Time to analgesia for care delivered by nurse practitioners in the emergency department: A retrospective chart audit

Objectives To evaluate quality of care delivered to patients presenting to the emergency department (ED) with pain and managed by emergency nurse practitioners by measuring: 1) Evaluate time to analgesia from initial presentation 2) Evaluate time from being seen to next analgesia 3) Pain score documentation Background The delivery of quality care in the emergency department (ED) is emerging as one of the most important service indicators being measured by health services. Emergency nurse practitioner services are designed to improve timely, quality care for patients. One of the goals of quality emergency care is the timely and effective delivery of analgesia for patients. Timely analgesia is an important indicator of ED service performance. Methods A retrospective explicit chart review of 128 consecutive patients with pain and managed by emergency nurse practitioners was conducted. Data collected included demographics, presenting complaint, pain scores, and time to first dose of analgesia. Patients were identified from the ED Patient Information System (Cerner log) and data were extracted from electronic medical records Results Pain scores were documented in 67 (52.3%; 95% CI: 43.3-61.2) patients. The median time to analgesia from presentation was 60.5 (IQR 30-87) minutes, with 34 (26.6%; 95% CI: 19.1-35.1) patients receiving analgesia within 30 minutes of presentation to hospital. There were 22 (17.2%; 95% CI: 11.1-24.9) patients who received analgesia prior to assessment by a nurse practitioner. Among patients that received analgesia after assessment by a nurse practitioner, the median time to analgesia after assessment was 25 (IQR 12-50) minutes, with 65 (61.3%; 95% CI: 51.4-70.6) patients receiving analgesia within 30 minutes of assessment. Conclusions The majority of patients assessed by nurse practitioners received analgesia within 30 minutes after assessment. However, opportunities for substantial improvement in such times along with documentation of pain scores were identified and will be targeted in future research.

Mid-Aged Adults' Sitting Time in Three Contexts

BACKGROUND: To develop evidence-based approaches for reducing sedentary behavior, there is a need to identify the specific settings where prolonged sitting occurs, associated factors, and variations. PURPOSE: To examine the sociodemographic and health factors associated with mid-aged adults' sitting time in three contexts and variations between weekdays and weekend days. METHODS: A mail survey was sent to 17,000 adults (aged 40-65 years) in 2007; 11,037 responses were received (68.5%); and 7719 were analyzed in 2010. Respondents indicated time spent sitting on a usual weekday and weekend day for watching TV, general leisure, and home computer use. Multivariate linear mixed models with area-level random intercepts were used to examine (1) associations between sociodemographic and health variables and sitting time, and (2) interaction effects of weekday/weekend day with each of gender, age, education, and employment status, on sitting time. RESULTS: For each context, longer sitting times were reported by those single and living alone, and those whose health restricted activity. For watching TV, longer sitting times were reported by men; smokers; and those with high school or lower education, not in paid employment, in poor health, and with BMI ≥25. For general leisure, longer sitting times were reported by women, smokers, and those not employed full-time. For home computer use, longer sitting times were reported by men; and those aged 40-44 years, with university qualifications; in the mid-income range; and with BMI ≥30. Sitting times tended to be longer on weekend days than weekdays, although the extent of this differed among sociodemographic groups. CONCLUSIONS: Sociodemographic and health factors associated with sitting time differ by context and between weekdays and weekend days.

Experience has no shadow

This research is situated in the field of practice-led research investigating embodied perspectives on the performance of dance making. In the stock of choreographic literature, the celebrated ‘creativity’ label is associated predominantly with the choreographer and is discussed in terms of product rather than process (Lussier-Ley and Durand-Bush 2009; Hennessey 2003). A reliance on the mystery of inspiration or choreographic genius (Penty 1998) for the production of ‘great’ dance works does not acknowledge the complex and timely process common in the creation of dance (Mace and Ward 2002) nor provide a true representation of the creative contributors (Farrer 2014). The failure to attribute creative impulses and skills to dancers is reminiscent of a time when they were thought of only as instruments in the creative process not active participants and collaborators (Jowitt 2001a; H’Doubler 1957). This project asked the question, to what end do dancers contribute to choreography and how is this contribution valued and recognised? Dancers are integral to the creative process. The research found that the scope of a dancers’ creative involvement in the development of a new work is dependent on: the individual choreographers approach to creating movement; the relationship between dancer and choreographer, and dancer and fellow company members; and the dancers collaborative skills and interpretive skills, versatility, and initiative. Recognition and attribution of dancers’ creative input is dependent on a choreographer’s viewpoint, generosity, and prior creative experiences. The work was created as a part of the Ausdance Queensland 2010 Bell Tower III Choreographic Residency program. Applicants were peer reviewed and vetted by a panel of local and national dance producers. The creative work was presented at the Judith Wright Centre for Live Arts. The project was funded by Ausdance Queensland and Arts Queensland. https://es-es.facebook.com/events/106661226023025/?hc_location=stream

