The Emergency Department: Rising wait times, costs, and possible remedies

Emergency Departments (EDs) and Emergency Rooms (ERs) are designed to manage trauma, respond to disasters, and serve as the initial care for those with serious illnesses. However, because of many factors, the ED has become the doorway to the hospital and a “catch-all net” for patients including those with non-urgent needs. This increase in the population in the ED has lead to an increase in wait times for patients. It has been well documented that there has been a constant and consistent rise in the number of patients that frequent the ED (National Center for Health Statistics, 2002); the wait time for patients in the ED has increased (Pitts, Niska, Xu, & Burt, 2008); and the cost of the treatment in the ER has risen (Everett Clinic, 2008). Because the ED was designed to treat patients who need quick diagnoses and may be in potential life-threatening circumstances, management of time can be the ultimate enemy. If a system was implemented to decrease wait times in the ED, decrease the use of ED resources, and decrease costs endured by patients seeking care, better outcomes for patients and patient satisfaction could be achieved. The goal of this research was to explore potential changes and/or alternatives to relieve the burden endured by the ED. In order to explore these options, data was collected by conducting one-on-one interviews with seven physicians closely tied to a Level 1 ED (Emergency Room physicians, Trauma Surgeons and Primary Care physicians). A qualitative analysis was performed on the responses of one-on-one interviews with the aforementioned physicians. The interviews were standardized, open-ended questions that probe what makes an effective ED, possible solutions to improving patient care in the ED, potential remedies for the mounting problems that plague the ED, and the feasibility of bringing Primary Care Physicians to the ED to decrease the wait times experienced by the patient. From the responses, it is clear that there needs to be more research in this area, several areas need to be addressed, and a variety of solutions could be implemented. The most viable option seems to be making the ED its own entity (similar to the clinic or hospital) that includes urgent clinics as a part of the system, in which triage and better staffing would be the most integral part of its success.^

A commentary on the global position of South African accounting research

The South African designation of Chartered Accountant is comparable to similar designations in most developed countries. However, the research outputs of Accountancy academics in South Africa seem to lag far behind those of their counterparts abroad. This article discusses the results of several inquiries into the status of South African Accounting research in a global context, and identifies several reasons and possible remedies for low research output.

On global solar dynamo simulations

Global dynamo simulations solving the equations of magnetohydrodynamics (MHD) have been a tool of astrophysicists who try to understand the magnetism of the Sun for several decades now. During recent years many fundamental issues in dynamo theory have been studied in detail by means of local numerical simulations that simplify the problem and allow the study of physical effects in isolation. Global simulations, however, continue to suffer from the age-old problem of too low spatial resolution, leading to much lower Reynolds numbers and scale separation than in the Sun. Reproducing the internal rotation of the Sun, which plays a crucual role in the dynamo process, has also turned out to be a very difficult problem. In the present paper the current status of global dynamo simulations of the Sun is reviewed. Emphasis is put on efforts to understand how the large-scale magnetic fields, i.e. whose length scale is greater than the scale of turbulence, are generated in the Sun. Some lessons from mean-field theory and local simulations are reviewed and their possible implications to the global models are discussed. Possible remedies to some of the current issues of the solar simulations are put forward.

Biometric challenges in fisheries research

This paper analyses the Biometric challenges in fisheries research from a cross section of activities in the core research areas, annual reports, technical reports, dissertations and field visits and provides insight into the development of possible remedies to the various challenges.

