When investors buy up the neighborhood: preventing investor ownership from causing neighborhood decline

Across the country, communities are struggling with the negative spillover effects of foreclosure. In states such as Arizona, California, and Nevada, an additional concern is the increased number of investors who are purchasing distressed properties. While investors are an important part of a vibrant housing market and can provide high-quality and affordable rental properties, there is a danger that unscrupulous investors are buying these properties without the intent to maintain them or contribute to the health of the surrounding neighborhood. This article, an excerpt from a longer report published by PolicyLink, reviews strategies that local governments can use to prevent investor ownership from causing neighborhood decline.

Fallen Kingdom: A Novella

Fallen Kingdom is a work of fiction that falls into the category of fantasy/romance. Exploring themes of PTSD and loss of self, we begin in a world on the brink of ruin. After The Fall, Scarlett finds herself in an unknown land, hunted, injured, and alone. She has few memories of her arrival or the time before--memories that become ever more frequent as a world of magic takes shape around her. Fallen Kingdom is a fast-paced, striking adventure that documents her struggle with responsibility, friendship, and love

Exploring Young Children\u27s Encounters with the More-Than-Human: A Multispecies Ethnography

Foregrounding moments from an early child care centre, this thesis employs a multispecies ethnography methodology to explore the opportunities children from a preschool class have to encounter the more-than-human in the ecological epoch of the Anthropocene. Drawing on a posthuman and common worlds theoretical framework, this thesis works to explore children/more-than-human entanglements that occur in a local, urban cemetery space while challenging practices of human exceptionalism in the field of early childhood education. Participants in the study included one preschool class of 16 three to four-year-old children and the diverse nonhuman residents of the cemetery space. Using a diffractive method of analysis, five data-stories tracing distinct multispecies encounters explore how the radical more-than-human turn is present and impactful at a local level, reshaping approaches to early childhood education in a community in Southern Ontario. This thesis concludes that the children express collective being and thinking within non-innocent, local, multispecies assemblages in unpredictable ways. It is through these complex entanglements children are experimenting with learning to live amid the inescapable relations within their common worlds

Evaluation of Student Competence in Simulation Following a Prebriefing Activity: A Pilot Study

Background: Simulation-based learning (SBL) shows promise to potentially improve clinical competence in nursing education. The efficacy of evidence-based prebriefing activities and valid and reliable systems to evaluate those strategies is a gap in the literature. Preliminary evidence shows that prebriefing can improve participant outcomes. The goal of this pilot study was to compare the outcome of clinical competence for prelicensure nursing students based on assignment to one of the following prebriefing activities: standard, careplan, or concept mapping. Methods: This is a quasi-experimental double-blind, posttest only, comparison-group design, pilot study. The participants were from an associate degree professional nursing program. Out of a potential 30 students, 28 agreed to participate. The data collection occurred during two laboratory sessions of their medical-surgical course. The students were exposed to an assigned prebriefing activity and then engaged in a simulation scenario. Two faculty simulation evaluators (FSEs) watched the videoed performance and evaluated the students’ clinical competence using the Creighton Competency Evaluation Instrument (C-CEI). Demographic data were used to analyze the homogeneity of the groups and to determine if other factors affected clinical competence. An ANOVA was used to answer the research questions. Results: Based on the analysis, gender, age, course grade, race and ethnicity, the groups were similar. Interrater reliability of the C-CEI overall (Kappa=0.096 with p=0.02) and communication (Kappa=0.349 with p=0.01) scores between the FSEs were significantly different. Based on their Cronbach’s alpha score (0.74) FSE Two’s ratings were used for analysis. There were no significant changes in C-CEI scores based on the students’ assigned prebriefing activity. There were significant differences between participant scores (communication 4.3(26), p = \u3c0.001; Clinical Judgement 2.7(26), p = 0.011; Overall 2.8(26), p = 0.01) based on their scenario. Conclusions: Issues with the FSFs and FSEs revealed ways to improved future simulation-based research. Ensuring scenario complexity is equivalent assures comparable participant performance. Measures to enhance FSE interrater reliability must be implemented. Limitations: The sample size was inadequate to determine statistically significant data. A lack of randomization of assignment to groups is also a limitation. An FSF provided additional cueing which could have affected some student’s C-CEI scores

Factors influencing pre-hospital decisions not to convey: a mixed methods study

This study has used a mixed methodology to explore the impact of geographic, temporal and ambulance crew skill factors on ambulance clinicians’ decisions to leave a patient on scene after attending a 999 call. Four phases of work were undertaken using both qualitative and quantitative methods to build an understanding of the complex nature of pre-hospital clinical reasoning. A novel scale, the DMASC survey was developed, which indicated four factors influence decision-making in this context. More experienced staff scored significantly differently to other staff groups on the ‘Experience’ and ‘Patient characteristic’ subscales of the tool. Qualitative work explored these findings in more detail and five inter-related themes were identified, namely, ‘Communication’, ‘The three ‘E’s’, education, experience and exposure’, ‘System influences’, ‘Professionalism’ and ‘Patient characteristics’. The final phase of the study undertook to analyse retrospective call data from one large ambulance service over a one-year period. All of the five predictor variables, rurality, time of day, day of the week, patient condition and crew skill level, influenced the likelihood of conveyance. Of these the level of clinical skill of the first crew at scene was independently significant. The results of this work are discussed in relation to the strategic and operational context of NHS ambulance services. The thesis is structured as a series of papers yet to be submitted for publication. Although this confers a degree of repetition, it provides a logical analysis of the methods used to explore factors that may influence paramedic’s clinical decision making when deciding to leave patients at home following a 999-call attendance

