The primacy of vital signs – Acute care nurses’ and midwives’ use of physical assessment skills: A cross sectional study

BACKGROUND: Registered nurses and midwives play an essential role in detecting patients at risk of deterioration through ongoing assessment and action in response to changing health status. Yet, evidence suggests that clinical deterioration frequently goes unnoticed in hospitalised patients. While much attention has been paid to early warning and rapid response systems, little research has examined factors related to physical assessment skills. OBJECTIVES: To determine a minimum data set of core skills used during nursing assessment of hospitalised patients and identify nurse and workplace predictors of the use of physical assessment to detect patient deterioration. DESIGN: The study used a single-centre, cross-sectional survey design. SETTING and PARTICIPANTS: The study included 434 registered nurses and midwives (Grades 5-7) involved in clinical care of patients on acute care wards, including medicine, surgery, oncology, mental health and maternity service areas, at a 929-bed tertiary referral teaching hospital in Southeast Queensland, Australia. METHODS: We conducted a hospital-wide survey of registered nurses and midwives using the 133-item Physical Assessment Skills Inventory and the 58-item Barriers to Registered Nurses’ Use of Physical Assessment scale. Median frequency for each physical assessment skill was calculated to determine core skills. To explore predictors of core skill utilisation, backward stepwise general linear modelling was conducted. Means and regression coefficients are reported with 95% confidence intervals. A p value < .05 was considered significant for all analyses. RESULTS: Core skills used by most nurses every time they worked included assessment of temperature, oxygen saturation, blood pressure, breathing effort, skin, wound and mental status. Reliance on others and technology (F = 35.77, p < .001), lack of confidence (F = 5.52, p = .02), work area (F = 3.79, p = .002), and clinical role (F = 44.24, p < .001) were significant predictors of the extent of physical assessment skill use. CONCLUSIONS: The increasing acuity of the acute care patient plausibly warrants more than vital signs assessment; however, our study confirms nurses’ physical assessment core skill set is mainly comprised of vital signs. The focus on these endpoints of deterioration as dictated by early warning and rapid response systems may divert attention from and devalue comprehensive nursing assessment that could detect subtle changes in health status earlier in the patient's hospitalisation.

Simultaneous underwater visibility assessment, enhancement and improved stereo

Vision-based underwater navigation and obstacle avoidance demands robust computer vision algorithms, particularly for operation in turbid water with reduced visibility. This paper describes a novel method for the simultaneous underwater image quality assessment, visibility enhancement and disparity computation to increase stereo range resolution under dynamic, natural lighting and turbid conditions. The technique estimates the visibility properties from a sparse 3D map of the original degraded image using a physical underwater light attenuation model. Firstly, an iterated distance-adaptive image contrast enhancement enables a dense disparity computation and visibility estimation. Secondly, using a light attenuation model for ocean water, a color corrected stereo underwater image is obtained along with a visibility distance estimate. Experimental results in shallow, naturally lit, high-turbidity coastal environments show the proposed technique improves range estimation over the original images as well as image quality and color for habitat classification. Furthermore, the recursiveness and robustness of the technique allows implementation onboard an Autonomous Underwater Vehicle for improving navigation and obstacle avoidance performance.

Class participation as a learning and assessment strategy in law : facilitating students’ engagement, skills development and deep learning

Assessment has widely been described as being ‘at the centre of the student experience’. It would be difficult to conceive of the modern teaching university without it. Assessment is accepted as one of the most important tools that an educator can deploy to influence both what and how students learn. Evidence suggests that how students allocate time and effort to tasks and to developing an understanding of the syllabus is affected by the method of assessment utilised and the weighting it is given. This is particularly significant in law schools where law students may be more preoccupied with achieving high grades in all courses than their counterparts from other disciplines. However, well-designed assessment can be seen as more than this. It can be a vehicle for encouraging students to learn and engage more broadly than with the minimums required to complete the assessment activity. In that sense assessment need not merely ‘drive’ learning, but can instead act as a catalyst for further learning beyond what a student had anticipated. In this article we reconsider the potential roles and benefits in legal education of a form of interactive classroom learning we term assessable class participation (‘ACP’), both as part of a pedagogy grounded in assessment and learning theory, and as a platform for developing broader autonomous approaches to learning amongst students. We also consider some of the barriers students can face in ACP and the ways in which teacher approaches to ACP can positively affect the socio-emotional climates in classrooms and thus reduce those barriers. We argue that the way in which a teacher facilitates ACP is critical to the ability to develop positive emotional and learning outcomes for law students, and for teachers themselves.