Exploring Bodies in Time and Space

While the body, time and space are fundamental to human experience, comparatively little attention has been given to the connections between them. Here scholars from a wide range of disciplines explore important themes of embodied life in time and space across cultures, activities and bodymind states. Motivated by a common desire to deepen and extend our comprehension of these phenomena and the connections and conversations between them, this book emerged from intense inter-disciplinary dialogue during the 1st Global Conferences on Time, Space and the Body and Body Horror. A plenitude of theoretical approaches and media are deployed to investigate assumptions and pose problems, to creatively deconstruct and reconstruct the terms through which experience is rendered meaningful, pleasurable, and functional. These investigations, pursued through various research methods in fields of the arts, social and psychological sciences and humanities, invite readers into a genuinely pluralistic conversation around the most basic and profound aspects of being.

Introduction : Understanding Connections between Time, Space and the Body

The experiences and constructs of time, space and bodies saturate human discourse—naturally enough, since they are fundamental to existence—yet there has long been a tendency for the terms to be approached somewhat independently, belying the depth of their interconnections. It was a desire to address that apparent shortcoming that inspired this book, and the interdisciplinary meetings from which it was born, the 1st Global Conferences on ‘Time, Space and the Body’ and ‘Body Horror’ held in Sydney in February 2013. Following the lively, often provocative, exchange of ideas throughout those meetings, the writing here crosses conventional boundaries inhabiting everyday life and liminal experiences, across cultures, life circumstances, and bodily states. Through numerous theoretical frameworks and with reference to a variety of media, the authors problematize or deconstruct commonplace assumptions to reveal challenging new perspectives on the diverse cultures and communities which make our world. If there is an overarching theme of this collection it is diversity itself. The writers here come from numerous academic fields, but a good number of them also draw on first-hand cultural production in the arts: photography, sculpture and fine art instillation, for example. Of course, however laudable it might be, there is a potential problem in such diversity: does it produce fruitful dialogue moving toward creative, workable syntheses or simply a cacophony of competing, incomprehensible, barely comprehending voices? To a large degree this depends upon the intellectual, existential ambitions as well as the old-fashioned goodnatured tolerance of both writers and readers. But we hope three unifying characteristics are discernable in the following chapters viewed as a whole: firstly, a genuine concern for the world humans inhabit and the communities they form as bodies in space and time; secondly, an emphasis upon the experience of the human subject, exemplified perhaps by the number of chapters drawing on phenomenology; thirdly, an adventurous, explorative impulse associated with an underlying sense that being, since it is inseparable from the body’s temporality, is always becoming, and here the presence of poststructuralist influences is unmistakable, often explicit. Our challenge as editors has been to present the enormous variety of subjects and views in a way that would render the book coherent and at the same time encourage readers to make explorations themselves into realms they might usually consider beyond their field of interest. To that end we have divided the book into six sections around loosely defined themes, each offering different angles on how time and/or space unfold in and around bodies.

