General practice patients in the emergency department

One of the mysteries of public policy is that at times the public discourse settles on a perspective that is based on flimsy or even contradictory evidence. One such discussion relates to the factors that contribute to the congestion of hospital emergency departments (EDs) in Australia.

A general model for host plant selection in phytophagous insects

We develop a general theoretical framework for exploring the host plant selection behaviour of herbivorous insects. This model can be used to address a number of questions, including the evolution of specialists, generalists, preference hierarchies, and learning. We use our model to: (i) demonstrate the consequences of the extent to which the reproductive success of a foraging female is limited by the rate at which they find host plants (host limitation) or the number of eggs they carry (egg limitation); (ii) emphasize the different consequences of variation in behaviour before and after landing on (locating) a host (termed pre- and post-alighting, respectively); (iii) show that, in contrast to previous predictions, learning can be favoured in post-alighting behaviour--in particular, individuals can be selected to concentrate oviposition on an abundant low-quality host, whilst ignoring a rare higher-quality host; (iv) emphasize the importance of interactions between mechanisms in favouring specialization or learning.

Bringing skills and general competences back into technological education

In this paper we show that industry-based student training is not limited to work experience; work integrated learning, internship or extended vacation work. It is also about bringing back the lost parts of technological education. We experience the unilateral focus on theoretical knowledge at the expense of skills and general competences as one important challenge in technological education. The lacking facilitation and training of practical skills and general competences in the curricula and programs are identified, but many institutions have failed to address the problem. Today’s curricula in many ways reduce technology to abstract concepts, calculations and models, and create a gap between the academic programs and the practical applications in the society. We explore two (Australia and Norway) initiatives on industry-based student training and discuss how these initiatives address and bridge the gap. We argue that these initiatives of industry-based student training contribute to bringing skills and general competences back into technological education, and that the effects are not limited to increased employability, but also include increased academic performance.

Mortality and cost outcomes of elderly trauma patients admitted to intensive care and the general wards of an Australian tertiary referral hospital

Mortality and cost outcomes of elderly intensive care unit (ICU) trauma patients were characterised in a retrospective cohort study from an Australian tertiary ICU. Trauma patients admitted between January 2000 and December 2005 were grouped into three major age categories: aged ≥65 years admitted into ICU (n=272); aged ≥65 years admitted into general ward (n=610) and aged <65 years admitted into ICU (n=1617). Hospital mortality predictors were characterised as odds ratios (OR) using logistic regression. The impact of predictor variables on (log) total hospital-stay costs was determined using least squares regression. An alternate treatment-effects regression model estimated the mortality cost-effect as an endogenous variable. Mortality predictors (P ≤0.0001, comparator: ICU ≥65 years, ventilated) were: ICU <65 not-ventilated (OR 0.014); ICU <65 ventilated (OR 0.090); ICU age ≥65 not-ventilated (OR 0.061) and ward ≥65 (OR 0.086); increasing injury severity score and increased Charlson comorbidity index of 1 and 2, compared with zero (OR 2.21 [1.40 to 3.48] and OR 2.57 [1.45 to 4.55]). The raw mean daily ICU and hospital costs in A$ 2005 (US$) for age <65 and ≥65 to ICU, and ≥65 to the ward were; for year 2000: ICU, $2717 (1462) and $2777 (1494); hospital, $1837 (988) and $1590 (855); ward $933 (502); for year 2005: ICU, $3202 (2393) and $3086 (2307); hospital, $1938 (1449) and $1914 (1431); ward $1180 (882). Cost increments were predicted by age ≥65 and ICU admission, increasing injury severity score, mechanical ventilation, Charlson comorbidity index increments and hospital survival. Mortalitycost-effect was estimated at -63% by least squares regression and -82% by treatment-effects regression model. Patient demographic factors, injury severity and its consequences predict both cost and survival in trauma. The cost mortality effect was biased upwards by conventional least squares regression estimation.

