Turnbull, has been somewhat more circumspect, recognizing that there is a need to ensure that copyright laws do not adversely impact upon competition in the digital economy. The final proposal is a somewhat awkward compromise between the discipline-and-punish regime preferred by Brandis, and the responsive regulation model favored by Turnbull. In his new book, Information Doesn't Want to Be Free: Laws for the Internet Age, Cory Doctorow has some sage advice for copyright owners: Things that don't make money: Complaining about piracy. Calling your customers thieves. Treating your customers like thieves. In this context, the push by copyright owners and the Coalition Government to have a copyright crackdown may well be counter-productive to their interests.

Blue future: Maude Barlow, water rights, investor clauses, and trade deals

Maude Barlow is the chairperson of the Council of Canadians, and the founder of the Blue Planet Project. She is a recipient of Sweden’s Right Livelihood Award, and a Lannan Cultural Freedom Fellowship. As well as being a noted human rights and trade activist, Barlow is the author of a number of books on water rights — including Blue Gold, Blue Covenant, and Blue Future. She has been particularly vocal on the impact of trade and investment agreements upon water rights. Barlow has been critical of the push to include investor-state dispute settlement clauses in trade agreements — such as the Comprehensive Economic and Trade Agreement (CETA) between Canada and the European Union, the Trans-Pacific Partnership (TPP), and the Trans-Atlantic Trade and Investment Partnership Agreement (TTIP). She has also been concerned by the Trade in Services Agreement (TISA) leaked by WikiLeaks.

Will the TPP feed consumers to the wolves of Wall Street?

In the wake of the global financial crisis, there’s been a push by policy-makers for greater regulation of banks, financial institutions and the “wolves of Wall Street”. This was accompanied by a highly visible Occupy Wall Street movement, demanding political and legal reform. But could new trade agreements undermine consumer protection?

Genetics of path lengths in brain connectivity networks: HARDI-based maps in 457 adults

Brain connectivity analyses are increasingly popular for investigating organization. Many connectivity measures including path lengths are generally defined as the number of nodes traversed to connect a node in a graph to the others. Despite its name, path length is purely topological, and does not take into account the physical length of the connections. The distance of the trajectory may also be highly relevant, but is typically overlooked in connectivity analyses. Here we combined genotyping, anatomical MRI and HARDI to understand how our genes influence the cortical connections, using whole-brain tractography. We defined a new measure, based on Dijkstra's algorithm, to compute path lengths for tracts connecting pairs of cortical regions. We compiled these measures into matrices where elements represent the physical distance traveled along tracts. We then analyzed a large cohort of healthy twins and show that our path length measure is reliable, heritable, and influenced even in young adults by the Alzheimer's risk gene, CLU.

Oldest pathology in a tetrapod bone illuminates the origin of terrestrial vertebrates

The origin of terrestrial tetrapods was a key event in vertebrate evolution, yet how and when it occurred remains obscure, due to scarce fossil evidence. Here, we show that the study of palaeopathologies, such as broken and healed bones, can help elucidate poorly understood behavioural transitions such as this. Using high-resolution finite element analysis, we demonstrate that the oldest known broken tetrapod bone, a radius of the primitive stem tetrapod Ossinodus pueri from the mid-Viséan (333 million years ago) of Australia, fractured under a high-force, impact-type loading scenario. The nature of the fracture suggests that it most plausibly occurred during a fall on land. Augmenting this are new osteological observations, including a preferred directionality to the trabecular architecture of cancellous bone. Together, these results suggest that Ossinodus, one of the first large (>2m length) tetrapods, spent a significant proportion of its life on land. Our findings have important implications for understanding the temporal, biogeographical and physiological contexts under which terrestriality in vertebrates evolved. They push the date for the origin of terrestrial tetrapods further back into the Carboniferous by at least two million years. Moreover, they raise the possibility that terrestriality in vertebrates first evolved in large tetrapods in Gondwana rather than in small European forms, warranting a re-evaluation of this important evolutionary event.

Race against time: The export of essential medicines to Rwanda

This article considers the significance of the first export of essential medicines under the WTO General Council Decision 2003. In July 2007, Rwanda became the first country to provide a notification under the WTO General Council Decision 2003 of its intent to import a fixed-dose, triple combination HIV/AIDS drug manufactured by the Canadian generic pharmaceuticalmanufacturer Apotex, Inc. In September 2007, Apotex was granted the first compulsory licence application under Canada's Access to Medicines Regime. This article considers the convoluted and protracted negotiations between the Government of Rwanda, Apotex and three patent holders, GlaxoSmithKline, Boehringer Ingleheim Canada and Shire BioChemical, Inc. It questions the efficiency of this process. This article considers the review of the Jean Chretien Pledge to Africa Act 2004 (Canada). It is critical of the refusal of the Conservative Government of Canada to make any amendments to the legislation to improve the cost-effective delivery of essential medicines. This article queries the proposed Hong Kong Amendment to the TRIPS Agreement 1994, given the concerns of the Africa Group. It is submitted that it is undesirable to codify the WTO General Council Decision 2003, given its failure to provide a speedy, efficient and cost-effective delivery of essential medicines.

Shine: Copyright law and film

This article looks at the various experiences of the film-makers involved in Shine in relation to copyright policy and litigation. Part 1 considers the involvement of Jan Sardi in the campaign to get screenwriters included in the moral rights regime in the film industry. Part 2 recounts the efforts of Scott Hicks to push for directors to acquire royalties under the retransmission scheme in the Copyright Amendment (Digital Agenda) Act 2000 (Cth). Part 3 discusses the contractual dispute between independent producer Jane Scott and the distributor over the gross receipts to the film Shine. Part 4 explores the disputes over the use of Sergei Rachmaninov's music in the film Shine.