Assessment and application of clustering techniques to atmospheric particle number size distribution for the purpose of source apportionment

Long-term measurements of particle number size distribution (PNSD) produce a very large number of observations and their analysis requires an efficient approach in order to produce results in the least possible time and with maximum accuracy. Clustering techniques are a family of sophisticated methods which have been recently employed to analyse PNSD data, however, very little information is available comparing the performance of different clustering techniques on PNSD data. This study aims to apply several clustering techniques (i.e. K-means, PAM, CLARA and SOM) to PNSD data, in order to identify and apply the optimum technique to PNSD data measured at 25 sites across Brisbane, Australia. A new method, based on the Generalised Additive Model (GAM) with a basis of penalised B-splines, was proposed to parameterise the PNSD data and the temporal weight of each cluster was also estimated using the GAM. In addition, each cluster was associated with its possible source based on the results of this parameterisation, together with the characteristics of each cluster. The performances of four clustering techniques were compared using the Dunn index and Silhouette width validation values and the K-means technique was found to have the highest performance, with five clusters being the optimum. Therefore, five clusters were found within the data using the K-means technique. The diurnal occurrence of each cluster was used together with other air quality parameters, temporal trends and the physical properties of each cluster, in order to attribute each cluster to its source and origin. The five clusters were attributed to three major sources and origins, including regional background particles, photochemically induced nucleated particles and vehicle generated particles. Overall, clustering was found to be an effective technique for attributing each particle size spectra to its source and the GAM was suitable to parameterise the PNSD data. These two techniques can help researchers immensely in analysing PNSD data for characterisation and source apportionment purposes.

Energy use assessment of educational buildings: Toward a campus-wide sustainable energy policy

The purpose of this article is to assess the viability of blanket sustainability policies, such as Building Rating Systems in achieving energy efficiency in university campus buildings. We analyzed the energy consumption trends of 10 LEED-certified buildings and 14 non-LEED certified buildings at a major university in the US. Energy Use Intensity (EUI) of the LEED buildings was significantly higher (EUILEED= 331.20 kBtu/sf/yr) than non-LEED buildings (EUInon-LEED=222.70 kBtu/sf/yr); however, the median EUI values were comparable (EUILEED= 172.64 and EUInon-LEED= 178.16). Because the distributions of EUI values were non-symmetrical in this dataset, both measures can be used for energy comparisons—this was also evident when EUI computations exclude outliers, EUILEED=171.82 and EUInon-LEED=195.41. Additional analyses were conducted to further explore the impact of LEED certification on university campus buildings energy performance. No statistically significant differences were observed between certified and non-certified buildings through a range of robust comparison criteria. These findings were then leveraged to devise strategies to achieve sustainable energy policies for university campus buildings and to identify potential issues with portfolio level building energy performance comparisons.

An ePortfolio Approach: Supporting Critical Reflection for Pedagogic Innovation

This chapter investigates the capacity of a well-supported holistic ePortfolio program, the QUT Student ePortfolio Program (QSeP), to support critical reflection for pedagogic innovation in higher education, by exploring practice examples. The chapter looks across faculty and discipline areas to illustrate a range of ePortfolio learning case studies, which have led pedagogical innovation across a whole institution, to enhance student learning and support academic teaching. The ePortfolio strategies discussed support innovation in learning and teaching where academics use the ePortfolio approach in different ways to develop connectedness (productive pedagogies) within learning. Students are supported to develop awareness of the connections between formal and informal learning opportunities and between their learning and personal and professional goals. Students are guided to understand what they have learned and how they have learned in terms of generic employability skills or graduate attributes and also in relation to professional standards and competencies and personal goals. In essence, the ePortfolio-supported pedagogy creates capstone events enabling students to develop a professional identity and understanding of ongoing professional development. The examples are drawn from distinct discipline areas and illustrate the capacity of ePortfolio to underpin pedagogic innovation across discipline areas: • Bachelor of Information Technology—the ePortfolio approach supports students to explore the IT industry as a means of clarifying personal expectations and goals, thereby enhancing student potential in the course c• Bachelor of Nursing and Master of Nursing Science—students develop a professional ePortfolio to show development of the nursing competencies • Master of Information Technology—Library and Information students compile a Professional Portfolio for assessment in the Professional Practice subject • Bachelor of Laws—Virtual Law Placement (VLP) is a unit of study that challenges students to critically reflect on their performance and development duringthe work placement Each case study illustrates the academic teaching goal and student ePortfolio task in context. Issues, challenges and support strategies are identified. Comments from the students and their lecturers give an indication of the effectiveness of the ePortfolio approach to meet learning and teaching goals.