Modelling total duration of traffic incidents including incident detection and recovery time

Traffic incidents are key contributors to non-recurrent congestion, potentially generating significant delay. Factors that influence the duration of incidents are important to understand so that effective mitigation strategies can be implemented. To identify and quantify the effects of influential factors, a methodology for studying total incident duration based on historical data from an ‘integrated database’ is proposed. Incident duration models are developed using a selected freeway segment in the Southeast Queensland, Australia network. The models include incident detection and recovery time as components of incident duration. A hazard-based duration modelling approach is applied to model incident duration as a function of a variety of factors that influence traffic incident duration. Parametric accelerated failure time survival models are developed to capture heterogeneity as a function of explanatory variables, with both fixed and random parameters specifications. The analysis reveals that factors affecting incident duration include incident characteristics (severity, type, injury, medical requirements, etc.), infrastructure characteristics (roadway shoulder availability), time of day, and traffic characteristics. The results indicate that event type durations are uniquely different, thus requiring different responses to effectively clear them. Furthermore, the results highlight the presence of unobserved incident duration heterogeneity as captured by the random parameter models, suggesting that additional factors need to be considered in future modelling efforts.

Using informative priors in the estimation of mixtures over time with application to aerosol particle size distributions

The issue of using informative priors for estimation of mixtures at multiple time points is examined. Several different informative priors and an independent prior are compared using samples of actual and simulated aerosol particle size distribution (PSD) data. Measurements of aerosol PSDs refer to the concentration of aerosol particles in terms of their size, which is typically multimodal in nature and collected at frequent time intervals. The use of informative priors is found to better identify component parameters at each time point and more clearly establish patterns in the parameters over time. Some caveats to this finding are discussed.

Editorial : is it the time for railway industry to reinvent itself?

Editorial: is it the time for railway industry to reinvent itself? Railway infrastructure plays a critical role in urban development, mobility, and economic growth of society. This focus issue of the Electronic Journal of Structural Engineering is devoted to a special theme, “Advances in Rail Track Infrastructure and Practice - ARTRP”. It contains articles, which were rigorously peer reviewed and accepted from a list of invited manuscripts that demonstrate significant innovation in the area of the structural engineering aspects of the rail track infrastructure...

A runtime integrity monitoring framework for real-time relative positioning systems based on GPS and DSRC

This paper provides a three-layered framework to monitor the positioning performance requirements of Real-time Relative Positioning (RRP) systems of the Cooperative Intelligent Transport Systems (C-ITS) that support Cooperative Collision Warning (CCW) applications. These applications exploit state data of surrounding vehicles obtained solely from the Global Positioning System (GPS) and Dedicated Short-Range Communications (DSRC) units without using other sensors. To this end, the paper argues the need for the GPS/DSRC-based RRP systems to have an autonomous monitoring mechanism, since the operation of CCW applications is meant to augment safety on roads. The advantages of autonomous integrity monitoring are essential and integral to any safety-of-life system. The autonomous integrity monitoring framework proposed necessitates the RRP systems to detect/predict the unavailability of their sub-systems and of the integrity monitoring module itself, and, if available, to account for effects of data link delays and breakages of DSRC links, as well as of faulty measurement sources of GPS and/or integrated augmentation positioning systems, before the information used for safety warnings/alarms becomes unavailable, unreliable, inaccurate or misleading. Hence, a monitoring framework using a tight integration and correlation approach is proposed for instantaneous reliability assessment of the RRP systems. Ultimately, using the proposed framework, the RRP systems will provide timely alerts to users when the RRP solutions cannot be trusted or used for the intended operation.

School based youth health nurses and attrition : the reasons for moving on

Like the UK, Australia has a number of school nursing models and programmes. The School Based Youth Health Nurse Program (SBYHNP) is a new and unique model of school nursing in Queensland, Australia. The SBYHNP represents a philosophical and structural shift from traditional school nursing programmes. The purpose of this qualitative case study is to explore the reasons School Based Youth Health Nurses (SBYHN) leave school nursing. Sixteen in-depth interviews were conducted with participants who practiced as SBYHN and left the SBYHNP. This case study reveals six themes: The politics’: Navigating the organisational divide, 'Unconditional positive regard’: Surviving without team cohesion, 'Absolutely exhausted’: Maintaining physical and emotional strength, ‘Definitely geographical’: Managing the tyranny of time and distance, ‘If things fell into place’: Thinking about what could have been, and ‘A stepping stone’: Moving on to the next nursing position. This case study suggests nurses considering school nursing as a specialty should seek opportunity to understand this complex role, ensure realistic expectations and ndertake relevant qualifications. This approach may secure the investment made by nurses and schools and create demand for a highly sort after position.

