The impact of nurse practitioner services on cost, quality of care, satisfaction and wait times in the emergency department: A systematic review

Aims To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. Background The delivery of quality care in the emergency department is one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. Data A comprehensive search of four electronic databases from 2006-­‐2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. Methods A three step approach was used. Following a comprehensive search, two reviewers assessed identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data extracted using standardised tools. Results Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-­‐analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding impact on costs. Conclusion Synthesis of the available research attempts to provide an evidence base for emergency nurse practitioner service to guide healthcare leaders, policy makers and clinicians in reforming emergency department service provision. The findings suggest that further quality research is required for comparative measures of clinical and service effectiveness of emergency nurse practitioner service. In the context of increased health service demand and the need to provide timely and effective care to patients, such measures will assist in delivering quality patient care.

Rapid on-site evaluation of fine needle aspiration specimens by cytology scientists : a review of 3032 specimens

Objectives To determine: (1) the accuracy of cytology scientists at assessing specimen adequacy by rapid on-site evaluation (ROSE) at fine needle aspiration (FNA) cytology collections; and (2) whether thyroid FNA with ROSE has lower inadequacy rates than non-attended FNAs. Methods The ROSE of adequacy for 3032 specimens from 17 anatomical sites collected over a 20-month period was compared with the final report assessment of adequacy. ROSE was performed by 19 cytology scientists. The report profile for 1545 thyroid nodules with ROSE was compared with that for 1536 consecutive non-ROSE thyroid FNAs reported by the same cytopathologists during the study period. Results ROSE was adequate in 75% (2276/3032), inadequate in 12% (366/3032) and in 13% (390/3032) no opinion was rendered. Of the 2276 cases assessed as adequate by ROSE, 2268 (99.6%) were finally reported as adequate for assessment; eight specimens had adequacy downgraded on the final report. Fifty eight per cent of cases with a ROSE assessment of inadequate were reported as adequate (212/366), whereas 93% (363/390) with no opinion rendered were reported as adequate. The overall final report adequacy rate for the 3032 specimens was 94% (2843/3032). Confirmation of a ROSE of adequacy at reporting was uniformly high amongst the 19 scientists, ranging from 98% to 100%. The inadequacy rate for thyroid FNAs with ROSE (6%) was significantly (P < 0.0001) lower than for non-ROSE thyroid FNAs (17%). A significantly (P = 0.02) higher proportion of adequate ROSE thyroid specimens was reported with abnormalities, compared with non-ROSE thyroid collections. Conclusions Cytology scientists are highly accurate at determining specimen adequacy at ROSE for a wide range of body sites. ROSE of thyroid FNAs can significantly reduce inadequate reports.

Designing schools as effective 21st C learning spaces : a review

The Queensland Centre for Social Science Innovation was formed in 2012 to develop collaborations among the Queensland Government and five Queensland universities—The University of Queensland, Griffith University, Queensland University of Technology, James Cook University and Central Queensland University. Three priorities for initial projects were established by the Queensland Government with response by the participating universities. This project addressed the identified priority area: factors affecting educational achievement and investigation of the link between school design, refurbishment and educational outcomes. The proposal for this project indicated that a Review of research literature would be undertaken that linked school and classroom design with educational outcomes for learners in the 21st century. Further, research would be examined for impact of technology on staff and students, as well as learning spaces that addressed the diversity of student learners. Specific investigation of research on effective design to enhance learning outcomes for Aboriginal and Torres Strait Islander students was to be undertaken. The project therefore consists of a Review of research literature to provide an evidence base on the impact of school and classroom on educational outcomes. The original proposal indicated that indicators of successful school and classroom design would be student learning outcomes on a range of variables, with input, the specific architectural design elements. The review was undertaken during the period July 2012 to June 2013. A search was undertaken of journals, databases, and websources to identify relevant material. These were examined for evidence-based statements and design of learning spaces to enhance learning. The Review is comprehensive, and representative of issues raised in research, and conceptualisations and debates informing modern educational design. Initial findings indicated two key findings central to reading this Review. The first key finding is that the predominant focus of modern design of learning space is on process and the engagement of stakeholders. Schools are social institutions and development of a school as a learning space to suit 21st century learning needs necessarily involves the staff, students and other members of the community as key participants. The concept of social aspects of design is threaded throughout the Review. The second key finding is that little research explicitly examined the relationship between the design of learning spaces and educational outcomes. While some research does exist, the most explicitly-focused research uses narrow test-based achievement as the learning outcomes. These are not sympathetic to the overall framings of the research on 21st century learning, future schooling and the needs of the new generation of learners and society.