Human interfaces to structured documents

This research investigates some of the reasons for the reported difficulties experienced by writers when using editing software designed for structured documents. The overall objective was to determine if there are aspects of the software interfaces which militate against optimal document construction by writers who are not computer experts, and to suggest possible remedies. Studies were undertaken to explore the nature and extent of the difficulties, and to identify which components of the software interfaces are involved. A model of a revised user interface was tested, and some possible adaptations to the interface are proposed which may help overcome the difficulties. The methodology comprised: 1. identification and description of the nature of a ‘structured document’ and what distinguishes it from other types of document used on computers; 2. isolation of the requirements of users of such documents, and the construction a set of personas which describe them; 3. evaluation of other work on the interaction between humans and computers, specifically in software for creating and editing structured documents; 4. estimation of the levels of adoption of the available software for editing structured documents and the reactions of existing users to it, with specific reference to difficulties encountered in using it; 5. examination of the software and identification of any mismatches between the expectations of users and the facilities provided by the software; 6. assessment of any physical or psychological factors in the reported difficulties experienced, and to determine what (if any) changes to the software might affect these. The conclusions are that seven of the twelve modifications tested could contribute to an improvement in usability, effectiveness, and efficiency when writing structured text (new document selection; adding new sections and new lists; identifying key information typographically; the creation of cross-references and bibliographic references; and the inclusion of parts of other documents). The remaining five were seen as more applicable to editing existing material than authoring new text (adding new elements; splitting and joining elements [before and after]; and moving block text).

Sistemas prisionais europeus

Ao longo dos últimos anos a reforma dos sistemas prisionais e a eficácia da reinserção social têm vindo a integrar as agendas políticas dos governos dos países europeus. Esta reforma deriva de vários problemas e carências com que se debatem os diversos sistemas prisionais, nomeadamente a sobrelotação, o ambiente propício à violência, o consumo de drogas, a inactividade do recluso e o elevado índice de reincidência criminal. Porém, qualquer reforma que se venha a delinear compreende matérias muito complexas que vão desde os direitos humanos aos recursos humanos e financeiros, imperativos legais, bem como a conciliação entre a punição e a ressocialização. Estas matérias não dependem apenas da vontade política, mas igualmente da sociedade, a qual ainda ergue barreiras à reinserção, tratando o ex-recluso como um excluído da sociedade. Neste sentido, os estudos universitários constituem um elemento chave na procura de soluções para esta problemática, na medida em que se servem das várias áreas do saber para de alguma forma contribuir com possíveis soluções, tendo em vista a melhoria de todo o sistema prisional e a eficácia da reinserção social. Esta dissertação tem assim como objectivo apresentar os principais modelos de sistemas prisionais adoptados em países europeus e efectuar uma comparação entre estes. Pretende-se retirar os aspectos mais relevantes de cada sistema e que têm contribuído para a melhoria das condições dos reclusos e do aumento da reinserção destes na sociedade, bem como na diminuição da taxa de reincidência criminal.

Clustering of attitudes towards obesity: a mixed methods study of Australian parents and children

BACKGROUND: Current population-based anti-obesity campaigns often target individuals based on either weight or socio-demographic characteristics, and give a 'mass' message about personal responsibility. There is a recognition that attempts to influence attitudes and opinions may be more effective if they resonate with the beliefs that different groups have about the causes of, and solutions for, obesity. Limited research has explored how attitudinal factors may inform the development of both upstream and downstream social marketing initiatives. METHODS: Computer-assisted face-to-face interviews were conducted with 159 parents and 184 of their children (aged 9-18 years old) in two Australian states. A mixed methods approach was used to assess attitudes towards obesity, and elucidate why different groups held various attitudes towards obesity. Participants were quantitatively assessed on eight dimensions relating to the severity and extent, causes and responsibility, possible remedies, and messaging strategies. Cluster analysis was used to determine attitudinal clusters. Participants were also able to qualify each answer. Qualitative responses were analysed both within and across attitudinal clusters using a constant comparative method. RESULTS: Three clusters were identified. Concerned Internalisers (27% of the sample) judged that obesity was a serious health problem, that Australia had among the highest levels of obesity in the world and that prevalence was rapidly increasing. They situated the causes and remedies for the obesity crisis in individual choices. Concerned Externalisers (38% of the sample) held similar views about the severity and extent of the obesity crisis. However, they saw responsibility and remedies as a societal rather than an individual issue. The final cluster, the Moderates, which contained significantly more children and males, believed that obesity was not such an important public health issue, and judged the extent of obesity to be less extreme than the other clusters. CONCLUSION: Attitudinal clusters provide new information and insights which may be useful in tailoring anti-obesity social marketing initiatives.