Integration-segregation decisions under general value functions: "create your own bundle - choose 1, 2, or all 3!",

Whether to keep products segregated (e.g., unbundled) or integrate some or all of them (e.g., bundle) has been a problem of profound interest in areas such as portfolio theory in finance, risk capital allocations in insurance and marketing of consumer products. Such decisions are inherently complex and depend on factors such as the underlying product values and consumer preferences, the latter being frequently described using value functions, also known as utility functions in economics. In this paper, we develop decision rules for multiple products, which we generally call ‘exposure units’ to naturally cover manifold scenarios spanning well beyond ‘products’. Our findings show, e.g. that the celebrated Thaler's principles of mental accounting hold as originally postulated when the values of all exposure units are positive (i.e. all are gains) or all negative (i.e. all are losses). In the case of exposure units with mixed-sign values, decision rules are much more complex and rely on cataloging the Bell number of cases that grow very fast depending on the number of exposure units. Consequently, in the present paper, we provide detailed rules for the integration and segregation decisions in the case up to three exposure units, and partial rules for the arbitrary number of units.

The responsibility to protect and the Arab Spring : Libya as the exception, Syria as the norm?

On March 17 2011 the UN Security Council passed resolution 1973 authorising the use of force for civilian protection purposes in Libya.1 This resolution was hailed by many supporters of the responsibility to protect (R2P) as a crucial step towards the consolidation of the concept’s normative standing.2 Gareth Evans described the intervention as ‘a textbook case of the R2P norm working exactly as it was supposed to’.3 For Lloyd Axworthy the Libya episode signalled a move towards a ‘more humane world’.4 UN Secretary-General Ban Ki-Moon declared that it ‘affirms, clearly and unequivocally, the international community’s determination to fulfil its responsibility to protect civilians from violence perpetrated by their own government.’5 At first glance, the Security Council’s rapid, decisive response to escalating violence in Libya might well have suggested a new willingness on the part of the international community to take collective action to avert intra-state humanitarian crises. However, a closer examination of the text of resolution 1973 and statements by Security Council member states reveals a less than complete endorsement of R2P. Disagreements between states over the scope of the mandate for the use of force in Libya quickly emerged. Long-standing fears among Russia, China and other non-Western states that R2P could be used as a pretext for regime change returned to the fore as the legality and legitimacy of NATO’s military action were called into question. This post-Libya backlash against R2P has been a central factor in the international community’s subsequent inability to agree on effective civilian protection measures in Syria. Much of the optimism that surrounded R2P in the immediate aftermath of resolution 1973 has given way to a sober realization that achieving international consensus on civilian protection measures will rarely be straightforward.

A practical approach to developing the general capabilities in middle-years English

Described as a three-dimensional “living” document, the new Australian Curriculum delineates the knowledge, understandings and skills considered necessary for students in the 21st Century to become confident and creative individuals, successful learners and active and informed citizens. The Australian Curriculum comprises discipline-based learning areas, general capabilities and contemporary cross-curriculum priorities. Teachers have particularly indicated the need for more professional development in relation to the general capabilities notably personal and social capability, ethical behaviour and intercultural understanding. This article provides ideas, activities and resources for middle-years English and literacy teachers to recognise and create opportunities for teaching and learning about these three general capabilities in their classrooms.

Genome-wide association study reveals three susceptibility loci for common migraine in the general population

Migraine is a common, heterogeneous and heritable neurological disorder. Its pathophysiology is incompletely understood, and its genetic influences at the population level are unknown. In a population-based genome-wide analysis including 5,122 migraineurs and 18,108 non-migraineurs, rs2651899 (1p36.32, PRDM16), rs10166942 (2q37.1, TRPM8) and rs11172113 (12q13.3, LRP1) were among the top seven associations (P < 5 × 10(-6)) with migraine. These SNPs were significant in a meta-analysis among three replication cohorts and met genome-wide significance in a meta-analysis combining the discovery and replication cohorts (rs2651899, odds ratio (OR) = 1.11, P = 3.8 × 10(-9); rs10166942, OR = 0.85, P = 5.5 × 10(-12); and rs11172113, OR = 0.90, P = 4.3 × 10(-9)). The associations at rs2651899 and rs10166942 were specific for migraine compared with non-migraine headache. None of the three SNP associations was preferential for migraine with aura or without aura, nor were any associations specific for migraine features. TRPM8 has been the focus of neuropathic pain models, whereas LRP1 modulates neuronal glutamate signaling, plausibly linking both genes to migraine pathophysiology.

