Implementing an emergency department patient admission predictive tool : insights from practice

Purpose: This paper aims to show that identification of expectations and software functional requirements via consultation with potential users is an integral component of the development of an emergency department patient admissions prediction tool. ---------- Design/methodology/approach: Thematic analysis of semi-structured interviews with 14 key health staff delivered rich data regarding existing practice and future needs. Participants included emergency department staff, bed managers, nurse unit managers, directors of nursing, and personnel from health administration. ---------- Findings: Participants contributed contextual insights on the current system of admissions, revealing a culture of crisis, imbued with misplayed communication. Their expectations and requirements of a potential predictive tool provided strategic data that moderated the development of the Emergency Department Patient Admissions Prediction Tool, based on their insistence that it feature availability, reliability and relevance. In order to deliver these stipulations, participants stressed that it should be incorporated, validated, defined and timely. ---------- Research limitations/implications: Participants were envisaging a concept and use of a tool that was somewhat hypothetical. However, further research will evaluate the tool in practice. ---------- Practical implications: Participants' unsolicited recommendations regarding implementation will not only inform a subsequent phase of the tool evaluation, but are eminently applicable to any process of implementation in a healthcare setting. ---------- Originality/value: The consultative process engaged clinicians and the paper delivers an insider view of an overburdened system, rather than an outsider's observations.

Quality of child abuse information in emergency department injury surveillance data : linking hospital and child welfare data

Emergency departments (EDs) are often the first point of contact with an abused child. Despite legal mandate, the reporting of definite or suspected abusive injury to child safety authorities by ED clinicians varies due to a number of factors including training, access to child safety professionals, departmental culture and a fear of ‘getting it wrong’. This study examined the quality of documentation and coding of child abuse captured by ED based injury surveillance data and ED medical records in the state of Queensland and the concordance of these data with child welfare records. A retrospective medical record review was used to examine the clinical documentation of almost 1000 injured children included in the Queensland Injury Surveillance Unit database (QISU) from 10 hospitals in urban and rural centres. Independent experts re-coded the records based on their review of the notes. A data linkage methodology was then used to link these records with records in the state government’s child welfare database. Cases were sampled from three sub-groups according to the surveillance intent codes: Maltreatment by parent, Undetermined and Unintentional injury. Only 0.1% of cases coded as unintentional injury were recoded to maltreatment by parent, while 1.2% of cases coded as maltreatment by parent were reclassified as unintentional and 5% of cases where the intent was undetermined by the triage nurse were recoded as maltreatment by parent. Quality of documentation varied across type of hospital (tertiary referral centre, children’s, urban, regional and remote). Concordance of health data with child welfare data varied across patient subgroups. Outcomes from this research will guide initiatives to improve the quality of intentional child injury surveillance systems.

Knowledge and attitudes about Vitamin D and impact on sun protection practices among urban office workers in Brisbane, Australia

Background: Sun exposure is the main source of vitamin D. Increasing scientific and media attention to the potential health benefits of sun exposure may lead to changes in sun exposure behaviors. Methods: To provide data that might help frame public health messages, we conducted an online survey among office workers in Brisbane, Australia, to determine knowledge and attitudes about vitamin D and associations of these with sun protection practices. Of the 4,709 people invited to participate, 2,867 (61%) completed the questionnaire. This analysis included 1,971 (69%) participants who indicated that they had heard about vitamin D. Results: Lack of knowledge about vitamin D was apparent. Eighteen percent of people were unaware of the bone benefits of vitamin D but 40% listed currently unconfirmed benefits. Over half of the participants indicated that more than 10 minutes in the sun was needed to attain enough vitamin D in summer, and 28% indicated more than 20 minutes in winter. This was significantly associated with increased time outdoors and decreased sunscreen use. People believing sun protection might cause vitamin D deficiency (11%) were less likely to be frequent sunscreen users (summer odds ratio, 0.63; 95% confidence interval, 0.52-0.75). Conclusions: Our findings suggest that there is some confusion about sun exposure and vitamin D, and that this may result in reduced sun-protective behavior. Impact: More information is needed about vitamin D production in the skin. In the interim, education campaigns need to specifically address the vitamin D issue to ensure that skin cancer incidence does not increase.

