The impact of a model of nurse education to improve knowledge and recognition of delirium in older persons by registered nurses

Introduction: Delirium is a serious issue associated with high morbidity and mortality in older hospitalised people. Early recognition enables diagnosis and treatment of underlying cause/s, which can lead to improved patient outcomes. However, research shows knowledge and accurate nurse recognition of delirium and is poor and lack of education appears to be a key issue related to this problem. Thus, the purpose of this randomised controlled trial (RCT) was to evaluate, in a sample of registered nurses, the usability and effectiveness of a web-based learning site, designed using constructivist learning principles, to improve acute care nurse knowledge and recognition of delirium. Prior to undertaking the RCT preliminary phases involving; validation of vignettes, video-taping five of the validated vignettes, website development and pilot testing were completed. Methods: The cluster RCT involved consenting registered nurse participants (N = 175) from twelve clinical areas within three acute health care facilities in Queensland, Australia. Data were collected through a variety of measures and instruments. Primary outcomes were improved ability of nurses to recognise delirium using written validated vignettes and improved knowledge of delirium using a delirium knowledge questionnaire. The secondary outcomes were aimed at determining nurse satisfaction and usability of the website. Primary outcome measures were taken at baseline (T1), directly after the intervention (T2) and two months later (T3). The secondary outcomes were measured at T2 by participants in the intervention group. Following baseline data collection remaining participants were assigned to either the intervention (n=75) or control (n=72) group. Participants in the intervention group were given access to the learning intervention while the control group continued to work in their clinical area and at that time, did not receive access to the learning intervention. Data from the primary outcome measures were examined in mixed model analyses. Results: Overall, the effect of the online learning intervention over time comparing the intervention group and the control group were positive. The intervention groups‘ scores were higher and the change over time results were statistically significant [T3 and T1 (t=3.78 p=<0.001) and T2 and T1 baseline (t=5.83 p=<0.001)]. Statistically significant improvements were also seen for delirium recognition when comparing T2 and T1 results (t=2.58 p=0.012) between the control and intervention group but not for changes in delirium recognition scores between the two groups from T3 and T1 (t=1.80 p=0.074). The majority of the participants rated the website highly on the visual, functional and content elements. Additionally, nearly 80% of the participants liked the overall website features and there were self-reported improvements in delirium knowledge and recognition by the registered nurses in the intervention group. Discussion: Findings from this study support the concept that online learning is an effective and satisfying method of information delivery. Embedded within a constructivist learning environment the site produced a high level of satisfaction and usability for the registered nurse end-users. Additionally, the results showed that the website significantly improved delirium knowledge & recognition scores and the improvement in delirium knowledge was retained at a two month follow-up. Given the strong effect of the intervention the online delirium intervention should be utilised as a way of providing information to registered nurses. It is envisaged that this knowledge would lead to improved recognition of delirium as well as improvement in patient outcomes however; translation of this knowledge attainment into clinical practice was outside the scope of this study. A critical next step is demonstrating the effect of the intervention in changing clinical behaviour, and improving patient health outcomes.

Some extensions to representation and encoding of structure in models of distributional semantics

This thesis makes several contributions towards improved methods for encoding structure in computational models of word meaning. New methods are proposed and evaluated which address the requirement of being able to easily encode linguistic structural features within a computational representation while retaining the ability to scale to large volumes of textual data. Various methods are implemented and evaluated on a range of evaluation tasks to demonstrate the effectiveness of the proposed methods.

Are two threats worse than one? The effects of face race and emotional expression on fear conditioning

Facial cues of racial outgroup or anger mediate fear learning that is resistant to extinction. Whether this resistance is potentiated if fear is conditioned to angry, other race faces has not been established. Two groups of Caucasian participants were conditioned with two happy and two angry face conditional stimuli (CSs). During acquisition, one happy and one angry face were paired with an aversive unconditional stimulus whereas the second happy and angry faces were presented alone. CS face race (Caucasian, African American) was varied between groups. During habituation, electrodermal responses were larger to angry faces regardless of race and declined less to other race faces. Extinction was immediate for Caucasian happy faces, delayed for angry faces regardless of race, and slowest for happy racial outgroup faces. Combining the facial cues of other race and anger does not enhance resistance to extinction of fear.

Delirium knowledge and recognition : a randomized controlled trial of a web-based educational intervention for acute care nurses

Delirium is a significant problem for older hospitalized people and is associated with poor outcomes. It is poorly recognized and evidence suggests that a major reason is lack of education. Nurses, who are educated about delirium, can play a significant role in improving delirium recognition. This study evaluated the impact of a delirium specific educational website. A cluster randomized controlled trial, with a pretest/post-test time series design, was conducted to measure delirium knowledge (DK) and delirium recognition (DR) over three time-points. Statistically significant differences were found between the intervention and non-intervention group. The intervention groups' DK scores were higher and the change over time results were statistically significant [T3 and T1 (t=3.78 p=<0.001) and T2 and T1 baseline (t=5.83 p=<0.001)]. Statistically significant improvements were also seen for DR when comparing T2 and T1 results (t=2.56 p=0.011) between both groups but not for changes in DR scores between T3 and T1 (t=1.80 p=0.074). Participants rated the website highly on the visual, functional and content elements. This study supports the concept that web-based delirium learning is an effective and satisfying method of information delivery for registered nurses. Future research is required to investigate clinical outcomes as a result of this web-based education.

