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Benefits of emergency department routine blood test performance on patients whose allocated triage category is not time critical: a retrospective study
Get PDFIntroduction: Emergency department clinicians, and particularly nurses in triage, frequently perform routine blood tests on patients whose allocated triage category is not time critical (triage categories 3, 4 and 5 of the Australasian Triage Scale). Some observers have questioned the utility of routine blood testing in these acute healthcare settings given the cost and workload implications. Methods: A quantitative method using retrospective observational design was utilised guided by STROBE checklist. Electronic medical records of patient data collected at a quaternary Australian metropolitan hospital emergency department were reviewed. Results and discussion: A total of 74,878 adult patients attended the emergency department between 1st January and 31st December 2021 and a sample of 383 were randomly allocated for this study. Of the 383 patients included, 51% were female, age ranges were 18–99 years (mean 51.6). The majority were Australasian Triage scale (ATS) triage category 3 (55%) and 62% had blood tests performed. Blood test performance was found to be associated with advancing age (p < 0.001) but not with department occupancy as determined by the national emergency department overcrowding scale (p = 0.230). Conclusion: Blood testing in the emergency department in triaged non-time critical patients was found to be frequent thereby affecting nurses’ already stretched time resource. Older patients were found to be more likely to have a blood test. There is a positive correlation between blood test performance and length of stay in the emergency department. © Crown 2024
Exploring the stepped care model in delivering primary mental health services—a scoping review
Get PDFThe stepped care model (SCM) is a patient-centred approach to mental health care, offering a range of services from least to most intensive, tailored to individual needs. This scoping review examines the adoption, effectiveness, challenges and implications associated with applying SCM within primary mental health service delivery. Evidence from global sources suggests the model is viable, effective and useful. This review explores the literature available, clarifies fundamental concepts and identifies existing knowledge gaps. The literature search included CINAHL, MEDLINE, PsycINFO, Scopus, the Federation University library, Google and Google Scholar databases. A systematic keyword-based search using terms like “stepped care model,” “mental health,” and “primary care”; and a combination of keywords and subject headings, were used. The search strategy was refined by considering factors such as relevance, publication date, objectives and outcomes. This strategy yielded 20 papers compiled in this review. They include randomised controlled trials and cross-sectional studies. The review supports SCM adoption in primary mental health care but acknowledges the need for further research. Key inclusions of the review include cost-effectiveness, diverse diagnoses, efficacy and the model's structural configuration. Clear treatment details, delivery methods, intervention durations and chronological sequences are essential. This systematic approach enhances generalisability across different SCM models and areas, strengthening reliable inferences. In summary, the SCM holds promise for enhancing mental health service delivery. However, there is a need to further examine the factors that determine its effectiveness and understand the different ways in which SCM is implemented. Such inquiry forms the foundation for implementing and advancing mental health care services in Australia and internationally. © 2024 The Author(s). International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd
Assessing the impact of griefing in MMORPGs using self-determination theory
Get PDFToxic behavior has been impacting players in online multiplayer environments since their inception. Griefing is a type of toxic behavior that focuses on player-to-player in-game disruption and is quite prevalent. However, research into the extent of the impact is still scarce. The present study investigated the impact on the psychological needs of autonomy, competence, and relatedness, as defined by the self-determination theory, for players that perform griefing (the griefers) and those subjected to griefing (the griefed). A sample of 656 respondents from massively multiplayer online role-playing game communities participated in the study. The results discovered that for the majority of players there is no change to their wellbeing, but that when there was a change, the griefed players in general were impacted more negatively, and the perpetrators were impacted more positively. Significant associations also revealed that the magnitude of impacts increased as the player was subjected to or performed griefing more frequently. © 2024 The Author
Prioritising the experimental procedures for Mode I fracture toughness using fuzzy group Multi Criteria Decision Making (MCDM) Methods