Blame it on Rio: Biodiscovery, native title, and traditional knowledge

This article examines the legal responses to protect traditional knowledge of biodiversity in the wake of the Rio Convention on Biological Diversity. It considers the relative merits of the inter-locking regimes of contract law, environmental law, intellectual property law, and native title law. Part 1 considers the natural drug discovery industry in Australia. In particular, it looks at the operations of Amrad, Astra Zeneca R & D, and the Australian Institute of Marine Science. This section examines the key features of the draft regulations proposed under the Environment Protection and Biodiversity Conservation Act 1999 (Cth) - model contracts, informed consent, benefit-sharing, and ministerial discretion. The use of Indigenous Land Use Agreements in the context of access to genetic resources is also explored. Part 2 considers the role played by native title law in dealing with tangible and intangible property interests. The High Court decision in Western Australia v Ward considers the relationship between native title rights and cultural knowledge. The Federal Court case of Neowarra v Western Australia provides an intriguing gloss on this High Court decision. Part 3 looks at whether traditional knowledge of biodiversity can be protected under intellectual property law. It focuses upon reforms such as Senator Aden Ridgeway's proposed amendments to the Plant Breeder's Rights Act 1994 (Cth), and the push to make disclosure of origin a requirement of patent law.

A Submission to the Senate Legal and Constitutional Affairs Committee on the Copyright Amendment (Online Infringement) Bill 2015 (Cth)

The film company, Roadshow, the pay television company Foxtel, and Rupert Murdoch’s News Corp and News Limited — as well as copyright industries — have been clamouring for new copyright powers and remedies. In the summer break, the Coalition Government has responded to such entreaties from its industry supporters and donors, with a new package of copyright laws and policies. There has been significant debate over the proposals between the odd couple of Attorney-General George Brandis and the Minister for Communications, Malcolm Turnbull. There has been deep, philosophical differences between the two Ministers over the copyright agenda. The Attorney-General George Brandis has supported a model of copyright maximalism, with strong rights and remedies for the copyright empires in film, television, and publishing. He has shown little empathy for the information technology companies of the digital economy. The Attorney-General has been impatient to press ahead with a copyright regime. The Minister for Communications, Malcolm Turnbull, has been somewhat more circumspect,recognising that there is a need to ensure that copyright laws do not adversely impact upon competition in the digital economy. The final proposal is a somewhat awkward compromise between the discipline-and-punish regime preferred by Brandis, and the responsive regulation model favoured by Turnbull. In his new book, Information Doesn’t Want to Be Free: Laws for the Internet Age, Cory Doctorow has some sage advice for copyright owners: Things that don’t make money: * Complaining about piracy. * Calling your customers thieves. * Treating your customers like thieves. In this context, the push by copyright owners and the Coalition Government to have a copyright crackdown may well be counter-productive to their interests. This submission considers a number of key elements of the Coalition Government’s Copyright Crackdown. Part 1 examines the proposals in respect of the Copyright Amendment (Online Infringement) Bill 2015 (Cth). Part 2 focuses upon the proposed Copyright Code. Part 3 considers the question of safe harbours for intermediaries. Part 4 examines the question of copyright exceptions – particularly looking at the proposal of the Australian Law Reform Commission for the introduction of a defence of fair use. Part 5 highlights the recommendations of the IT Pricing Inquiry and the Harper Competition Policy Review in respect of copyright law, consumer rights, and competition law.

Micro inverter with a front-end current-fed converter

The reliability of micro inverters is an important factor as it would be necessary to reduce cost and maintenance of the small and medium scale distributed PV power conversion systems. Electrolytic capacitors and active power decouple circuits can be avoided in micro inverters with the use of medium voltage DC-link. Such a DC-link based micro inverter is proposed with a front-end dual inductor current-fed push-pull converter. The primary side power switches of the front-end converter have reduced switching losses due to multi-resonant operation. In addition, the voltage and current stresses on the diodes of the secondary diode voltage doubler rectifier are reduced due to the presence of a series resonant circuit in the front-end converter. The operation of the proposed micro inverter is explained using an in-depth analysis of the switching characteristics of the power semiconductor devices. The theoretical analysis of the proposed micro inverter is validated using simulation result.

Time, place and space – student group collaboration using Google Drive

Virtual working environments are intrinsic to the contemporary workplace and collaborative skills are a vital graduate capability. To develop students’ collaborative skills, first year medical laboratory science students undertake a group poster project, based on a blended learning model. Learning is scaffolded in lectures, workshops in collaborative learning spaces, practitioner mentoring sessions, and online resources. Google Drive provides an online collaborative space for students to realise tangible outcomes from this learning. A Google Drive document is created for each group and shared with members. In this space, students assign tasks and plan workflow, share research, progressively develop poster content, reflect and comment on peer contributions and use the messaging functions to ‘talk’ to group members. This provides a readily accessible, transparent record of group work, crucial in peer assessment, and a communication channel for group members and the lecturer, who can support groups if required. This knowledge creation space also augments productivity and effectiveness of face-to-face collaboration. As members are randomly allocated to groups and are often of diverse backgrounds and unknown to each other, resilience is built as students navigate the uncertainties and complexities of group dynamics, learning to focus on the goal of the team task as they constructively and professionally engage in team dialogue. Students are responsible and accountable for individual and group work. The use of Google Drive was evaluated in a survey including Likert scale and open ended qualitative questions. Statistical analysis was carried out. Results show students (79%) valued the inclusion of online space in collaborative work and highly appreciated (78%) the flexibility provided by Google Drive, while recognising the need for improved notification functionality. Teaching staff recognised the advantages in monitoring and moderating collaborative group work, and the transformational progression in student collaborative as well as technological skill acquisition, including professional dialogue.