Quality assurance of assessment and moderation discourses involving sessional staff

Quality assurance is a major agenda in tertiary education. The casualisation of academic work, especially in teaching, is also a quality assurance issue. Casual or sessional staff members teach and assess more than 50% of all university courses in Australia, and yet the research in relation to the role sessional staff play in quality assurance of student assessment outcomes is scarce. Moderation processes are a pivotal part of robust quality assurance measures. Drawing upon previous work surrounding four discourses of moderation, this pilot project reports the results of research into the role and impact of sessional staff in moderation processes at tertiary level. Qualitative data were gathered through focus interviews. Results, in the form of various moderation discourses, indicate that sessional staff impact the formal quality assurance processes in numerous ways.

Geography and international assessment: Opportunity or distraction

Assessments of students in primary and secondary education are debated among practitioners, policy-makers, and parents. In some countries, assessment scores serve a criterion for passage between levels of education, for example, from secondary school to post-secondary education. Those practices are often traditions and while they come under criticism, they are a long-accepted part of the educational practices within a country. In those countries, the students’ assessment and examination scores are posted in public places or published in local news media. In other countries, assessments are used for the periodic checks on individual student progress. The results of assessments may be used for rating schools, and in some cases, they are used for evaluating the performance of teachers. Assessments are used less often to analyze student performance and make judgments regarding the performance of the curriculum. Even less often, assessments serve to critically establish strategies for the improvement of student learning and educational practices. The ends on the continuum of the assessment debate often focus on the opportunities that assessments present to improve education on one end. The other end is that assessments serve as a major distraction from the important work of teachers by removing classroom room time from instruction. The debate on those issues continues.

Enhanced student learning in accounting utilising web-based technology, peer-review feedback and reflective practices: A learning community approach to assessment

Higher education is becoming a major driver of economic competitiveness in an increasingly knowledge-driven global economy. Maintaining the competitive edge has seen an increase in public accountability of higher education institutions through the mechanism of ranking universities based on the quality of their teaching and learning outcomes. As a result, assessment processes are under scrutiny, creating tensions between standardisation and measurability and the development of creative and reflective learners. These tensions are further highlighted in the context of large undergraduate subjects, learner diversity and time-poor academics and students. Research suggests that high level and complex learning is best developed when assessment, combined with effective feedback practices, involves students as partners in these processes. This article reports on a four-phase, cross-institution and cross-discipline project designed to embed peer-review processes as part of the assessment in two large, undergraduate accounting classes. Using a social constructivist view of learning, which emphasises the role of both teacher and learner in the development of complex cognitive understandings, we undertook an iterative process of peer review. Successive phases built upon students’ feedback and achievements and input from language/learning and curriculum experts to improve the teaching and learning outcomes.

Social audit: A mess or means in CSR assessment?

Social Audits play an important role in the measurement and analysis of a company's social performance. They provide corporations with a tool to plan and manage their social responsibility activities. Similarly, they provide stakeholders with a tool which they could use when monitoring, assessing and analysing concrete and accurate company data. Whilst the topic of social audits has been raised and discussed by a number of scholars, industry representatives and government institutions over the years, such contributions have mostly revolved around the general notion and importance of social audit, rather than addressing the most effective ways to achieve a widespread and reliable adoption of the practice through the implementation of specific legal regulation and other methods. This matter is of significant importance as corporations can exert a considerable amount control over the entire social audit process, allowing them to disclose only information deemed beneficial to their own corporate image instead of releasing all relevant social and environmental data. In order to achieve a truly transparent system promoting corporate accountability, there is an obvious need for social audits to be regulated. One of the purposes of this book is to provide an overview of the development of social audit practices and regulation. It also sets out to explore the issues and challenges which have arisen relating to this matter around the world.