No full textMode I fracture toughness is the most common amongst the three fracture modes because of its applications in rocks/materials engineering. There are different experimental methods that are available for its measurements and the selection of the available procedures to be used is usually a difficult task and highly multi criteria in nature. Therefore, this study proposed novel applications of two fuzzy-based multi criteria decision making (MCDM) methods for prioritising the experimental procedures. Thirteen different experimental methods were identified and evaluated under three different criteria by the experts. The weights were computed using both expert-assigned weights to each criterion and the fuzzy intuitionistic entropy measure obtained weights. This study reveals that ISRM-suggested cracked chevron notched Brazilian disc method is the most preferred follow by the semi-circular bend specimen and Brazilian disc method. The Pearson’s correlation between the models is very strong (˃ 0.9), indicating that either of the two proposed approaches is suitable for this purpose. The sensitivity analysis was conducted by generating twenty-one sets of weights and the outcome ranked ISRM-suggested cracked chevron notched Brazilian disc, the most suitable follow by semi-circular bend specimen and Brazilian disc methods. The correlations amongst the MCDM methods for the sensitivity analysis are also very strong as previously observed. This study shows that the proposed models are suitable in prioritising the most appropriate experimental procedures for mode I fracture toughness. © The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature 2024
Community Energy and Microgrids : Control, Operation and Optimization
No full textThis book focuses on community energy and microgrids with details including system control, operation, optimization, as well as communication requirements. It provides insight into future community microgrids development for scholars/engineers in academic and industry communities with conceptual illustration, investigations, and examples in the changing energy landscape. The topics covered includes Basic understanding of community energy and microgrids; Overview of cutting-edge technologies in power converter control and distributed power generation; Energy storage systems and electric vehicles in home energy systems; Demand response and fault protection with working principles; Monitoring, communication and control of a microgrid from a practical point of view, toward operational benefit optimization. This book can promote research in renewable energy and future smart grid and motivate the generation of new technologies to address the current challenges. The target audiences include scholars, researchers, students, lab technicians, engineers, managers in both academic and industry broader communities
The influence of rock slope scales of joint network and slope height on the stability and failure mechanisms
No full textThis paper demonstrates the influence of slope geometry and scale of the joint networks on the stability and failure mechanisms in discontinued rock masses. These analyses are based on the finite element method (FEM) to calculate the factor of safety (FOS) and to simulate the explicit discontinuity deformations for different scales of rock masses. The study was carried out through examples of regular jointed models having different slope heights and irregular jointed dry rock slopes. Joints usually decrease the strength of the slopes and suggestively increase slope stability problems. The result shows that the slope stability decreases with increased block size and shape and that the irregular columnar joints are more unfavorable to the slope stability than the regular joints. Furthermore, with dropping the factor of safety and randomly distributed joints the rock failure mechanism appears to shift from structurally controlled for the 50 m slopes towards a step-like failure path for the 100 m and 200 m slopes. © 2024, Iraq Geological Survey. All rights reserved
An attachment-based family therapy for anxiety and depression in children : a mixed-methods evaluation of BEST-Foundations †
No full textBackground/Objectives: Parent–child attachment and family relationships have been identified as risk factors for childhood internalising symptoms such as anxiety and depressive symptoms. This mixed-methods evaluation examined the feasibility of a recently developed attachment-based family intervention, Behaviour Exchange Systems Therapy-Foundations (BEST-F), delivering 16 h of therapy over 8 weeks to treat internalising symptoms in children aged between 3 and 11 years. Methods: The quantitative outcomes of this uncontrolled study of 17 families were based on the parent-reported Child Behaviour Checklist (CBCL) measure, completed at four-timepoints (baseline, pre-, post-intervention, and follow-up), while qualitative data were collected from interviews with participants at follow-up. Results: Pre- and post-BEST-F intervention results demonstrated a significant change in internalising symptoms from the borderline and clinical range to the normal range, with a large effect size (d = 0.85). Notably, additional reductions in internalising symptoms were reported two months after cessation of treatment, with a very large effect size (d = 1.85). Furthermore, there were substantial reductions in child externalising symptoms and parental mental health symptoms, with large effect sizes ranging from d = 0.80 to 1.12. Qualitative reports were consistent with these quantitative findings. Conclusions: These pilot results suggest that children presenting with clinical-range internalising symptoms may benefit from family-based approaches where the parent–child relationship is a focus. © 2024 by the authors
Optimal fuzzy robust state feedback control for a five DOF active suspension system
