Leadership and teamwork in medical emergencies: performance of nursing students and registered nurses in simulated patient scenarios

Aims and objectives: To examine nursing students' and registered nurses' teamwork skills whilst managing simulated deteriorating patients. Background: Studies continue to show the lack of timely recognition of patient deterioration. Management of deteriorating patients can be influenced by education and experience. Design: Mixed methods study conducted in two universities and a rural hospital in Victoria, and one university in Queensland, Australia. Methods: Three simulation scenarios (chest pain, hypovolaemic shock and respiratory distress) were completed in teams of three by 97 nursing students and 44 registered nurses, equating to a total of 32 student and 15 registered nurse teams. Data were obtained from (1) Objective Structured Clinical Examination rating to assess performance; (2) Team Emergency Assessment Measure scores to assess teamwork; (3) simulation video footage; (4) reflective interview during participants' review of video footage. Qualitative thematic analysis of video and interview data was undertaken. Results: Objective structured clinical examination performance was similar across registered nurses and students (mean 54% and 49%); however, Team Emergency Assessment Measure scores differed significantly between the two groups (57% vs 38%, t = 6·841, p < 0·01). In both groups, there was a correlation between technical (Objective Structured Clinical Examination) and nontechnical (Team Emergency Assessment Measure) scores for the respiratory distress scenario (student teams: r = 0·530, p = 0·004, registered nurse teams r = 0·903, p < 0·01) and hypovolaemia scenario (student teams: r = 0·534, p = 0·02, registered nurse teams: r = 0·535, p = 0·049). Themes generated from the analysis of the combined quantitative and qualitative data were as follows: (1) leadership and followership behaviours; (2) help-seeking behaviours; (3) reliance on previous experience; (4) fixation on a single detail; and (5) team support. Conclusions: There is scope to improve leadership, team work and task management skills for registered nurses and nursing students. Simulation appears to be beneficial in enabling less experienced staff to assess their teamwork skills. Relevance to clinical practice: There is a need to encourage less experienced staff to become leaders and for all staff to develop improved teamwork skills for medical emergencies. © 2014 John Wiley & Sons Ltd.

Hallucinating optimal high-dimensional subspaces

Linear subspace representations of appearance variation are pervasive in computer vision. This paper addresses the problem of robustly matching such subspaces (computing the similarity between them) when they are used to describe the scope of variations within sets of images of different (possibly greatly so) scales. A naïve solution of projecting the low-scale subspace into the high-scale image space is described first and subsequently shown to be inadequate, especially at large scale discrepancies. A successful approach is proposed instead. It consists of (i) an interpolated projection of the low-scale subspace into the high-scale space, which is followed by (ii) a rotation of this initial estimate within the bounds of the imposed "downsampling constraint". The optimal rotation is found in the closed-form which best aligns the high-scale reconstruction of the low-scale subspace with the reference it is compared to. The method is evaluated on the problem of matching sets of (i) face appearances under varying illumination and (ii) object appearances under varying viewpoint, using two large data sets. In comparison to the naïve matching, the proposed algorithm is shown to greatly increase the separation of between-class and within-class similarities, as well as produce far more meaningful modes of common appearance on which the match score is based. © 2014 Elsevier Ltd.

A snapshot of the scope of obesity prevention practice in Australia.

Community-based initiatives (CBIs) that build capacity and promote healthy environments hold promise for preventing obesity and non-communicable disease, however their characteristics remain poorly understood and lessons are learned in isolation. This limits understanding of likely effectiveness of CBIs; the potential for actively supporting practice; and the translation of community-based knowledge into policy. Building on an initial survey (2010), an online survey was launched (2013) with the aim to describe the reach and characteristics of Australian CBIs and identify and evaluate elements known to contribute to best practice, effectiveness and sustainability. Responses from 104 CBIs were received in 2013. Geographic location generally reflected population density in Australia. Duration of CBIs was short-term (median 3 years; range 0.2-21.0 years), delivered mostly by health departments and local governments. Median annual funding had more than doubled since the 2010 survey, but average staffing had not increased. CBIs used at least two strategy types, with a preference for individual behaviour change strategies. Targeting children was less common (31%) compared with the 2010 survey (57%). Logic models and theory were used in planning, but there was low use of research evidence and existing prevention frameworks. Nearly, all CBIs had an evaluation component (12% of budget), but dissemination was limited. This survey provides information on the scope and varied quality of the current obesity prevention investment in Australia. To boost the quality and effectiveness of CBIs, further support systems may be required to ensure that organizations adopt upstream, evidence-informed approaches; and integrate CBIs into systems, policies and environments.