Small and medium enterprises’ solution to improve on-site waste management in office building retrofit projects

Office building retrofit projects are increasingly more intensified as existing buildings are aging. At the same time, building owners and occupants are looking for environmentally sustainable products. These retrofit projects usually take place in center business district (CBDs) with on-site waste becoming one of the critical issues. Small and Medium Enterprises (SMEs) carry out most of the work in retrofit projects as subcontractors. Despite their large involvement, they often do not have adequate resources to deal with the specific technical challenges and project risks related to waste. Few research has been done on their performance of waste management operations. This paper identifies characteristics of on-site waste in office building retrofit projects. It examines the specific requirements for contractors to manage waste in the projects before exploring the existing performance of SMEs. By comparing requirements for SMEs and their potential areas for improvement, a framework is established for performance promotion of SMEs in on-site waste management of office building retrofit projects. The paper will raise the consciousness and commitment of SMEs as sub-contractors to waste management. It also explores ways of supporting SMEs for experience accumulation, performance promotion and project culture establishment towards effective and efficient on-site waste management in the growing sector of office building retrofit and upgrade.

Raised Floor System applications for refurbishing office spaces

While raised floors as a building component has been around since the 70's, its application in terms of a holistic system in the fit-out of commercial office buildings has not been fully embraced due to some inherent problems and negative perceptions of the stakeholders involved. Today, the new generation of raised floor systems(RFS) offers a suite of innovative and integrated products and solutions, and as such are not only suitable for the changing office space requirements, but also capable of meeting tbe smart and sustainable challenges, which are becoming the prerequisite in the refurbishment of existing buildings. As there has been a prediction for continued growth in refurbishment projects in major cities around the globe, RFS as an alternative methodology warrants new examination and highlight. This paper introduces research recently completed in Australia that provided a holistic approach to the application of RFS enabled by intelligent building technologies, and examined key issues of project development when refurbishing commercial office buildings. It focuses on the constructability of RFS, and how it will respond to smart feature requirements in buildings while extending service life, meeting new organisational change and workplace health needs for applications in today's office environment. It also introduces key project procurement issues and the integrated decision support when dealing with the refurbishment of office buildings. The paper recommends procurement strategies as well as the justification of adopting the RFS technology in the Australian office building sector. Given the current economic downturn, refitting as opposed to new build .projects will come onto the spotlight. This paper will provide valuable information for building owners and developers alike when contemplating the retrofit of office buildings.

Standards-driven reform years 1-10 : moderation an optional extra?

While externally moderated standards-based assessment has been practised in Queensland senior schooling for more than three decades, there has been no such practice in the middle years. With the introduction of standards at state and national levels in these years, teacher judgement as developed in moderation practices is now vital. This paper argues, that in this context of assessment reform, standards intended to inform teacher judgement and to build assessment capacity are necessary but not sufficient for maintaining teacher and public confidence in schooling. Teacher judgement is intrinsic to moderation, and to professional practice, and can no longer remain private. Moderation too is intrinsic to efforts by the profession to realise judgements that are defensible, dependable and open to scrutiny. Moderation can no longer be considered an optional extra and requires system-level support especially if, as intended, the standards are linked to system-wide efforts to improve student learning. In presenting this argument we draw on an Australian Research Council funded study with key industry partners (the Queensland Studies Authority and the National Council for Curriculum and Assessment of the Republic of Ireland). The data analysed included teacher interview data and additional teacher talk during moderation sessions. These were undertaken during the initial phase of policy development. The analysis identified those issues that emerge in moderation meetings that are designed to reach consistent, reliable judgements. Of interest are the different ways in which teachers talked through and interacted with one another to reach agreement about the quality of student work in the application of standards. There is evidence of differences in the way that teachers made compensations and trade-offs in their award of grades, dependent on the subject domain in which they teach. This article concludes with some empirically derived insights into moderation practices as policy and social events.

Listening to voices of self : digital journaling among gifted young adolescents

The lives of gifted young adolescents are often subject to adult-generated and expert narratives that can impact a developing sense of self. However, opportunities for gifted young adolescents to represent themselves as informants can emerge through digital forms of qualitative research. This paper reports on the value of digital writing of journal entries, delivered by email to a researcher over several months, as an alternative to face-to-face interviews. Journaling methods combined with techniques of 'listening for voices' can support young adolescents in generating their own multi-vocal narratives of self. This method capturing self-narratives in email form has the potential to produce rich understandings of individual young adolescents' self-constructions.