Socially critical pedagogy and the 'production of skilled performers': Further considerations of teaching and learning in physical education

The growing call for physical educators to move beyond the bounds of performance has been a powerful discourse. However, it is a discourse that has tended to be heavy on theory but light on practical application. This paper discusses recent work in the area of skill acquisition and what this might mean for pedagogical practices in physical education. The acquisition of motor skill has traditionally been a core objective for physical educators, and there has been a perception that child-centred pedagogies have failed in the achievement of this traditional yardstick. However, drawing from the work of Rovegno and Kirk (1995) and Langley (1995; 1997), and making links with current work in the motor learning area, it is possible to show that skill acquisition is not necessarily compromised by child-centred pedagogy. Indeed, working beyond Mosston's discovery threshold and using models such as Games for Understanding, can provide deeper skill-learning experiences as well as being socially just.

Comparison of IQS and verbal-performance IQ discrepancies estimated from two seven-subtest short forms of the WAIS-R

The present study compared IQs and Verbal-Performance IQ discrepancies estimated from two seven-subtest short forms of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) in a sample of 100 subjects referred for neuropsychological assessment. The short forms of Warrington, James, and Maciejewski (1986) and Ward (1990) yielded similar correlation coefficients and absolute error rates with respect to WAIS-R IQs, although the Warrington short form requires more time to administer and score. Both short forms were able to detect significant Verbal-Performance IQ discrepancies 70% of the time. However, they incorrectly yielded significant discrepancies for approximately 25% of the sample who did not have significant differences on the full WAIS-R. The results do not support reporting and interpreting significant Verbal-Performance IQ discrepancies estimated from these short forms.

Diffusion indices on magnetic resonance imaging and neuropsychological performance in amnestic mild cognitive impairment

Background: Magnetic resonance diffusion tensor imaging (DTI) shows promise in the early detection of microstructural pathophysiological changes in the brain. Objectives: To measure microstructural differences in the brains of participants with amnestic mild cognitive impairment (MCI) compared with an age-matched control group using an optimised DTI technique with fully automated image analysis tools and to investigate the correlation between diffusivity measurements and neuropsychological performance scores across groups. Methods: 34 participants (17 participants with MCI, 17 healthy elderly adults) underwent magnetic resonance imaging (MRI)-based DTI. To control for the effects of anatomical variation, diffusion images of all participants were registered to standard anatomical space. Significant statistical differences in diffusivity measurements between the two groups were determined on a pixel-by-pixel basis using gaussian random field theory. Results: Significantly raised mean diffusivity measurements (p<0.001) were observed in the left and right entorhinal cortices (BA28), posterior occipital-parietal cortex (BA18 and BA19), right parietal supramarginal gyrus (BA40) and right frontal precentral gyri (BA4 and BA6) in participants with MCI. With respect to fractional anisotropy, participants with MCI had significantly reduced measurements (p<0.001) in the limbic parahippocampal subgyral white matter, right thalamus and left posterior cingulate. Pearson's correlation coefficients calculated across all participants showed significant correlations between neuropsychological assessment scores and regional measurements of mean diffusivity and fractional anisotropy. Conclusions: DTI-based diffusivity measures may offer a sensitive method of detecting subtle microstructural brain changes associated with preclinical Alzheimer's disease.

Manipulating the data: Teaching and NAPLAN in the control society

High-stakes testing is changing what it means to be a ‘good teacher’ in the contemporary school. This paper uses Deleuze and Guattari's ideas on the control society and dividuation in the context of National Assessment Program Literacy and Numeracy (NAPLAN) testing in Australia to suggest that the database generates new understandings of the ‘good teacher’. Media reports are used to look at how teachers are responding to the high-stakes database through manipulating the data. This article argues that manipulating the data is a regrettable, but logical, response to manifestations of teaching where only the data counts.

Comparison of visual inspection and structural-health monitoring as bridge condition assessment methods

This paper presents the results of a research project aimed at examining the capabilities and challenges of two distinct but not mutually exclusive approaches to in-service bridge assessment: visual inspection and installed monitoring systems. In this study, the intended functionality of both approaches was evaluated on its ability to identify potential structural damage and to provide decision-making support. Inspection and monitoring are compared in terms of their functional performance, cost, and barriers (real and perceived) to implementation. Both methods have strengths and weaknesses across the metrics analyzed, and it is likely that a hybrid evaluation technique that adopts both approaches will optimize efficiency of condition assessment and ultimately lead to better decision making.