PREHOSPITAL TROPONIN TESTING PROTOCOL FOR ACCELERATED DIAGNOSIS AND EARLY INTERVENTION IN CHEST PAIN PATIENTS

Non-ST elevation acute coronary syndromes (NSTE-ACS) have significant morbidity and mortality rates despite the progress made in diagnosis and management and represent a significant public health burden in the United States. Lengthy diagnostic algorithms contribute to emergency department over-crowding, increased health care costs, and adverse patient outcomes. A troponin assay instituted earlier in the diagnostic pathway of patients with chest pain suspected of NSTE-ACS will reduce time to definitive diagnosis and medical intervention. This will improve patient outcomes, decrease emergency department crowding through improved ED workflow, and reduce the economic burden. The Star Model of Knowledge Transformation was used to guide an understanding of the cycles, nature, and characteristics of knowledge of NSTE-ACS, organize previous and current concepts of improving care, and provided the framework to guide design, implementation, evaluation and sustainability. The Prehospital Troponin Testing Protocol (PHTTP) instituted a point-of-care troponin assay in the ambulances of the Plainview Fire-EMS department and used this value in an accelerated diagnostic pathway in the Covenant Plainview Emergency Department. The PHTTP reduced the time to first troponin from 79 minutes (1.32 hours) to 22 minutes (0.37 hours) and time to disposition of patients from 191.00 minutes (3.18 hour) to 150.04 minutes (2.50 hours). Time to first troponin was reduced by 47.00 minutes (0.78 hours) and length of stay was reduced by 40.96 minutes (0.67 hours). The prehospital scene time was increased by 1 minute which was not statistically significant

Final Report: Preparing Academics to Teach in Higher Education

This work is published under the terms of the Creative Commons Attribution-Noncommercial- ShareAlike 2.5 Australia Licence. Under this Licence you are free to copy, distribute, display and perform the work and to make derivative works. Support for the original work was provided by the Australian Learning and Teaching Council Ltd, an initiative of the Australian Government Department of Education, Employment and Workplace Relations

A critical analysis of arbitral provisional measures in England and Wales

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.Arbitral provisional measures are of great importance in protecting the rights of the parties to an arbitration agreement. Arbitration as a dispute mechanism is becoming increasingly powerful due to the ability of tribunals and courts to grant and enforce provisional measures which make the final award meaningful. The importance of provisional measures has increased in recent years as more parties are seeking them, and is likely to grow still more in the coming years. This project examines the problems surrounding arbitral provisional measures in England and Wales; as such problems constitute a threat to current and future arbitration. The thesis aims to identify, analyse and offer solutions to those problems that impede arbitral proceedings. This thesis initially examines the roots and the legislative development of the powers of arbitral tribunals to grant provisional measures and the role of the courts in arbitral proceedings in England. The examination highlights the roots of the problems and demonstrates how the approach towards provisional measures in England has shifted in due course from judicial dominance to arbitral competence, and how the role of the courts has become subsidiary. Further, the analysis highlights the problem of arbitrators in the granting and enforcement of provisional measures across borders, due to the inadequacy of the current Arbitration Act 1996, which provides very limited power to tribunals under its S.38,39 and 48. Additionally, the research aims to demonstrate that arbitral tribunals should be given effective and actual authority to grant arbitral provisional measures in order to comply with the arbitration agreement (party autonomy). Since no dispute mechanism can stand alone as an island, the courts should only become involved in support of the process – subject to the arbitral Acts that provide them with exclusive jurisdiction –where this is necessary in order to avoid conflicting decisions. However, the power of the courts to aid arbitration in granting such measures is limited by Council Regulation (EC) 44/2001 of the European Union, of which England is a member. In international arbitration, timely application and enforcement of interim measures have a substantial effect on the possibility of the enforcement of a final arbitration award, especially when issues relating to the protection of assets or evidence arise before or during the course of proceedings. Hence the purpose of this project is to provide a brief analysis of the international practice regarding the enforcement of provisional measures in international arbitration