Fusing curricula : science, technology and ICT

Curriculum demands continue to increase on school education systems with teachers at the forefront of implementing syllabus requirements. Education is reported frequently as a solution to most societal problems and, as a result of the world’s information explosion, teachers are expected to cover more and more within teaching programs. How can teachers combine subjects in order to capitalise on the competing educational agendas within school timeframes? Fusing curricula requires the bonding of standards from two or more syllabuses. Both technology and ICT complement the learning of science. This study analyses selected examples of preservice teachers’ overviews for fusing science, technology and ICT. These program overviews focused on primary students and the achievement of two standards (one from science and one from either technology or ICT). These primary preservice teachers’ fused-curricula overviews included scientific concepts and related technology and/or ICT skills and knowledge. Findings indicated a range of innovative curriculum plans for teaching primary science through technology and ICT, demonstrating that these subjects can form cohesive links towards achieving the respective learning standards. Teachers can work more astutely by fusing curricula; however further professional development may be required to advance thinking about these processes. Bonding subjects through their learning standards can extend beyond previous integration or thematic work where standards may not have been assessed. Education systems need to articulate through syllabus documents how effective fusing of curricula can be achieved. It appears that education is a key avenue for addressing societal needs, problems and issues. Education is promoted as a universal solution, which has resulted in curriculum overload (Dare, Durand, Moeller, & Washington, 1997; Vinson, 2001). Societal and curriculum demands have placed added pressure on teachers with many extenuating education issues increasing teachers’ workloads (Mobilise for Public Education, 2002). For example, as Australia has weather conducive for outdoor activities, social problems and issues arise that are reported through the media calling for action; consequently schools have been involved in swimming programs, road and bicycle safety programs, and a wide range of activities that had been considered a parental responsibility in the past. Teachers are expected to plan, implement and assess these extra-curricula activities within their already overcrowded timetables. At the same stage, key learning areas (KLAs) such as science and technology are mandatory requirements within all Australian education systems. These systems have syllabuses outlining levels of content and the anticipated learning outcomes (also known as standards, essential learnings, and frameworks). Time allocated for teaching science in obviously an issue. In 2001, it was estimated that on average the time spent in teaching science in Australian Primary Schools was almost an hour per week (Goodrum, Hackling, & Rennie, 2001). More recently, a study undertaken in the U.S. reported a similar finding. More than 80% of the teachers in K-5 classrooms spent less than an hour teaching science (Dorph, Goldstein, Lee, et al., 2007). More importantly, 16% did not spend teaching science in their classrooms. Teachers need to learn to work smarter by optimising the use of their in-class time. Integration is proposed as one of the ways to address the issue of curriculum overload (Venville & Dawson, 2005; Vogler, 2003). Even though there may be a lack of definition for integration (Hurley, 2001), curriculum integration aims at covering key concepts in two or more subject areas within the same lesson (Buxton & Whatley, 2002). This implies covering the curriculum in less time than if the subjects were taught separately; therefore teachers should have more time to cover other educational issues. Expectedly, the reality can be decidedly different (e.g., Brophy & Alleman, 1991; Venville & Dawson, 2005). Nevertheless, teachers report that students expand their knowledge and skills as a result of subject integration (James, Lamb, Householder, & Bailey, 2000). There seems to be considerable value for integrating science with other KLAs besides aiming to address teaching workloads. Over two decades ago, Cohen and Staley (1982) claimed that integration can bring a subject into the primary curriculum that may be otherwise left out. Integrating science education aims to develop a more holistic perspective. Indeed, life is not neat components of stand-alone subjects; life integrates subject content in numerous ways, and curriculum integration can assist students to make these real-life connections (Burnett & Wichman, 1997). Science integration can provide the scope for real-life learning and the possibility of targeting students’ learning styles more effectively by providing more than one perspective (Hudson & Hudson, 2001). To illustrate, technology is essential to science education (Blueford & Rosenbloom, 2003; Board of Studies, 1999; Penick, 2002), and constructing technology immediately evokes a social purpose for such construction (Marker, 1992). For example, building a model windmill requires science and technology (Zubrowski, 2002) but has a key focus on sustainability and the social sciences. Science has the potential to be integrated with all KLAs (e.g., Cohen & Staley, 1982; Dobbs, 1995; James et al., 2000). Yet, “integration” appears to be a confusing term. Integration has an educational meaning focused on special education students being assimilated into mainstream classrooms. The word integration was used in the late seventies and generally focused around thematic approaches for teaching. For instance, a science theme about flight only has to have a student drawing a picture of plane to show integration; it did not connect the anticipated outcomes from science and art. The term “fusing curricula” presents a seamless bonding between two subjects; hence standards (or outcomes) need to be linked from both subjects. This also goes beyond just embedding one subject within another. Embedding implies that one subject is dominant, while fusing curricula proposes an equal mix of learning within both subject areas. Primary education in Queensland has eight KLAs, each with its established content and each with a proposed structure for levels of learning. Primary teachers attempt to cover these syllabus requirements across the eight KLAs in less than five hours a day, and between many of the extra-curricula activities occurring throughout a school year (e.g., Easter activities, Education Week, concerts, excursions, performances). In Australia, education systems have developed standards for all KLAs (e.g., Education Queensland, NSW Department of Education and Training, Victorian Education) usually designated by a code. In the late 1990’s (in Queensland), “core learning outcomes” for strands across all KLA’s. For example, LL2.1 for the Queensland Education science syllabus means Life and Living at Level 2 standard number 1. Thus, a teacher’s planning requires the inclusion of standards as indicated by the presiding syllabus. More recently, the core learning outcomes were replaced by “essential learnings”. They specify “what students should be taught and what is important for students to have opportunities to know, understand and be able to do” (Queensland Studies Authority, 2009, para. 1). Fusing science education with other KLAs may facilitate more efficient use of time and resources; however this type of planning needs to combine standards from two syllabuses. To further assist in facilitating sound pedagogical practices, there are models proposed for learning science, technology and other KLAs such as Bloom’s Taxonomy (Bloom, 1956), Productive Pedagogies (Education Queensland, 2004), de Bono’s Six Hats (de Bono, 1985), and Gardner’s Multiple Intelligences (Gardner, 1999) that imply, warrant, or necessitate fused curricula. Bybee’s 5 Es, for example, has five levels of learning (engage, explore, explain, elaborate, and evaluate; Bybee, 1997) can have the potential for fusing science and ICT standards.

