A Multifaceted Strategy for Implementation of the Ottawa Ankle Rules in Two Emergency Departments

Problem Despite widespread acceptance of the Ottawa ankle rules for assessment of acute ankle injuries, their application varies considerably. Design Before and after study. Background and setting Emergency departments of a tertiary teaching hospital and a community hospital in Australia. Key measures for improvement Documentation of the Ottawa ankle rules, proportion of patients referred for radiography, proportion of radiographs showing a fracture. Strategies for change Education, a problem specific radiography request form, reminders, audit and feedback, and using radiographers as “gatekeepers.” Effects of change Documentation of the Ottawa ankle rules improved from 57.5% to 94.7% at the tertiary hospital, and 51.6% to 80.8% at the community hospital (P<0.001 for both). The proportion of patients undergoing radiography fell from 95.8% to 87.2% at the tertiary hospital, and from 91.4% to 78.9% at the community hospital (P<0.001 for both). The proportion of radiographs showing a fracture increased from 20.4% to 27.1% at the tertiary hospital (P=0.069), and 15.2% to 27.2% (P=0.002) at the community hospital. The missed fracture rate increased from 0% to 2.9% at the tertiary hospital and from 0% to 1.6% at the community hospital compared with baseline (P=0.783 and P=0.747). Lessons learnt Assessment of case note documentation has limitations. Clinician groups seem to differ in their capacity and willingness to change their practice. A multifaceted change strategy including a problem specific radiography request form can improve the selection of patients for radiography.

The rules of autogeddon : sex death and law in J G Ballard’s Crash

It was reported that the manuscript of Crash was returned to the publisher with a note reading ‘The author is beyond psychiatric help’. Ballard took the lay diagnosis as proof of complete artistic success. Crash conflates the Freudian tropes of libido and thanatos, overlaying these onto the twentieth century erotic icon, the car. Beyond mere incompetent adolescent copulatory fumblings in the back seat of the parental sedan or the clichéd phallic locomotor of the mid-life Ferrari, Ballard engages the full potentialities of the automobile as the locus and sine qua non of a perverse, though functional erotic. ‘Autoeroticism’ is transformed into automotive, traumatic or surgical paraphilia, driving Helmut Newton’s insipid photo-essays of BDSM and orthopædics into an entirely new dimension, dancing precisely where (but more crucially, because) the ‘body is bruised to pleasure soul’. The serendipity of quotidian accidental collisions is supplanted, in pursuit of the fetishised object, by contrived (though not simulated) recreations of iconographic celebrity deaths. Penetration remains as a guiding trope of sexuality, but it is confounded by a perversity of focus. Such an obsessive pursuit of this autoerotic-as-reality necessitates the rejection of the law of human sexual regulation, requiring the re-interpretation of what constitutes sex itself by looking beyond or through conventional sexuality into Ballard’s paraphiliac and nightmarish consensual Other. This Other allows for (if not demands) the tangled wreckage of a sportscar to function as a transformative sexual agent, creating, of woman, a being of ‘free and perverse sexuality, releasing within its dying chromium and leaking engine-parts, all the deviant possibilities of her sex’.

Triangular Linguistic Fuzzy based performance measurement model for supply chain to assess leanness attributes

Increasing global competitiveness worldwide has forced manufacturing organizations to produce high-quality products more quickly and at a competitive cost. In order to reach these goals, they need good quality components from suppliers at optimum price and lead time. This actually forced all the companies to adapt different improvement practices such as lean manufacturing, Just in Time (JIT) and effective supply chain management. Applying new improvement techniques and tools cause higher establishment costs and more Information Delay (ID). On the contrary, these new techniques may reduce the risk of stock outs and affect supply chain flexibility to give a better overall performance. But industry people are unable to measure the overall affects of those improvement techniques with a standard evaluation model .So an effective overall supply chain performance evaluation model is essential for suppliers as well as manufacturers to assess their companies under different supply chain strategies. However, literature on lean supply chain performance evaluation is comparatively limited. Moreover, most of the models assumed random values for performance variables. The purpose of this paper is to propose an effective supply chain performance evaluation model using triangular linguistic fuzzy numbers and to recommend optimum ranges for performance variables for lean implementation. The model initially considers all the supply chain performance criteria (input, output and flexibility), converts the values to triangular linguistic fuzzy numbers and evaluates overall supply chain performance under different situations. Results show that with the proposed performance measurement model, improvement area for each variable can be accurately identified.