The True Cost of Greenhouse Gas Emissions: Analysis of 1,000 Global Companies

This study elucidated the shadow price of greenhouse gas (GHG) emissions for 1,024 international companies worldwide that were surveyed from 15 industries in 37 major countries. Our results indicate that the shadow price of GHG at the firm level is much higher than indicated in previous studies. The higher shadow price was found in this study as a result of the use of Scope 3 GHG emissions data. The results of this research indicate that a firm would carry a high cost of GHG emissions if Scope 3 GHG emissions were the focus of the discussion of corporate social responsibility. In addition, such shadow prices were determined to differ substantially among countries, among sectors, and within sectors. Although a number of studies have calculated the shadow price of GHG emissions, these studies have employed country-level or industry-level data or a small sample of firm-level data in one country. This new data from a worldwide firm analysis of the shadow price of GHG emissions can play an important role in developing climate policy and promoting sustainable development.

Time, space, and text in the elementary school digital writing classroom

Theorists of multiliteracies, social semiotics, and the New Literacy Studies have drawn attention to the potential changing nature of writing and literacy in the context of networked communications. This article reports findings from a design-based research project in Year 4 classrooms (students aged 8.5-10 years) in a low socioeconomic status school. A new writing program taught students how to design multimodal and digital texts across a range of genres and text types, such as web pages, online comics, video documentaries, and blogs. The authors use Bernstein’s theory of the pedagogic device to theorize the pedagogic struggles and resolutions in remaking English through the specialization of time, space, and text. The changes created an ideological struggle as new writing practices were adapted from broader societal fields to meet the instructional and regulative discourses of a conventional writing curriculum.

Socio-demographic vulnerability to heatwave impacts in Brisbane, Australia : a time series analysis

Objective: Examining the association between socioeconomic disadvantage and heat-related emergency department (ED) visits during heatwave periods in Brisbane, 2000–2008. Methods: Data from 10 public EDs were analysed using a generalised additive model for disease categories, age groups and gender. Results: Cumulative relative risks (RR) for non-external causes other than cardiovascular and respiratory diseases were 1.11 and 1.05 in most and least disadvantaged areas, respectively. The pattern persisted on lags 0–2. Elevated risks were observed for all age groups above 15 years in all areas. However, with RRs of 1.19–1.28, the 65–74 years age group in more disadvantaged areas stood out, compared with RR=1.08 in less disadvantaged areas. This pattern was observed on lag 0 but did not persist. The RRs for male presentations were 1.10 and 1.04 in most and less disadvantaged areas; for females, RR was 1.04 in less disadvantaged areas. This pattern persisted across lags 0–2. Conclusions: Heat-related ED visits increased during heatwaves. However, due to overlapping confidence intervals, variations across socioeconomic areas should be interpreted cautiously. Implications: ED data may be utilised for monitoring heat-related health impacts, particularly on the first day of heatwaves, to facilitate prompt interventions and targeted resource allocation.

An analytical framework for quantifying aquifer response time scales associated with transient boundary conditions

A major challenge in studying coupled groundwater and surface-water interactions arises from the considerable difference in the response time scales of groundwater and surface-water systems affected by external forcings. Although coupled models representing the interaction of groundwater and surface-water systems have been studied for over a century, most have focused on groundwater quantity or quality issues rather than response time. In this study, we present an analytical framework, based on the concept of mean action time (MAT), to estimate the time scale required for groundwater systems to respond to changes in surface-water conditions. MAT can be used to estimate the transient response time scale by analyzing the governing mathematical model. This framework does not require any form of transient solution (either numerical or analytical) to the governing equation, yet it provides a closed form mathematical relationship for the response time as a function of the aquifer geometry, boundary conditions, and flow parameters. Our analysis indicates that aquifer systems have three fundamental time scales: (i) a time scale that depends on the intrinsic properties of the aquifer; (ii) a time scale that depends on the intrinsic properties of the boundary condition, and; (iii) a time scale that depends on the properties of the entire system. We discuss two practical scenarios where MAT estimates provide useful insights and we test the MAT predictions using new laboratory-scale experimental data sets.