An empirical study of the antecedents and consequences of brand engagement

Purpose – The purpose of this paper is to develop and empirically test a model of brand engagement. More specifically, the aim is to evaluate both antecedents and consequences of brand engagement, from a management perspective. Design/methodology/approach – A quantitative survey of 403 firms is undertaken to test the model. Structural equation modelling (SEM) is used to estimate the parameters of the model. Findings – A reliable and valid measure of brand engagement is established. The SEM model works well, in terms of goodness of fit indices. The results demonstrate that there are major brand performance benefits (consequences) of brand engagement. Additionally, and important for the practical implications, the results show that brand orientation is a major antecedent to brand engagement. Research limitations/implications – The study needs to be replicated in other countries, with scope to add other explanatory variables for influencing brand engagement. The results have considerable practical benefits for guiding the introduction of measures to enhance brand engagement. Originality/value – The study builds on earlier (mainly consumer) conceptual approaches to brand engagement, but goes further in that it provides empirical evidence about the nature, antecedents and consequences of brand engagement and further, offers a management rather than consumer perspective. Essentially, the study reveals a new perspective of factors that encourage firms to connect/engage their brands with consumers. Brand engagement is a dual concept, reflecting both a consumer and a firm perspective.

The perceived scope of internal audit function in libyan public enterprises

Purpose - The aim of this exploratory study is to examine the perceptions of stakeholders regarding the scope of internal audit (IA) work in Libyan state-owned enterprises. Design/methodology/approach - Data were gathered through semi-structured interviews with chief executive officers, IA directors, administrative affairs managers, financial affairs managers and external auditors, which were supplemented with a review of relevant documentary evidence. Findings - The results of the study show that the scope of IA in Libyan organizations may not be sufficiently wide ranging to be considered as a value-adding service. The scope of the IA function may need to be expanded to cover a broader range of organizational functions if internal auditors are to offer value-adding services to their stakeholders. Practical implications - The IA profession has received scant attention in the literature, especially in the context of developing countries such as Libya. Therefore, such settings offer the potential to enhance the understanding of IA practices. As a study on a developing economy, it enhances understanding of the IA profession’s global configuration beyond the predominantly market-driven, industrialized Western economies. Originality/value - In contrast to most previous studies, this study covers a broad range of IA stakeholders’ views on the role of internal auditors. This coverage enabled an in-depth investigation of the factors affecting IA scope and understanding of stakeholder perceptions on the IA function.

GCC market scope and competitiveness

This chapter provides an overview of the recent trends and emerging patterns in Gulf Cooperation Council (GCC) consumer market and business environment. The chapter starts by assessing the potential consumer market size of the GCC by analysing emerging demographic trends. Then, the chapter provides an overview of emerging economic sectors with future growth opportunities. This is followed by an analysis of the international competitiveness of the GCC and its member states.

A way through the dark and thorny thickets? The adjudication of ‘serious injury’ under the narrative tests in the Transport Accident Act 1986 (Vic) and the Workplace Injury Rehabilitation and Compensation Act 2013 (Vic)

The so-called narrative test provides the means by which injured persons who satisfy the statutory and common law definition of serious injury may bring proceedings for common law damages under s 93 of the Transport Accident Act 1986 (Vic) and s 134AB of the Accident Compensation Act 1985 (Vic) (or, for injuries after 1 July 2014, under ss 324-347 of the Workplace Injury Rehabilitation and Compensation Act 2013 (Vic)). These are among the most litigated provisions in Australia. This article outlines the legislative and political background to these provisions, the provisions themselves, and an account of the statutory and common law requirements needed to satisfy the provisions.

Is there scope for community health nurses to address lifestyle risk factors? The community nursing SNAP trial

Background
This paper examines the opportunity and need for lifestyle interventions for patients attending generalist community nursing services in Australia. This will help determine the scope for risk factor management within community health care by generalist community nurses (GCNs).

Methods
This was a quasi-experimental study conducted in four generalist community nursing services in NSW, Australia. Prior to service contacts, clients were offered a computer-assisted telephone interview to collect baseline data on socio-demographics, health conditions, smoking status, physical activity levels, alcohol consumption, height and weight, fruit and vegetable intake and 'readiness-to-change' for lifestyle risk factors.

Results
804 clients participated (a response rate of 34.1%). Participants had higher rates of obesity (40.5% vs 32.1%) and higher prevalence of multiple risk factors (40.4% vs 29.5%) than in the general population. Few with a SNAPW (S moking-N utrition-A lcohol-P hysical-Activity-Weight) risk factor had received advice or referral in the previous 3 months. The proportion of clients identified as at risk and who were open to change (i.e. contemplative, in preparation or in action phase) were 65.0% for obese/overweight; 73.8% for smokers; 48.2% for individuals with high alcohol intake; 83.5% for the physically inactive and 59.0% for those with poor nutrition.

Conclusions
There was high prevalence of lifestyle risk factors. Although most were ready to change, few clients recalled having received any recent lifestyle advice. This suggests that there is considerable scope for intervention by GCNs. The results of this trial will shed light on how best to implement the lifestyle risk factor management in routine practice.