Young, inexperienced and on the road: Do novice drivers comply with road rules?

Young novice drivers are at considerable risk of injury and fatality, particularly when they first drive independently. Graduated Driver Licensing (GDL) has been introduced in numerous jurisdictions to allow more driving experience in conditions of reduced risk and increasing driving privileges over a longer duration. Queensland, Australia, enhanced GDL July 2007. Learners must record 100 hours in a logbook (10 hours at night) over 1 year, no mobile handsfree/loudspeaker by driver or any passenger. Provisional 1 (P1) drivers must not carry 2 or more peer passengers 11pm - 5am, no mobile handsfree/loudspeaker by any passenger. Self-reported compliance with new GDL and general road rules has not been examined.

Practice and procedure : an application under r367 of the Uniform Civil Procedure Rules may be of use in obtaining copies of otherwise unavailable documents held by government agencies.

In Bowenbrae Pty Ltd v Flying Fighters Maintenance and Restoration [2010] QDC 347 Reid DCJ made orders requiring the plaintiffs to make application under the Freedom of Information Act 1982 (Cth) (“the FOI Act”) for documents sought by the defendant.

New design rules for the shear strength of LiteSteel Beams

Abstract: The LiteSteel Beam (LSB) is a new cold-formed hollow flange channel section produced using dual electric resistance welding and automated continuous roll-forming technologies. The innovative LSB sections have many beneficial characteristics and are commonly used as flexural members in building construction. However, limited research has been undertaken on the shear behaviour of LSBs. Therefore a detailed investigation including both numerical and experimental studies was undertaken to investigate the shear behaviour of LSBs. Finite element models of LSBs in shear were developed to simulate the nonlinear ultimate strength behaviour of LSBs including their elastic buckling characteristics, and were validated by comparing their results with experimental test results. Validated finite element models were then used in a detailed parametric study into the shear behaviour of LSBs. The parametric study results showed that the current design rules in cold-formed steel structures design codes are very conservative for the shear design of LSBs. Significant improvements to web shear buckling occurred due to the presence of torsionally rigid rectangular hollow flanges while considerable post-buckling strength was also observed. This paper therefore proposes improved shear strength design rules for LSBs within the current cold-formed steel code guidelines. It presents the details of the parametric study and the new shear strength equations. The new equations were also developed based on the direct strength method. The proposed shear strength equations have the potential to be used with other conventional cold-formed steel sections such as lipped channel sections.

New design rules for the shear strength of LiteSteel Beams with web openings

Abstract: LiteSteel beam (LSB) is a new cold-formed steel hollow flange channel section produced using a patented manufacturing process involving simultaneous cold-forming and dual electric resistance welding. The LSBs are commonly used as floor joists and bearers with web openings in residential, industrial and commercial buildings. Their shear strengths are considerably reduced when web openings are included for the purpose of locating building services. However, no research has been undertaken on the shear behaviour and strength of LSBs with web openings. Therefore experimental and numerical studies were undertaken to investigate the shear behaviour and strength of LSBs with web openings. In this research, finite element models of LSBs with web openings in shear were developed to simulate the shear behaviour and strength of LSBs including their buckling characteristics. They were then validated by comparing their results with available experimental test results and used in a detailed parametric study. The results showed that the current design rules in cold-formed steel structures design codes are very conservative for the shear design of LSBs with web openings. Improved design equations have been proposed for the shear capacity of LSBs with web openings based on both experimental and parametric study results. An alternative shear design method based on an equivalent reduced web thickness was also proposed. It was found that the same shear strength design rules developed for LSBs without web openings can be used for LSBs with web openings provided the equivalent reduced web thickness equation developed in this paper is used. This is a significant advancement as it simplifies the shear design methods of LSBs with web openings considerably.