Baseline study of alcohol dependence among general drivers and drunk driving offenders in Guangzhou, China

This study aimed to investigate drink driving in a sample of general drivers and convicted drunk driving offenders in Guangzhou, China. The study also aimed to explore some potential factors that impact on alcohol-related driving behaviour. Samples of 406 general drivers and 101 drunk driving offenders were recruited between May and October 2012. A survey was used to collect information about demographic characteristics, knowledge, attitudes and practices related to drink driving. The Alcohol Use Disorders Identification Test (AUDIT) was used to assess possible drinking problems. The average age reported for starting to drink alcohol for both groups of participants was around 19 years old. The mean AUDIT score of general drivers was 7.4 (SD = 5.4) representing a low level of alcohol problems, and for convicted drunk driving offenders was 11.1 (SD = 5.9) representing a medium level of alcohol problems (significant difference between means, t = 5.75, p < 0.001). AUDIT scores indicated that a substantial proportion (65%) of the offenders had medium to high levels of alcohol use disorders, compared with 38.5% among general drivers. Offenders who knew the drunk driving legal limit had a lower AUDIT score (M = 9.8, SD = 5.16) than those who did not know it (M = 12.2, SD = 6.257, t = -1.987. p = 0.05). In addition, offenders who were novice drivers (licensed less than 2 years) had a higher AUDIT score (M = 16.4, SD = 7.6) than the other three driver experience categories used.

An exploration of the roles of nurses working in emergency care services in general hospitals in West Java, Indonesia : a grounded theory study

A review of literature on the role of emergency nurses in Indonesia revealed a dearth of research. Anecdotal evidence suggests a lack of clarity in role definition which has led to uncertainty and role ambiguity. Despite advances in the development of specialist nursing roles in Indonesia, that of the emergency nurse remains unclear. This study explored the role of nurses working in emergency care services in three general hospitals in West Java, Indonesia. The theoretical framework is grounded in Charmaz’s constructivist grounded theory. Data collection methods were observation, in-depth interviews and interrogation of related documents. Phase one of data collection involved 74 h of observation and nterviews with 35 nurses working in the three ED settings. For the purposes of theoretical sampling, a second phase of data collection was conducted. This involved a second nterview with eight participants from the three EDs. nterviews were also undertaken with the three key informants of nursing management of three related hospitals; key informants from the Indonesian Nurses Association; the Directorate of Nursing, Ministry of Health; and from the organization for ED nurses. Data analysis drew on Charmaz’s constructivist approach and the concepts of simultaneous data collection and analysis, constant comparison, coding, and theoretical sampling. The analysis generated four theoretical concepts that characterized the role of the emergency nurse: An arbitrary scope of practice, Struggling for recognition, Learning on the job and Looking to better practice. These concepts provided analytical direction for an exploration of the clinical and political dimensions of the role of the emergency nurse in Indonesia.

Relational regulation theory and the role of social support and organisational fairness for nurses in a general acute context

Aims and objectives. To present a novel approach to nurse stress by exploring the demand–control–support model with organisational justice through the lens of relational regulation theory. Background. Nursing is often stressful due to high demands and dissatisfaction with pay, which impacts the mental well-being and productivity of nurses. Design. A cross-sectional design. Methods. A validated questionnaire was sent to the work addresses of all nursing and midwifery staff in a medium-sized general acute hospital in Australia. A total of 190 nurses and midwives returned completed questionnaires for the analyses. Results. The multiple regression analyses demonstrated that the model applies to the prototypical context of a general acute hospital and that job control, supervisor support and outside work support improve the job satisfaction and mental health of nurses. Conclusions. Most importantly, supervisor support was found to buffer the impact of excessive work demands. Fairness of procedures, distribution of resources and the quality and consistency of information are also beneficial. Relational regulation theory is applied to these findings as a novel way to conceptualise the mechanisms of support and fairness in nursing. Relevance to clinical practice. The importance of nurses’ well-being and job satisfaction is a priority for improving clinical outcomes. Practically, this means nurse managers should be encouraging nurses in the pursuit of diverse relational activities both at work and outside work.