Collaborative digital media performance with generative music systems

Music is inherently active and interactive. Like technologies before them, digital systems provide a range of enhanced music performance opportunities. In this paper we outline the educational advantages of ensemble performance in which generative media systems are integrated. As a concrete example, we focus on our work with the jam2jam system which uses generative music processes to enhance collaborative music making. We suggest that our research points toward a new class of activities that maintain the well established benefits of ensemble performance while adding cultural and pedagogical value by leveraging the capabilities and cachet of digital media practices.

Information transfer for multi-trauma patients on discharge from the emergency department : mixed-method narrative review

Aim. This paper is a report of a review conducted to identify (a) best practice in information transfer from the emergency department for multi-trauma patients; (b) conduits and barriers to information transfer in trauma care and related settings; and (c) interventions that have an impact on information communication at handover and beyond. Background. Information transfer is integral to effective trauma care, and communication breakdown results in important challenges to this. However, evidence of adequacy of structures and processes to ensure transfer of patient information through the acute phase of trauma care is limited. Data sources. Papers were sourced from a search of 12 online databases and scanning references from relevant papers for 1990–2009. Review methods. The review was conducted according to the University of York’s Centre for Reviews and Dissemination guidelines. Studies were included if they concerned issues that influenced information transfer for patients in healthcare settings. Results. Forty-five research papers, four literature reviews and one policy statement were found to be relevant to parts of the topic, but not all of it. The main issues emerging concerned the impact of communication breakdown in some form, and included communication issues within trauma team processes, lack of structure and clarity during handovers including missing, irrelevant and inaccurate information, distractions and poorly documented care. Conclusion. Many factors influence information transfer but are poorly identified in relation to trauma care. The measurement of information transfer, which is integral to patient handover, has not been the focus of research to date. Nonetheless, documented patient information is considered evidence of care and a resource that affects continuing care.

An enriched radial point interpolation method (e-RPIM) for analysis of crack tip fields

In this paper, an enriched radial point interpolation method (e-RPIM) is developed the for the determination of crack tip fields. In e-RPIM, the conventional RBF interpolation is novelly augmented by the suitable trigonometric basis functions to reflect the properties of stresses for the crack tip fields. The performance of the enriched RBF meshfree shape functions is firstly investigated to fit different surfaces. The surface fitting results have proven that, comparing with the conventional RBF shape function, the enriched RBF shape function has: (1) a similar accuracy to fit a polynomial surface; (2) a much better accuracy to fit a trigonometric surface; and (3) a similar interpolation stability without increase of the condition number of the RBF interpolation matrix. Therefore, it has proven that the enriched RBF shape function will not only possess all advantages of the conventional RBF shape function, but also can accurately reflect the properties of stresses for the crack tip fields. The system of equations for the crack analysis is then derived based on the enriched RBF meshfree shape function and the meshfree weak-form. Several problems of linear fracture mechanics are simulated using this newlydeveloped e-RPIM method. It has demonstrated that the present e-RPIM is very accurate and stable, and it has a good potential to develop a practical simulation tool for fracture mechanics problems.