Young, inexperienced and on the road : do novice drivers comply with road rules?

The graduated driver licensing (GDL) program in Queensland, Australia, was considerably enhanced in July 2007. This paper explores the compliance of young Learner and Provisional (intermediate) drivers with current GDL requirements and general road rules. Unsupervised driving, Learner logbook accuracy, and experiences of punishment avoidance were explored, along with speeding as a Provisional driver. Participants (609 females; M = 17.43 years) self-reported sociodemographic characteristics, driving behaviours and licensing experiences as Learners. A subset of participants (238 females, 105 males) completed another survey six months later exploring their Provisional behaviours and experiences. While the majority of the participants reported compliance with both the GDL requirements and general road rules such as stopping at red lights on their Learner licence; a considerable proportion reported speeding. Furthermore, they reported becoming less compliant during the Provisional phase, particularly with speed limits. Self-reported speeding was predicted by younger age at licensure, being in a relationship, driving unsupervised, submitting inaccurate Learner logbooks, and speeding as a Learner. Enforcement and education countermeasures should focus upon curtailing noncompliance, targeting speeding in particular. Novice drivers should be encouraged to comply with all road rules, including speed limits, and safe driving behaviours should be developed and reinforced during the Learner and early Provisional periods. Novice drivers have been found to model their parents’ driving, and parents are pivotal in regulating novice driving. It is vital young novice drivers and parents alike are encouraged to comply with all road rules, including GDL requirements.

Construction of Francophone families’ health literacy in a linguistic minority situation

With the increase in international mobility, healthcare systems should no longer be ignoring language barriers. In addition to the benefit of reducing long‐term costs, immigrant‐friendly organizations should be concerned with mitigating the way language barriers increase individuals’ social vulnerabilities and inequities in health care and health status. This paper reports the findings of a qualitative, exploratory study of the health literacy of 28 Francophone families living in a linguistic‐minority situation in Canada. Analysis of interviews revealed that participants’ social vulnerability, mainly due to their limited social and informational networks, influenced the construction of family health literacy. Disparities in access to healthcare services could be decreased by having health professionals’ work in alliance with Francophone community groups and by hiring bilingual health professionals. Linguistic isolation and lack of knowledge about local cultural organizations among Francophone immigrants were two important findings of this study

Improved design rules for hollow flange sections subject to lateral distortional buckling

The LiteSteel Beam (LSB) is a new hollow flange section with a unique geometry consisting of torsionally rigid rectangular hollow flanges and a relatively slender web. It is subjected to lateral distortional buckling when used as flexural members, which reduces its member moment capacity. An investigation into the flexural behaviour of LSBs using experiments and numerical analyses led to the development of new design rules for LSBs subject to lateral distortional buckling. However, the comparison of moment capacity results with the new design rules showed that they were conservative for some LSB sections while slightly unconservative for others due to the effects of section geometry. It is also unknown whether these design rules are applicable to other hollow flange sections such as hollow flange beams (HFB). This paper presents the details of a study into the lateral distortional buckling behaviour of hollow flange sections such as LSBs, HFBs and their variations. A geometrical parameter defined as the ratio of flange torsional rigidity to the major axis flexural rigidity of the web (GJf/EIxweb) was found to be a critical parameter in evaluating the lateral distortional buckling behaviour and moment capacities of hollow flange sections. New design rules were therefore developed by using a member slenderness parameter modified by K, where K is a function of GJf/EIxweb. The new design rules based on the modified slenderness parameter were found to be accurate in calculating the moment capacities of not only LSBs and HFBs, but also other types of hollow flange sections.