Pharmacist, general practitioner, and nurse perceptions, experiences, and knowledge of medication dosage form modification

Background: People often modify oral solid dosage forms when they experience difficulty swallowing them. Modifying dosage forms may cause adverse effects to the patient, and the person undertaking the modification. Pharmacists are often the first point of contact for people in the general community seeking advice regarding medications. Nurses are at the forefront of administering medications to patients and are likely to be most directly affected by a patient’s swallowing ability, while general practitioners (GPs) are expected to consider swallowing abilities when prescribing medications. Objective: To compare the perspectives and experiences of GPs, pharmacists, and nurses regarding medication dosage form modification and their knowledge of medication modification. Method: Questionnaires tailored to each profession were posted to 630 GPs, and links to an online version were distributed to 2,090 pharmacists and 505 nurses. Results: When compared to pharmacists and GPs, nurses perceived that a greater proportion of the general community modified solid dosage forms. Pharmacists and GPs were most likely to consider allergies and medical history when deciding whether to prescribe or dispense a medicine, while nurses’ priorities were allergies and swallowing problems when administering medications. While nurses were more likely to ask their patients about their ability to swallow medications, most health professionals reported that patients “rarely” or “never” volunteered information about swallowing difficulties. The majority of health professionals would advise a patient to crush or split noncoated non-sustained-release tablets, and would consult colleagues or reference sources for sustained-release or coated tablets. Health professionals appeared to rely heavily upon the suffix attached to medication names (which suggest modified release properties) to identify potential problems associated with modifying medications. Conclusion: The different professional roles and responsibilities of GPs, pharmacists, and nurses are associated with different perspectives of, and experiences with, people modifying medications in the general community and knowledge about consequences of medication modification.

Developing a model of links between general and workplace belongingness and depressive symptoms

Given the high prevalence of depression in the community there is urgent need to understand the interpersonal predictors of this disorder. Data from large community samples indicates that a diminished sense of belonging appears to be the most salient and immediate antecedent of a rapid depressive response. Belongingness in the workplace is also very important and associated with depressive symptoms over and above associations attributable to general or community belongingness. Finally it appears that the personality factor of interpersonal sensitivity moderates the relationship between belongingness and depressive symptoms. Results have extensive future implications for the prevention and treatment of depression.

Autonomous forced landing system for light general aviation aircraft in unknown environments

This paper presents a system which enhances the capabilities of a light general aviation aircraft to land autonomously in case of an unscheduled event such as engine failure. The proposed system will not only increase the level of autonomy for the general aviation aircraft industry but also increase the level of dependability. Safe autonomous landing in case of an engine failure with a certain level of reliability is the primary focus of our work as both safety and reliability are attributes of dependability. The system is designed for a light general aviation aircraft but can be extended for dependable unmanned aircraft systems. The underlying system components are computationally efficient and provides continuous situation assessment in case of an emergency landing. The proposed system is undergoing an evaluation phase using an experimental platform (Cessna 172R) in real world scenarios.

General theory of stigmergy : modelling stigma semantics

Stigmergy is a biological term used when discussing a sub-set of insect swarm-behaviour describing the apparent organisation seen during their activities. Stigmergy describes a communication mechanism based on environment-mediated signals which trigger responses among the insects. This phenomenon is demonstrated in the behavior of ants and their food gathering process when following pheromone trails, where the pheromones are a form of environment-mediated communication. What is interesting with this phenomenon is that highly organized societies are achieved without an apparent management structure. Stigmergy is also observed in human environments, both natural and engineered. It is implicit in the Web where sites provide a virtual environment supporting coordinative contributions. Researchers in varying disciplines appreciate the power of this phenomenon and have studied how to exploit it. As stigmergy becomes more widely researched we see its definition mutate as papers citing original work become referenced themselves. Each paper interprets these works in ways very specific to the research being conducted. Our own research aims to better understand what improves the collaborative function of a Web site when exploiting the phenomenon. However when researching stigmergy to develop our understanding we discover a lack of a standardized and abstract model for the phenomenon. Papers frequently cited the same generic descriptions before becoming intimately focused on formal specifications of an algorithm, or esoteric discussions regarding sub-facets of the topic. None provide a holistic and macro-level view to model and standardize the nomenclature. This paper provides a content analysis of influential literature documenting the numerous theoretical and experimental papers that have focused on stigmergy. We establish that stigmergy is a phenomenon that transcends the insect world and is more than just a metaphor when applied to the human world. We present from our own research our general theory and abstract model of semantics of stigma in stigmergy. We hope our model will clarify the nuances of the phenomenon into a useful road-map, and standardise vocabulary that we witness becoming confused and divergent. Furthermore, this paper documents the analysis on which we base our next paper: Special Theory of Stigmergy: A Design Pattern for Web 2.0 Collaboration.