More than the power of two: leading school improvement in Indigenous education

Australian schools are now under constant pressure to improve their schools for students to have increased achievement and wellbeing outcomes, particularly for Aboriginal and Torres Strait Islander learners. This thesis has investigated the professional relationships of Indigenous Education Workers/Community Education Counsellors (IEWs/CECs) and principals and how they can lead together to improve their schools for Aboriginal and Torres Strait Islander students. Until now, their professional relationship has not been well understood or documented. This thesis captures the research that has sought to examine, interpret and transform the ambiguity of the professional relationship between IEW/CEC and principal. On another level, the study has aimed to highlight effective practice, inform future improvements for Indigenous education within the schools studied and for those in the greater region, and finally, provide a call for change of policy and practice within the wider school system of Queensland. Informed by a plurality of paradigms, that of transformation and pragmatism and a tripartite of theory—critical theory, Indigenous standpoint theory and relationship leadership theory—this investigation was conducted across a large state educational region in Queensland. Using a mixed methods approach, quantitative and qualitative data were concurrently and sequentially collected over two phases in a four-year process. Each phase provided a collection of data that contributed to the separate and integrated, consecutive analysis of the core research questions. In Phase 1, 41 principals and 35 IEWs/CECs were surveyed for the broad analysis of the region's schools and contributed answers to the first core research question. In Phase 2, an instrumental case study was then undertaken in four schools with five exemplar IEW/CEC and principal pairs within the same region. The predominant methodological orientation for the case study was participatory and an adaption of critical participatory action research (CPAR) was conducted in three cycles over three years. Case study data were collected from a partnership assessment questionnaire, nine hours of responsive interviews, school documents and descriptive field notes from 13 site visits. This provided data for a holistic and detailed analysis of the IEW/CEC and principal professional relationship to answer all of the core research questions. Overall three rounds of data analysis occurred, multiple logics were employed together, with abduction, deduction and induction of descriptive statistics and thematic analysis of documentation. Results of this study indicate while similar conditions were experienced by most schools across the region, the IEW/CEC and principal relationship was variable and fragmented for many and the role of IEW/CEC was underestimated and underutilised. The case study pairs presented differently and of the six relational dynamics evident between every pair, the most highly enacted was that of trusting interpersonal communication. Their strong relationships were created through certain personal predispositions and deliberate practices, but these occurred more by chance and less by systemic design. Strong relationships between IEW/CEC and principals showed they could mitigate detrimental contextual features like racism, perceived or actual uncertainty of funding and insufficiency of system support, while they ameliorated school members' capacity so leader agency, student success, parent engagement and staff cultural competency growth could occur. This study revealed that the IEW/CEC and principal relationship was not only microcosmic to school-community partnerships, but was also that of the greater project of national reconciliation. This thesis provides implications that call for a change of policy and practice within the wider school system in the state of Queensland. It concludes that if educational outcomes for Indigenous students and engagement their families are to be maximised, professional relationships between IEWs/CECs and their principals need to exist and then expand beyond the pair through deliberate and greater systemic support. The position of IEW/CEC needs to be guaranteed in schools, training for Indigenist perspectives must be promulgated and systemic provision of resources for IEWs/CECs and principals in schools to grow their professional relationship must occur. A strong IEW/CEC and principal relationship can lead to less a transactional and different type of leader collaboration, one that creates a 'vorticity' of influence that enrols others into taking on the responsibility of supporting every Aboriginal and Torres Strait Islander student succeed, something that is more than the power of two

Epidemiology of cancer as a tool to develop a population based cancer registry in the United Arab Emirates

The purpose of this study was to assess the possibility of developing a population based cancer registry in the United Arab Emirates. As this was retrospective and explorative in nature, the study was performed in two stages, the initial stage where the researcher examined critically routinely collected data that is needed to support a cancer registry as well as assessed data on cancer that were obtained from Al Mafraq Hospital records. The final stage took place in Al Ain Medical District where detailed study of the existing practice with respect to cancer registration were undertaken in respond to a request form Ministry of Health, data on cancer were obtained from health care services and cancer registry records. Other information was obtained from key officials and health professionals in the district using qualitative methods. The initial stage showed that this was the first study of this kind in the United Arab Emirates and that cancer data production and recording is a complex intervention, where health and health related professionals and patients are involved. It also revealed that the key professionals were supportive to the study and showed positive attitude. The initial study indicated that there was deficiency in the data collected routinely as well as there was no cancer registry in Al-Mafraq Hospital. Furthermore, the data collected from medical record witnessed deficiency in their completeness and quality. Lack of education and training related to cancer data handling were observed during the fieldwork. The assessment of the population data sources indicated that there was no single data source that might provide a comprehensive and accurate data regarding Al Ain population. This condition was mainly created due to unique demographic pattern of a highly mobile population dominated by expatriates. The final stage showed that health facilities in Al Ain Medical District are capable of producing cancer data especially clinical data. However deficiencies in item definition, complete recording and storing of data by health professionals within the health facilities were identified

Collaboration in English higher education estates

Globalisation and changes in public policy act as a catalyst for change in the English Higher Education Sector. Consequently, Institutions place a greater focus on their supply chain to offer services that best fit their requirements, during the construction and refurbishment of physical assets. The construction industry will need to offer innovation, value for money and other benefits that associate with the collaborative procurement movement, which has been gathering pace since the 1990s. The aim of the research is to develop a framework to evaluate collaborative practice in Higher Education Property and Estates’ departments in England. The work is practitioner research that relates to a real world problem. The objectives include: construct a suitable framework; develop the framework using a particular institution; and assess the framework in the wider context of England. The research philosophy has foundations in both constructionism and pragmatism. The work develops the initial framework using literature. A Primary Case Study tests, relates and develops the framework in practice. To an extent, the literature review is able to provide transferability of the maturity model, particularly in relation to the implementation and motivation themes. Where the literature review could not provide transferability, a pragmatic approach is undertaken to improve the transferability of the research findings, which uses data from 44 estate strategies, 6 auxiliary case studies, 11 tender notices and industry sources. Data is generally qualitative and from such sources as interviews and documentation. The work uses thematic content analysis to explore organisations and summative content analysis to improve transferability. The work embraces Robson’s strategy for validity including that, which associates with prolonged involvement, triangulation, peer debriefing, member checking and audit trail. The research deliverable includes a clearly defined framework. The Framework includes three maturity models, namely implementation, motivation and risk. Each model has a particular purpose in relation to clients overall deliverables. The implementation theme relates to working efficiently. The motivation theme relates to exceeding performance requirements. The risk theme relates to achieving performance requirements. The Framework is for use by Directors of Estates and other policy makers that make decisions concerning collaboration in property and estates departments. The particular emphasis is collaboration with supply chains. The purpose of the study is to create the framework. The study does not make generalisations concerning the use of collaborative features. The framework has been created using cross sectional data form across the English higher education sector. The framework will be of use in other sectors and geographical locations following further research