A review of the profile of endothelin axis in cancer and its management

The endothelins and their associated receptors are important controllers of vascular growth, inflammation and vascular tone. In cancer, they have roles in the control of numerous factors in cancer development and progression, including angiogenesis, stromal reaction, epithelial mesenchymal transitions, apoptosis, invasion, metastases and drug resistance. Also, we consider current information on the role of this signalling system in cancer and examine the state of the current cell, animal and clinical trials utilizing endothelin targeted drugs for cancer management. Although targeting the endothelin axis in cell lines and xenografts show some promise in retarding cellular growth, results from limited clinical trials in prostatic cancer are less encouraging and did not offer significant survival benefit. The ability to target both cancer cells and vasculature via endothelin is an important consideration that necessitates the further refining of therapeutic strategies as we continue to explore the possibilities of the endothelin axis in cancer treatment.

Carcinoma ex pleomorphic adenoma : a comprehensive review of clinical, pathological and molecular data

Carcinoma ex pleomorphic adenoma (Ca ex PA) is a carcinoma arising from a primary or recurrent benign pleomorphic adenoma. It often poses a diagnostic challenge to clinicians and pathologists. This study intends to review the literature and highlight the current clinical and molecular perspectives about this entity. The most common clinical presentation of CA ex PA is of a firm mass in the parotid gland. The proportion of adenoma and carcinoma components determines the macroscopic features of this neoplasm. The entity is difficult to diagnose pre-operatively. Pathologic assessment is the gold standard for making the diagnosis. Treatment for Ca ex PA often involves an ablative surgical procedure which may be followed by radiotherapy. Overall, patients with Ca ex PA have a poor prognosis. Accurate diagnosis and aggressive surgical management of patients presenting with Ca ex PA can increase their survival rates. Molecular studies have revealed that the development of Ca ex PA follows a multi-step model of carcinogenesis, with the progressive loss of heterozygosity at chromosomal arms 8q, then 12q and finally 17p. There are specific candidate genes in these regions that are associated with particular stages in the progression of Ca ex PA. In addition, many genes which regulate tumour suppression, cell cycle control, growth factors and cell-cell adhesion play a role in the development and progression of Ca ex PA. It is hopeful that these molecular data can give clues for the diagnosis and management of the disease.

Green IT segment analysis : an academic literature review

Research on Green Information Technology (IT) is becoming a prevalent research theme in Green Information Systems (IS) research. This article provides a review of 98 papers published on Green IT between 2007−2013 to facilitate future research and to provide a retrospective analysis of existing knowledge and gaps thereof. While some researchers have discussed phenomena such as Green IT, motivation of Green IT and the Green IT adoption lifecycle, others have researched the importance of Green IT implementation within the organisational and individual level. Throughout the literature, scholars are trying to portray a constructive relationship between IT and the environment. Through our analysis, we can provide an assessment of the status of information systems literature on Green IT and, we provide taxonomy of segments of Green IT publications. Future research opportunities are identified based on the review.

A review of the effects of sedation on thermoregulation : insights for the cardiac catheterisation laboratory

Purpose To examine the effects that the sedative and analgesic medications which are commonly used in the cardiac catheterisation laboratory have on thermoregulation. Design A structured review strategy was used. Methods Medline and CINAHL were searched for published studies and reference lists of retrieved studies were scrutinized for further research. Data were extracted using a standardised extraction tool. Results A total of nine studies examined the effect that sedative and analgesic medications have on thermoregulation. Midazolam has minimal impact on thermoregulation while opioids, dexmedetomidine and propofol markedly decrease vasoconstriction and shivering thresholds. Conclusions Patients who receive sedation in the cardiac catheterisation laboratory may be at risk of hypothermia, due to the use of medications that impair thermoregulation. Further research is required to identify the prevalence of unplanned hypothermia during sedation in the cardiac catheterisation laboratory.

Review and future options for computer modelling in the sugar industry

Computer modelling has been used extensively in some processes in the sugar industry to achieve significant gains. This paper reviews the investigations carried out over approximately the last twenty five years,including the successes but also areas where problems and delays have been encountered. In that time the capability of both hardware and software have increased dramatically. For some processes such as cane cleaning, cane billet preparation, and sugar drying, the application of computer modelling towards improved equipment design and operation has been quite limited. A particular problem has been the large number of particles and particle interactions in these applications, which, if modelled individually, is computationally very intensive. Despite the problems, some attempts have already been made and knowledge gained on tackling these issues. Even if the detailed modelling is wanting, a model can provide some useful insights into the processes. Some options to attack these more intensive problems include the use of commercial software packages, which are usually very robust and allow the addition of user-supplied subroutines to adapt the software to particular problems. Suppliers of such software usually charge a fee per CPU licence, which is often problematic for large problems that require the use of many CPUs. Another option to consider is using open source software that has been developed with the capability to access large parallel resources. Such software has the added advantage of access to the full internal coding. This paper identifies and discusses the detail of software options with the potential capability to achieve improvements in the sugar industry.