The role of indomethacin and tezosentan on renal effects induced by Bothrops moojeni Lys49 myotoxin I

Renal changes determined by Lys49 myotoxin I (BmTx I), isolated from Bothrops moojeni are well known. The scope of the present study was to investigate the possible mechanisms involved in the production of these effects by using indomethacin (10 mu g/mL), a non-selective inhibitor of cyclooxygenase, and tezosentan (10 mu g/mL), an endothelin antagonist. By means of the method of mesenteric vascular bed, it has been observed that B. moojeni myotoxin (5 mu g/mL) affects neither basal perfusion pressure nor phenylephrine-preconstricted vessels. This fact suggests that the increase in renal perfusion pressure and in renal vascular resistance did not occur by a direct effect on renal vasculature. Isolated kidneys from Wistar rats, weighing 240-280 g, were perfused with Krebs-Henseleit solution. The infusion of BmTx-I increased perfusion pressure, renal vascular resistance, urinary flow and glomerular filtration rate. Sodium, potassium and chloride tubular transport was reduced after addition of BmTx-I. Indomethacin blocked the effects induced by BmTx-I on perfusion pressure and renal vascular resistance, however, it did not revert the effect on urinary flow and sodium, potassium and chloride tubular transport. The alterations of glomerular filtration rate were inhibited only at 90 min of perfusion. The partial blockade exerted by indomethacin treatment showed that prostaglandins could have been important mediators of BmTx-I renal effects, but the participation of other substances cannot be excluded.The blockage of all renal alterations observed after tezosentan treatment support the hypothesis that endothelin is the major substance involved in the renal pathophysiologic alterations promoted by the Lys49 PLA(2) myotoxin I, isolated from B. moojeni. In conclusion, the rather intense renal effects promoted by B. moojeni myotoxin-I were probably caused by the release of renal endothelin, interfering with the renal parameters studied. (c) 2006 Elsevier Ltd. All rights reserved.

Use of scrap tire rubber in place of SBS in modified asphalt as an environmentally correct alternative for Brazil

Reusing scrap tires has become a worldwide challenge, especially due to the great difficulty in finding ecologically and economically feasible ways to dispose of them. This has led to the creation of specific programs and legislation for reusing scrap tires. Research has shown that a certain percentage of scrap tire rubber can be added to asphalt compositions, and this has become a worldwide practice. This paper describes the properties of four asphalt compositions modified with scrap tire rubber (STR) prepared in the laboratory. These properties are then compared with those of asphalt modified with styrene butadiene styrene (SBS), a synthetic polymer and one of the most common modifiers, to verify the feasibility of using scrap tire rubber as a substitute for SBS. The scope of this study does not include an analysis of how STR affects end-of-life asphalt. The main findings indicate that STR is a potential substitute of SBS in paving material, and although it does not meet some of the standard specifications when compared with SBS, these issues can be overcome by proper care during storage and transportation. The substitution of SBS by STR also showed the potential for about 10% in expenditure savings. (C) 2012 Elsevier Ltd. All rights reserved.

A contribution for thermoeconomic modelling: A methodology proposal

This work presents a thermoeconomic optimization methodology for the analysis and design of energy systems. This methodology involves economic aspects related to the exergy conception, in order to develop a tool to assist the equipment selection, operation mode choice as well as to optimize the thermal plants design. It also presents the concepts related to exergy in a general scope and in thermoeconomics which combines the thermal sciences principles (thermodynamics, heat transfer, and fluid mechanics) and the economic engineering in order to rationalize energy systems investment decisions, development and operation. Even in this paper, it develops a thermoeconomic methodology through the use of a simple mathematical model, involving thermodynamics parameters and costs evaluation, also defining the objective function as the exergetic production cost. The optimization problem evaluation is developed for two energy systems. First is applied to a steam compression refrigeration system and then to a cogeneration system using backpressure steam turbine. (C) 2010 Elsevier Ltd. All rights reserved.

Behavioural defences of anurans: an overview

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Light Front Boson Model Propagation

The scope and aim of this work is to describe the two-body interaction mediated by a particle (either the scalar or the gauge boson) within the light-front formulation. To do this, first of all we point out the importance of propagators and Green functions in Quantum Mechanics. Then we project the covariant quantum propagator onto the light front time to get the propagator for scalar particles in these coordinates. This operator propagates the wave function from x(+) = 0 to x(+) > 0. It corresponds to the definition of the time ordering operation in the light front time x(+). We calculate the light-front Green's function for 2 interacting bosons propagating forward in x(+). We also show how to write down the light front Green's function from the Feynman propagator and finally make a generalization to N bosons.

Palm heart harvesting in the Brazilian Atlantic forest: changes in industry structure and the illegal trade

1. Until the late 1960s, Euterpe edulis was the most important edible palm species in the Brazilian markets. Since then, overharvesting of natural stands and the limited scope of plantations have caused the industry to shift to the multistemmed E, oleracea from the Amazon river estuary.2, As a result of the relocation of the industry, the structure of the palm harvesting industry has changed and illegal trade has continued to exploit the remaining natural stands of E, edulis.3, it is suggested that, to avoid the total harvesting of E. edulis and to achieve sustainable management of the palm heart, it will be necessary to diversify the local economy, create incentives for small land owners to improve their management practices, while keeping their competitiveness against the illegal trade, create the incentive of new sources of palm hearts and create a 'green stamping' For management palms.4, Transformation of the illegal structure of the palm heart industry is probably the only solution to avoid the total depletion of the wild stands of E. edulis.