Racism, Representation and Photography

Representation of Aborigines by Aborigines and non -Aborigines; articles by Andrew Dewdney, Mervyn Biship, Alana Harris, Sandy Edwards, Rea Saunders, Ricky Maynard , Brenda Croft, Ruth Braunstein, Michael Riley, Huw Davies, Penny Taylor, Darlene McKenzie, Kurt Brereton and Eric Michaels, annotated separately.

Representation and authenticity of historic landscapes in Australia and China

Histories of past communities are embedded in landscapes around the world but many are suffering from material change or neglect of their fabric. This study was aimed at discovering and representing the authentic intangible experience of two historic landscapes for conservation purposes. A 2500 year old site in Yangzhou, China and a 2000 year old site on St Helena Island in Moreton Bay were found to be managed under two culturally different regimes of authenticity. This research has contributed to challenging the notion that there is only one way to conserve authenticity in historic landscapes of the Asia Pacific.

A student-centred approach to support, reward and recognition of student peer ‘learnership’

The benefits for university graduates in growing skills and capabilities through volunteering experiences are gaining increased attention. Building leadership self-efficacy supports students develop their capacity for understanding, articulating and evidencing their learning. Reward and recognition is fundamental in the student’s journey to build self-efficacy. Through this research, concepts of reward and recognition have been explored and articulated through the experiences and perceptions of actively engaged student peer leaders. The research methodology has enabled a collaborative, student-centred approach in shaping an innovative Rewards Framework, which supports, recognises and rewards the learning journey from beginning peer leader to competent and confident graduate.

Representation and properties of para-Bose oscillator operators. II. Coherent states and the minimum uncertainty states

The energy, position, and momentum eigenstates of a para-Bose oscillator system were considered in paper I. Here we consider the Bargmann or the analytic function description of the para-Bose system. This brings in, in a natural way, the coherent states ||z;alpha> defined as the eigenstates of the annihilation operator ?. The transformation functions relating this description to the energy, position, and momentum eigenstates are explicitly obtained. Possible resolution of the identity operator using coherent states is examined. A particular resolution contains two integrals, one containing the diagonal basis ||z;alpha>and the other containing the pseudodiagonal basis ||z;alpha><−z;alpha||. We briefly consider the normal and antinormal ordering of the operators and their diagonal and discrete diagonal coherent state approximations. The problem of constructing states with a minimum value of the product of the position and momentum uncertainties and the possible alpha dependence of this minimum value is considered. Journal of Mathematical Physics is copyrighted by The American Institute of Physics.

Learning Feature Trajectories Using Gabor Filter Bank for Human Activity Segmentation and Recognition

We describe a novel method for human activity segmentation and interpretation in surveillance applications based on Gabor filter-bank features. A complex human activity is modeled as a sequence of elementary human actions like walking, running, jogging, boxing, hand-waving etc. Since human silhouette can be modeled by a set of rectangles, the elementary human actions can be modeled as a sequence of a set of rectangles with different orientations and scales. The activity segmentation is based on Gabor filter-bank features and normalized spectral clustering. The feature trajectories of an action category are learnt from training example videos using dynamic time warping. The combined segmentation and the recognition processes are very efficient as both the algorithms share the same framework and Gabor features computed for the former can be used for the later. We have also proposed a simple shadow detection technique to extract good silhouette which is necessary for good accuracy of an action recognition technique.

Designing a Dependency Representation and Grammar Definition Corpus for Finnish

We outline the design and creation of a syntactically and morphologically annotated corpora of Finnish for use by the research community. We motivate a definitional, systematic “grammar definition corpus” as a first step in an three-year annotation effort to help create higher-quality, better-documented extensive parsebanks at a later stage. The syntactic representation, consisting of a dependency structure and a basic set of dependency functions, is outlined with examples. Reference is made to double-blind annotation experiments to measure the applicability of the newgrammar definition corpus methodology.

Synthesis of workspaces of planar manipulators with arbitrary topology using shape representation and simulated annealing

This paper presents a general methodology for the synthesis of the external boundary of the workspaces of a planar manipulator with arbitrary topology. Both the desired workspace and the manipulator workspaces are identified by their boundaries and are treated as simple closed polygons. The paper introduces the concept of best match configuration and shows that the corresponding transformation can be obtained by using the concept of shape normalization available in image processing literature. Introduction of the concept of shape in workspace synthesis allows highly accurate synthesis with fewer numbers of design variables. This paper uses a new global property based vector representation for the shape of the workspaces which is computationally efficient because six out of the seven elements of this vector are obtained as a by-product of the shape normalization procedure. The synthesis of workspaces is formulated as an optimization problem where the distance between the shape vector of the desired workspace and that of the workspace of the manipulator at hand are minimized by changing the dimensional parameters of the manipulator. In view of the irregular nature of the error manifold, the statistical optimization procedure of simulated annealing has been used. A number of worked-out examples illustrate the generality and efficiency of the present method. (C) 1998 Elsevier Science Ltd. All rights reserved.