Longitudinal investigation of wandering behavior in department of veterans affairs nursing home care units

Objectives To explore the extent of and factors associated with male residents who change wandering status post nursing home admission. Design Longitudinal design with secondary data analyses. Admissions over a 4-year period were examined using repeat assessments with the Minimum Data Set (MDS) to formulate a model understanding the development of wandering behavior. Setting One hundred thirty-four Veterans Administration (VA) nursing homes throughout the United States. Participants: Included 6673 residents admitted to VA nursing homes between October 2000 and October 2004. Measurements MDS variables (cognitive impairment, mood, behavior problems, activities of daily living and wandering) included ratings recorded at residents’ admission to the nursing home and a minimum of two other time points at quarterly intervals. Results The majority (86%) of the sample were classified as non wanderers at admission and most of these (94%) remained non wanderers until discharge or the end of the study. Fifty one per cent of the wanderers changed status to non wanderers with 6% of these residents fluctuating in status more than two times. Admission variables associated with an increased risk of changing status from non-wandering to wandering included older age, greater cognitive impairment, more socially inappropriate behavior, resisting care, easier distractibility, and needing less help with personal hygiene. Requiring assistance with locomotion and having three or more medical comorbidities were associated with a decreased chance of changing from non-wandering to wandering status. Conclusion A resident’s change from non-wandering to wandering status may reflect an undetected medical event that affects cognition, but spares mobility.

A coupled meshless technique/molecular dynamics approach for deformation characterization of monocrystalline metal

This paper presents a multiscale study using the coupled Meshless technique/Molecular Dynamics (M2) for exploring the deformation mechanism of mono-crystalline metal (focus on copper) under uniaxial tension. In M2, an advanced transition algorithm using transition particles is employed to ensure the compatibility of both displacements and their gradients, and an effective local quasi-continuum approach is also applied to obtain the equivalent continuum strain energy density based on the atomistic poentials and Cauchy-Born rule. The key parameters used in M2 are firstly investigated using a benchmark problem. Then M2 is applied to the multiscale simulation for a mono-crystalline copper bar. It has found that the mono-crystalline copper has very good elongation property, and the ultimate strength and Young's modulus are much higher than those obtained in macro-scale.

Decoupled trajectory planning for a submerged rigid body subject to dissipative and potential forces

This paper studies the practical but challenging problem of motion planning for a deeply submerged rigid body. Here, we formulate the dynamic equations of motion of a submerged rigid body under the architecture of differential geometric mechanics and include external dissipative and potential forces. The mechanical system is represented as a forced affine-connection control system on the configuration space SE(3). Solutions to the motion planning problem are computed by concatenating and reparameterizing the integral curves of decoupling vector fields. We provide an extension to this inverse kinematic method to compensate for external potential forces caused by buoyancy and gravity. We present a mission scenario and implement the theoretically computed control strategy onto a test-bed autonomous underwater vehicle. This scenario emphasizes the use of this motion planning technique in the under-actuated situation; the vehicle loses direct control on one or more degrees of freedom. We include experimental results to illustrate our technique and validate our method.

Low intensity CBT by mail

Introduction: There are many low intensity (LI) cognitive behavoural therapy (CBT) solutions to the problem of limited service access. In this chapter, we aim to discuss a relatively low-technology approach to access using standard postal services-CBT by mail, or M-CBT. Bibliotherapies including M-CBT teach key concepts and self-management techniques, together with screening tools and forms to structure home practice. M-CBT differs from other bibliotherapies by segmenting interventions and mailing them at regular intervals. Most involve participants returning copies of monitoring forms or completed handouts. Therapist feedback is provided, often in personal letters that accompany the printed materials. Participants may also be given access to telephone or email support. ----- ----- M-CBT clearly fulfills criteria for an LI CBT (see Bennett-Levy et al., Chapter 1, for a definition of LI interventions). Once written, they involve little therapist time and rely heavily on self-management. However, content and overall treatment duration need not be compromised. Long-term interventions with multiple components can be delivered via this method, provided their content can be communicated in letters and engagement is maintained.