A systematic review of triage-related interventions to improve patient flow in emergency departments

Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay.

Constructive alignment in Computer Engineering and Informatics departments at Dalarna University : An empirical investigation

Background: Constructive alignment (CA) is a pedagogical approach that emphasizes the alignment between the intended learning outcomes (ILOs), teaching and learning activities (TLAs) and assessment tasks (ATs) as well as creation of a teaching/learning environment where students will be able to actively create their knowledge. Objectives: This paper aims at investigating the extent of constructively-aligned courses in Computer Engineering and Informatics department at Dalarna University, Sweden. This study is based on empirical observations of teacher’s perceptions of implementation of CA in their courses. Methods: Ten teachers (5 from each department) were asked to fill a paper-based questionnaire, which included a number of questions related to issues of implementing CA in courses. Results: Responses to the items of the questionnaire were mixed. Teachers clearly state the ILOs in their courses and try to align the TLAs and ATs to the ILOs. Computer Engineering teachers do not explicitly communicate the ILOs to the students as compared to Informatics teachers. In addition, Computer Engineering teachers stated that their students are less active in learning activities as compared to Informatics teachers. When asked about their subjective ratings of teaching methods all teachers stated that their current teaching is teacher-centered but they try to shift the focus of activity from them to the students. Conclusions: From teachers’ perspectives, the courses are partially constructively-aligned. Their courses are “aligned”, i.e. ILOs, TLAs and ATs are aligned to each other but they are not “constructive” since, according to them, there was a low student engagement in learning activities, especially in Computer Engineering department.

PokerMapper: : mapping executive functions, poker playing ability and responsible gambling in online environments

Research objectives Poker and responsible gambling both entail the use of the executive functions (EF), which are higher-level cognitive abilities. The main objective of this work was to assess if online poker players of different ability show different performances in their EF and if so, which functions are the most discriminating ones. The secondary objective was to assess if the EF performance can predict the quality of gambling, according to the Gambling Related Cognition Scale (GRCS), the South Oaks Gambling Screen (SOGS) and the Problem Gambling Severity Index (PGSI). Sample and methods The study design consisted of two stages: 46 Italian active players (41m, 5f; age 32±7,1ys; education 14,8±3ys) fulfilled the PGSI in a secure IT web system and uploaded their own hand history files, which were anonymized and then evaluated by two poker experts. 36 of these players (31m, 5f; age 33±7,3ys; education 15±3ys) accepted to take part in the second stage: the administration of an extensive neuropsychological test battery by a blinded trained professional. To answer the main research question we collected all final and intermediate scores of the EF tests on each player together with the scoring on the playing ability. To answer the secondary research question, we referred to GRCS, PGSI and SOGS scores.  We determined which variables that are good predictors of the playing ability score using statistical techniques able to deal with many regressors and few observations (LASSO, best subset algorithms and CART). In this context information criteria and cross-validation errors play a key role for the selection of the relevant regressors, while significance testing and goodness-of-fit measures can lead to wrong conclusions.   Preliminary findings We found significant predictors of the poker ability score in various tests. In particular, there are good predictors 1) in some Wisconsin Card Sorting Test items that measure flexibility in choosing strategy of problem-solving, strategic planning, modulating impulsive responding, goal setting and self-monitoring, 2) in those Cognitive Estimates Test variables related to deductive reasoning, problem solving, development of an appropriate strategy and self-monitoring, 3) in the Emotional Quotient Inventory Short (EQ-i:S) Stress Management score, composed by the Stress Tolerance and Impulse Control scores, and in the Interpersonal score (Empathy, Social Responsibility, Interpersonal Relationship). As for the quality of gambling, some EQ-i:S scales scores provide the best predictors: General Mood for the PGSI; Intrapersonal (Self-Regard; Emotional Self-Awareness, Assertiveness, Independence, Self-Actualization) and Adaptability  (Reality Testing, Flexibility, Problem Solving) for the SOGS, Adaptability for the GRCS. Implications for the field Through PokerMapper we gathered knowledge and evaluated the feasibility of the construction of short tasks/card games in online poker environments for profiling users’ executive functions. These card games will be part of an IT system able to dynamically profile EF and provide players with a feedback on their expected performance and ability to gamble responsibly in that particular moment. The implementation of such system in existing gambling platforms could lead to an effective proactive tool for supporting responsible gambling. 