Get PDFActive suspension systems are integral to modern vehicles, enhancing driving comfort by addressing road irregularities and isolating the vehicle's interior from vibrations. In this research, we construct an active suspension system with five degrees of freedom (DOF) and find the best fuzzy robust state feedback controller to control it. While designing the state feedback controller, we considered the initial errors in the relative displacement and acceleration as well as their derivatives. A singleton fuzzifier, center average russification, and product inference engine are all control parameters managed by a fuzzy system. Optimization using the Sine Cosine Algorithm (SCA) is then used to determine the optimal gains for the controller that has been constructed. The technique uses two objective functions for depreciation: the body's acceleration, the relative displacement between the tire and sprung mass. Results show that the suggested active suspension system is better than that of previous studies. © 2024 The Author(s
‘It's not just a matter of taking the drug. It's about changing the way you function in your society too’ : narratives of power and resistance in the lived experiences of opioid agonist therapy consumers in regional Victoria, Australia
No full textOpioid Agonist Therapy (OAT) has initiated extensive discussion regarding its efficacy, cost-effectiveness and best practice delivery. Although this discussion has been dominated by pharmacologists, clinicians, pharmacists and public policy-makers, there is increasing interest in examining OAT consumer experience and voice, particularly regarding consumers’ navigation and experience of the social field of their treatment. Concerned with the expression and circulation of power and resistance, Michel Foucault's work offers rich resources for examining OAT consumers’ experience and navigation of the social field of their treatment, including the administration of OAT as a harm reduction and social welfare intervention and consumers’ efforts to shape their relationships with medical and allied health professionals and other stakeholders. In the case of this study, Foucault's conceptions of power provide a productive means to critically interrogate the experience of 16 OAT consumers participating in pharmacotherapy treatments within a community pharmacy model in regional Victoria, Australia. Through the application of Foucauldian analyses of subjects and power to OAT participant accounts, precisely what the participant responses in our study have shown is that the relationship between OAT practitioners and consumers is neither always oppositional nor binary. Findings suggest that practitioners must pay attention to the everyday interactions they have with consumers (and others)—to how they communicate, listen, understand, present and provide solutions. Interactions with consumers should be treated as sites that produce complex power relations with moral and ethical implications for subjects, including consumers, practitioners and other stakeholders. Both practitioner and consumers need to remember that they are both productive subjects locked in a complex assemblage of practices and social discourses that circumscribe the social field of opioid treatments. © 202
Acute care nurses' decisions to recognise and respond to patient improvement : a qualitative study
Get PDFAim: To explore and describe acute care nurses’ decisions to recognise and respond to improvement in patients’ clinical states as they occurred in the real-world clinical environment. Design: A descriptive study. Methods: Nine medical and eleven surgical nurses in a large Australian metropolitan hospital were individually observed during nurse–patient interactions and followed up in interview to describe their reasoning and clinical judgements behind observed decisions. Verbal description of observations and interviews were recorded and transcribed. Reflexive thematic analysis was used to analyse the data. Results: The three themes constructed from the data were as follows: nurses checking in; nurses reaching judgements about improvements; and nurses deciding on the best person to respond. Acute care nurses made targeted assessment decisions based on predicted safety risks related to improvement in clinical states. Subjective and objective cues were used to assess for and make judgements about patient improvement. Acute care nurses’ judgment of patient safety and a desire to promote patient centred care guided their decisions to select the appropriate person to manage improvement. Conclusions: The outcomes of this research have demonstrated that the proven safety benefits of acute care nurses’ decision making in response to deterioration extend to improvement in patients’ clinical states. In response to improvement, acute care nurses’ decisions protect patients from harm and promote recovery. Implications for patient care: Early recognition and response to improvement enable acute care nurses to protect patients from risks of unnecessary treatment and promote recovery. Impact: This study makes explicit nurses’ essential safety role in recognising and responding to improvement in patients’ clinical states. Healthcare policy and education must reflect the equal importance of assessment for and management of deterioration and improvement to ensure patients are protected and provided with safe care. © 2024 The Author(s). Journal of Clinical Nursing published by John Wiley & Sons Ltd