RP979-56 Long-Term Installment Land Contracts

The installment land contract is both an instrument of transfer and a method of financing sales of land. If properly drawn, it can have a number of advantages for both the buyer and seller. Both parties should contact their attorneys to be sure that the terms of the contract are clearly stated and understood. This research publication discusses how long-term installment land contracts are used in the agricultural community.

The Holdout Problem and Urban Sprawl

Developers attempting land assembly often face a potential holdout problem that raises the cost of development. To minimize this extra cost, developers will prefer land whose ownership is less dispersed. This creates a bias toward development at the urban fringe where average lot sizes are larger, resulting in urban sprawl. This paper examines the link between the holdout problem and urban sprawl and discusses possible remedies.

Searching for harm or harming search? A look at the European Commission’s antitrust investigation against Google. CEPS Special Report No. 118/September 2015

As the European Commission’s antitrust investigation against Google approaches its final stages, its contours and likely outcome remain obscure and blurred by a plethora of nonantitrust-related arguments. At the same time, the initial focus on search neutrality as an antitrust principle seems to have been abandoned by the European Commission, in favour of a more standard allegation of ‘exclusionary abuse’, likely to generate anticompetitive foreclosure of Google’s rivals. This paper discusses search neutrality as an antitrust principle, and then comments on the current investigation based on publicly available information. The paper provides a critical assessment of the likely tests that will be used for the definition of the relevant product market, the criteria for the finding of dominance, the anticompetitive foreclosure test and the possible remedies that the European Commission might choose. Overall, and regardless of the outcome of the Google case, the paper argues that the current treatment of exclusionary abuses in Internet markets is in urgent need of a number of important clarifications, and has been in this condition for more than a decade. The hope is that the European Commission will resist the temptation to imbue the antitrust case with an emphasis and meaning that have nothing to do with antitrust (from industrial policy motives to privacy, copyright or media law arguments) and that, on the contrary, the Commission will devote its efforts to sharpening its understanding of dynamic competition in cyberspace, and the tools that should be applied in the analysis of these peculiar, fast-changing and often elusive settings.

Relaunching the European Retail Finance Market: Comments on the Commission's Green Paper. ECRI Commentary No. 20, 15 December 2015

The European Commission’s Green Paper on retail financial services, published on December 10th, provides valuable insights into the possible benefits of a single market, as well as the obstacles to its development and the possible remedies. While a greater diversity of products within countries could have a positive impact on both consumers and providers, it is also important to highlight that it could contribute to more effective macroeconomic policies at European level. The development of such a single market for Europe where consumers can confidently purchase more profitable financial products abroad necessitates the establishment of a European body along the lines of the US Consumer Financial Protection Bureau (CFPB), or at least the establishment of closer European supervisory cooperation and enforcement. A framework for the digitalisation of financial services should not only focus on mitigating specific types of risk, such as cyber insecurity, lack of privacy and financial exclusion, but it should also continue to maintain a “space of creation” for innovative financial firms.

Essays on the Issue of Piracy in the Market of Information Goods

Thesis (Ph.D.)--University of Washington, 2016-06

Trademark Licensing in Keyword Advertising

This article examines the use of trademarks as keywords in sponsored links campaigns - in particular the impact of such usage on consumer confusion. It is thus important to highlight that there are a number of reasons why a consumer uses search engines. For example, it may be that a consumer searches for a type of product or service that appeals to them; the consumer may engage in comparison-shopping; or the consumer may already know the specific brand that he or she intends to purchase. Secondly, this article explores the possibility of infringement on other functions of trademarks in the case of the double-identity rule. Thirdly, the article discusses the negative aspects of broadening the concept of taking advantage and isolates this concept from the possibilities of confusion, detriment to the distinctive character, or the reputation of the trademark. Lastly, the article proposes possible remedies to the current situation – in particular the introduction of licensing models for the use of trademarks in keyword advertising and the application of the law on comparative advertising regarding the way the licensee uses those trademarks.