Eight simple rules for losing your doctoral virginity

Right now, there are thousands of brand new PhD candidates entering universities around the country. Many of them will be highly anxious, knowing that they have a long, difficult journey ahead of them which, statistically speaking, they have less than a 75 per cent chance of completing successfully...

Simple rules to contain an invasive species with a complex life cycle and high dispersal capacity

Designing practical rules for controlling invasive species is a challenging task for managers, particularly when species are long-lived, have complex life cycles and high dispersal capacities. Previous findings derived from plant matrix population analyses suggest that effective control of long-lived invaders may be achieved by focusing on killing adult plants. However, the cost-effectiveness of managing different life stages has not been evaluated. We illustrate the benefits of integrating matrix population models with decision theory to undertake this evaluation, using empirical data from the largest infestation of mesquite (Leguminosae: Prosopis spp) within Australia. We include in our model the mesquite life cycle, different dispersal rates and control actions that target individuals at different life stages with varying costs, depending on the intensity of control effort. We then use stochastic dynamic programming to derive cost-effective control strategies that minimize the cost of controlling the core infestation locally below a density threshold and the future cost of control arising from infestation of adjacent areas via seed dispersal. Through sensitivity analysis, we show that four robust management rules guide the allocation of resources between mesquite life stages for this infestation: (i) When there is no seed dispersal, no action is required until density of adults exceeds the control threshold and then only control of adults is needed; (ii) when there is seed dispersal, control strategy is dependent on knowledge of the density of adults and large juveniles (LJ) and broad categories of dispersal rates only; (iii) if density of adults is higher than density of LJ, controlling adults is most cost-effective; (iv) alternatively, if density of LJ is equal or higher than density of adults, management efforts should be spread between adults, large and to a lesser extent small juveniles, but never saplings. Synthesis and applications.In this study, we show that simple rules can be found for managing invasive plants with complex life cycles and high dispersal rates when population models are combined with decision theory. In the case of our mesquite population, focussing effort on controlling adults is not always the most cost-effective way to meet our management objective.

The pedagogical, linguistic and content features of popular English language learning websites in China : a framework for analysis and design

As increasing numbers of Chinese language learners choose to learn English online (CNNIC, 2012), there is a need to investigate popular websites and their language learning designs. This paper reports on the first stage of a study that analysed the pedagogical, linguistic and content features of 25 Chinese English Language Learning (ELL) websites ranked according to their value and importance to users. The website ranking was undertaken using a system known as PageRank. The aim of the study was to identify the features characterising popular sites as opposed to those of less popular sites for the purpose of producing a framework for ELL website design in the Chinese context. The study found that a pedagogical focus with developmental instructional materials accommodating diverse proficiency levels was a major contributor to website popularity. Chinese language use for translations and teaching directives and intermediate level English for learning materials were also significant features. Content topics included Anglophone/Western and non-Anglophone/Eastern contexts. Overall, popular websites were distinguished by their mediation of access to and scaffolded support for ELL.

Six rules for practice-led research

Recent experience of practice-led postgraduate supervision has prompted me to conclude that the practice-led research method, as it is currently construed, produces good outcomes, especially in permitting practitioners in the creative arts, design and media into the research framework, but at the same time it also generates certain recurring difficulties. What are these difficulties? Practice-led candidates tend to rely on a narrow range of formulations with the result that they assume: (i) the innovative nature of practice-led research; (ii) that its novelty is based in opposition to other research methods; (iii) that practice is intrinsically research, often leading to tautological formulations; (iv) the hyper-self-reflexive nature of practice-led research. This set of guidelines was composed in order to circumvent the shortcomings that result from these recurring formulations. My belief is that, if these shortcomings are avoided, there is nothing to prevent practice-led from further developing as a research inquiry and thus achieving rewarding and successful research outcomes. Originally composed for the purposes of postgraduate supervision, these six rules are presented here in the context of a wider analysis of the emergence of practice-led research and its current conditions of possibility as a research method.