Development and pilot of clinical performance indicators for English ambulance services

Introduction: There is a compelling need to develop clinical performance indicators for ambulance services in order to move from indicators based primarily on response times and in light of the changing clinical demands on services. We report on progress on the national pilot of clinical performance indicators for English ambulance services. Method: Clinical performance indicators were developed in five clinical areas: acute myocardial infarction, cardiac arrest, stroke (including transient ischaemic attack), asthma and hypoglycaemia. These were determined on the basis of common acute conditions presenting to ambulance services and in line with a previously published framework. Indicators were piloted by ambulance services in England and results were presented in tables and graphically using funnel (statistical process control) plots. Results: Progress for developing, agreeing and piloting of indicators has been rapid, from initial agreement in May 2007 to completion of the pilot phase by the end of March 2008. The results of benchmarking of indicators are shown. The pilot has informed services in deciding the focus of their improvement programme in 2008 and 2009 and indicators have been adopted for national performance assessment of standards of prehospital care. Conclusion: The pilot will provide the basis for further development of clinical indicators, benchmarking of performance and implementation of specific evidencebased interventions to improve care in areas identified for improvement. A national performance improvement registry will enable evaluation and sharing of effective improvement methods as well as increasing stakeholder and public access to information on the quality of care provided by ambulance services

Joining the dots: measuring the effects of a national quality improvement collaborative in ambulance services

Context: We undertook a national collaborative to improve cardiovascular care by frontline clinicians in 12 English Ambulance Services. Data were collected by clinical audit staff and submitted centrally where they were collated and analysed. Problem: Cardiovascular disease is the commonest cause of death in the United Kingdom (UK). Acute Myocardial Infarction (AMI) causes 250,000 deaths per year and 1 in 3 heart attack victims die before reaching hospital. There are approximately 152,000 strokes per year causing more than 49,000 deaths. Early and effective treatment decreases death rates for AMI and stroke, improves long-term health and reduces future disability. National guidelines for ambulance clinicians are based on evidence for best clinical practice for AMI and stroke care by ambulance services as defined in the National Service Framework for CHD and National Stroke Strategy. Whilst ambulance clinicians were good at delivering specific aspects of care they were less effective at delivering whole bundles of care. Assessment of problem and analysis of its causes: The process of care delivered by English ambulance services is now assessed using National Clinical Performance Indicators (nCPIs) which include measures of complete bundles of care. The care bundle for AMI is: administration of aspirin and GTN, pain score recorded before and after treatment and administration of analgesia. The stroke care bundle consists of recording of FAST, blood glucose and blood pressure. A key project aim was to produce a sustained improvement in the national rate of care bundle delivery for AMI from 43% (range 26.2%-90.32%) to 90% and for stroke from 83.1% (range 39.4 %– 97.6%) to 90% within 2 years. Intervention: Frontline clinicians identified barriers and facilitators to delivery of care bundles and designed and tested new processes using quality improvement (QI) methods after being trained in process mapping, root cause analysis and Plan Do Study Act cycles. The effects of interventions were tracked using annotated control charts. Strategy for change: Quality Improvement Teams and Fellows were appointed in each service to form QI collaboratives. Collaboratives were responsible for developing and trialling localised interventions and spreading successful interventions more widely within Trusts. QI Fellows were to meet regularly to share learning. Measurement of improvement: Statistical Process control (SPC) methods were utilised to measure the effectiveness and sustainability of interventions. Effects of changes: With 6 months of the project left to run, the nCPIs have shown improvements in the care bundle for STEMI (mean 58.8%) and Stroke (mean 89.8%) with significant improvements in some trusts. There is evidence in some Trusts that interventions (particularly those affecting a whole Trust) are being reflected in the data although more data is needed to see whether these changes will be sustained. Lessons learnt: Small sample sizes sometimes made local level measurement of change problematic and ways of overcoming this were developed. Barriers in service reconfiguration caused delays in starting collaboratives or trialling interventions; this highlighted the importance o f ensuring that corporate bodies clearly understood the scale and purpose of the collaboratives. Baseline and prospective data collection took longer than expected and resources for this were stretched, particularly in Trusts without electronic systems. If running similar projects on a similar scale greater clarity about roles and expectations around resourcing data collection would be needed from the outset. Annotation of the control charts proved invaluable in monitoring the effects of interventions and their sustainability. Message for others: Annotated control charts were a powerful tool in determining whether and to what extent interventions led to improvements in care. This enabled an evidence base for spreading intervention within and beyond ambulance services on a national scale

Carer and clinician perceptions of the use of emergency medical services by people with dementia: A qualitative study

A growing number of older people are accessing emergency medical services (EMS), and many calls to EMS are made by, or on behalf of, people with dementia. Their needs are frequently complex, however EMS staff are often given minimal guidance on ensuring patient safety, accurate diagnosis, and timely transfer to the most appropriate care. This study aimed to qualitatively explore the EMS experiences of carers for people with dementia and assess the views of EMS staff on the management of dementia, using focus groups and interviews. Themes were focussed on the circumstances surrounding EMS calls to people with dementia. These can prove frustrating due to a lack of information sharing, limited alternatives to hospital attendance and the amount of time that it can take to meet the complex needs of a person with dementia