Rectifier systems for variable speed wind generation : a review

The drive towards high efficiency wind energy conversion systems has resulted in almost all the modern wind turbines to operate in the variable speed mode which inevitably requires back-to-back power electronic converters to decouple generator dynamics from the grid. The aim of this paper is to present an analysis on suitable topologies for the generator-side converter (rectifier) of the back-to-back converter arrangement. Performance of the two most popular rectifier systems, namely, the passive diode bridge rectifier and the active six-switch two-level rectifier are taken as two extremes to evaluate other topologies presented in this paper. The other rectifier systems considered in this study include combinations of a diode bridge rectifier and electronic reactance(s), a combination of a rectifier and a dc-dc converter and a half controlled rectifier. Diode-clamped and capacitor-clamped three-level active rectifier topologies and their possible switch reductions are also discussed in relation to the requirements of modern high power wind energy conversion systems (WECSs). Simulation results are presented to support conclusion derived from this analysis.

Plasmodium falciparum parasites lacking histidine-rich protein 2 and 3 : a review and recommendations for accurate reporting

Malaria rapid diagnostic tests (RDTs) play a critical role in malaria case management, surveillance and case investigations. Test performance is largely determined by design and quality characteristics, such as detection sensitivity, specificity, and thermal stability. However, parasite characteristics such as variable or absent expression of antigens targeted by RDTs can also affect RDT performance. Plasmodium falciparum parasites lacking the PfHRP2 protein, the most common target antigen for detection of P. falciparum, have been reported in some regions. Therefore, accurately mapping the presence and prevalence of P. falciparum parasites lacking pfhrp2 would be an important step so that RDTs targeting alternative antigens, or microscopy, can be preferentially selected for use in such regions. Herein the available evidence and molecular basis for identifying malaria parasites lacking PfHRP2 is reviewed, and a set of recommended procedures to apply for future investigations for parasites lacking PfHRP2, is proposed.

A review of modern computational algorithms for Bayesian optimal design

Bayesian experimental design is a fast growing area of research with many real-world applications. As computational power has increased over the years, so has the development of simulation-based design methods, which involve a number of algorithms, such as Markov chain Monte Carlo, sequential Monte Carlo and approximate Bayes methods, facilitating more complex design problems to be solved. The Bayesian framework provides a unified approach for incorporating prior information and/or uncertainties regarding the statistical model with a utility function which describes the experimental aims. In this paper, we provide a general overview on the concepts involved in Bayesian experimental design, and focus on describing some of the more commonly used Bayesian utility functions and methods for their estimation, as well as a number of algorithms that are used to search over the design space to find the Bayesian optimal design. We also discuss other computational strategies for further research in Bayesian optimal design.

A review on solar assisted heat pump systems in Singapore

A solar assisted heat pump is used for different applications, such as, water heating, drying and air conditioning. The unglazed evaporator-collector enables to absorb both solar energy and ambient energy due to low operating temperature. Three different systems are described: solar assisted heat pump system for hot water using an unglazed evaporator collector; solar assisted heat pump for hot water and drying, where evaporator collector and air collector are used; an integrated solar heat pump system making use of solar and ambient energy, and air-con waste heat. Unlike conventional collector, evaporator collector was found to have higher efficiency, 80% to 90%, and the coefficient of performance attained a value as high as 8.0. The integrated system leads to a reduction of global warming, as it uses solar energy, ambient energy and air-con waste heat.

A review of the potential role of greenhouse gas abatement in native vegetation management in Queensland's rangelands

Concern about the risk of harmful human-induced climate change has resulted in international efforts to reduce greenhouse gas emissions to the atmosphere. We review the international and national context for consideration of greenhouse abatement in native vegetation management and discuss potential options in Queensland. Queensland has large areas of productive or potentially productive land with native woody vegetation cover with approximately 76 million ha with woody cover remaining in 1991. High rates of tree clearing, predominantly to increase pasture productivity, continued throughout the 1990s with an average 345,000 ha/a estimated to have been cleared, including non-remnant (woody regrowth) as well as remnant vegetation. Estimates of greenhouse gas emissions associated with land clearing currently have a high uncertainty but clearing was reported to contribute a significant proportion of Australia's total greenhouse gas emissions from 1990 (21%) to 1999 (13%). In Queensland, greenhouse emissions from land clearing were estimated to have been 54.5 Mt CO(2)-e in 1999. Management of native vegetation for timber harvesting and the proliferation of woody vegetation (vegetation thickening) in the grazed woodlands also represent large carbon fluxes. Forestry (plantations and native forests) in Queensland was reported to be a 4.4 Mt CO(2)-e sink in 1999 but there are a lack of comprehensive data on timber harvesting in private hardwood forests. Vegetation thickening is reported for large areas of the c. 60 million ha grazed woodlands in Queensland. The magnitude of the carbon sink in 27 million ha grazed eucalypt woodlands has been estimated to be 66 Mt CO(2)-e/a but this sink is not currently included in Australia's inventory of anthropogenic greenhouse emissions. Improved understanding of the function and dynamics of natural and managed ecosystems is required to support management of native vegetation to preserve and enhance carbon stocks for greenhouse benefits while meeting objectives of sustainable and productive management and biodiversity protection.