Desenvolvimento de um protótipo de EIS(executive information system) que possibilita a integração dos níveis hierárquicos : o caso UCS

Este trabalho tem o objetivo de desenvolver e avaliar um Protótipo de um EIS (Executive Information System) que integre os níveis hierárquicos operacional, tático e estratégico, a fim de suprir e dar suporte, quanto a informações, a uma das Pró- Reitorias da Universidade de Caxias do Sul - UCS. Quer-se demonstrar não só a importância mas também a contribuição da integração, através do acesso e compartilhamento das informações, dos níveis hierárquicos, proporcionada pelo Protótipo, para a obtenção da eficiência e eficácia das atividades desenvolvidas na Pró-Reitoria em estudo. Através de revisão bibliográfica e de levantamentos efetuados por meio de questionários, elaborou-se o Protótipo EIS -UCS, o qual posteriormente foi avaliado através de dois protocolos, aplicados em momentos distintos, e também através da grade de análise do modelo conceitual de EIS. Os resultados obtidos demonstram o cumprimento do objetivo de desenvolver e avaliar o protótipo EIS-UCS. Os resultados apresentam o obtido em relação ao processo, ao sistema, ao conteúdo, a integração dos níveis hierárquicos e o aprendizado da organização e do pesquisador. Concluiu-se que o Protótipo EIS-UCS integra, através do acesso e compartilhamento das informações, os níveis hierárquicos e também supre e dá suporte, quanto ao nível de informações à Pró-Reitoria de Extensão e Relações Universitárias da Universidade de Caxias do Sul.

The executive toolbox: building legislative support in a multiparty presidential regime

How do presidents win legislative support under conditions of extreme multipartism? Comparative presidential research has offered two parallel answers, one relying on distributive politics and the other claiming that legislative success is a function of coalition formation. We merge these insights in an integrated approach to executive-legislative relations, also adding contextual factors related to dynamism and bargaining conditions. We find that the two presidential “tools” – pork and coalition goods – are substitutable resources, with pork functioning as a fine-tuning instrument that interacts reciprocally with legislative support. Pork expenditures also depend upon a president’s bargaining leverage and the distribution of legislative seats.

The creative and advanced technology economy in Brazil: executive summary

This document brings together in a succinct form the available data about the current state of the Creative and Advanced Technology Economy of Brazil, presents some suggestions for public policies which can contribute to the development of technological and creative activities, and also points to issues to be studied and actions to be carried out in the future.

Benefits of physical exercise on executive functions in older people with Parkinson's disease

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Balance, executive functions and falls in elderly with Alzheimer's disease (AD): A longitudinal study

Elderly individuals with AD are more susceptible to falls, which might be associated with decrements in their executive functions and balance, among other things. We aimed to analyze the effects of a program of dual task physical activity on falls, executive functions and balance of elderly individuals with AD. We studied 21 elderly with probable AD, allocated to two groups: the training group (TG), with 10 elderly who participated in a program of dual task physical activity; and the control group (CG), with 11 elderly who were not engaged in regular practice of physical activity. The Clock Drawing Test (CDT) and the Frontal Assessment Battery (FAB) were used in the assessment of the executive functions, while the Berg Balance Scale (BBS) and the Timed Up-and-Go (TUG)-test evaluated balance. The number of falls was obtained by means of a questionnaire. We observed a better performance of the TG as regards balance and executive functions. Moreover, the lower the number of steps in the TUG scale, the higher the scores in the CDT, and in the FAB. The practice of regular physical activity with dual task seems to have contributed to the maintenance and improvement of the motor and cognitive functions of the elderly with AD. (C) 2011 Elsevier B.V. All rights reserved.

Towards a new international financial architecture: report of the Task Force of the Executive Committee on Economic and Social Affairs of the United Nations, 21 January 1999 = Hacia una nueva arquitectura financiera internacional: informe del Grupo de Trabajo del Comité Ejecutivo de Asuntos Económicos y Sociales de las Naciones Unidas, 21 de enero de 1999

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