Towards scenarios for a sustainable and equitable future Australia

A scenario is an internally consistent narrative about the future, developed using a structured approach with clear and consistent logic to consider systematically how uncertainties and surprises in the future might lead to alternative plausible outcomes. Scenarios can share meaning at deeper levels than logic-based communication through their basis in narrative. Scenario development draws on a range of information, quantitative modelling, expert judgement and creative thinking. These ingredients are combined using procedures that ensure that three key requirements are satisfied: legitimacy (that the information base is reliable and the models used are sound), saliency (that the questions or future uncertainties probed by the scenarios are pertinent) and credibility within specified boundaries (that the scenario is considered plausible by participants in the scenario-building process and by observers). A crucial starting point in scenario development is the specification of a focal question. To exemplify these concepts, we consider scenarios arising from three different focal questions, respectively concerning approaches to climate change, governance and complexification. Finally, we consider processes that could potentially engage Australian society in using scenarios to navigate the future, thereby aiding a national strategic conversation about the issues driving change in Australia over the next 40 years and their relevance for human wellbeing

Application of 3D-printed patient-specific skeletal implants augmented with autologous skeletal stem cells

Joint replacements have proved a medical success providing symptomatic relief and return to mobility in many patients with arthritis. However, multiple revision surgeries due to joint failure can result in complex revision scenarios with significant bone tissue loss, in an elderly population, which poses a significant clinical challenge. Computer-aided design-computer-assisted manufacturing (CAD-CAM) prototyped bespoke implants are currently being used as an alternative and innovative approach for joint restoration in salvage cases, while the incorporation of autologous skeletal stem cells to optimize regenerative capacity can enhance implant osseointegration. We present a case series of 11 patients with severe disability and significant bone loss due to failed joint replacements. The choice of CAD-CAM prototyped joint implants enhanced with autologous skeletal stem cells resulted in significant patient-reported clinical and radiological improvements.</p

BRAHSS1415_Dataset_ALL

Measured response variables for migrating humpback whale baseline groups and groups exposed to control (vessel only) and full array seismic air gun trials

Implementation of Computerized Physician Order Entry for Critical Patients in an Academic Emergency Department is Not Associated with a Change in Mortality Rate

Introduction: There is limited literature on the effect of computerized physician order entry (CPOE) on mortality. The objective of our study was to determine if there was a change in mortality among critically ill patients presenting to the emergency department (ED) after the implementation of a CPOE system. Methods: This was a retrospective study of all critically ill patients in the ED during the year before and the year after CPOE implementation. The primary outcome measures were mortality in the ED, after admission, and overall. Secondary outcome measures included length of stay in the resuscitation area of the ED, length of hospital stay, and disposition following hospitalization. Patient disposition was used as a marker for neurologic function, and patients were grouped as either being discharged to home vs. nursing home, rehabilitation center, or a long-term healthcare facility. We analyzed data using descriptive statistics, chi- square, and Wilcoxon rank sum tests. Results: There were 2,974 critically ill patients in the year preceding CPOE and 2,969 patients in the year following CPOE implementation. There were no differences in mortality between the two groups in the ED, after admission, or overall. The pre- and post-CPOE mortality rate for the ED, hospital, or overall was 2.52% vs. 2.02% (P = 0.19, 95% confidence interval [CI] -0.3 to 1.3), 7.8% versus 8.29% (P = 0.61, 95% CI -1.9 to 0.9), and 10.32% vs. 10.31% (P = .60, 95% CI -1.5 to 1.6), respectively. There was no difference in hospital length of stay between pre- and post- CPOE patients (3 days versus 3 days), a difference of 0.05 days (95% CI -0.47 to 0.57). Length of stay in the ED resuscitation area was longer in the post-CPOE group (31 versus 32 minutes), a difference of -1.96 minutes (95% CI -3.4 to -0.53). More patients were discharged to home in the pre-CPOE group (66.8% versus 64.3%), a difference of 2.54% (95% CI 0.13% to 4.96%). Conclusion: The implementation of CPOE was not associated with a change in mortality of critically ill ED patients, but was associated with a decrease in proportion of patients discharged to home after hospitalization. [West J Emerg Med 2013;14(2):114-120.

Development of a portal to Texas history

Article discussing the development of the University of North Texas (UNT) Libraries' Portal to Texas History

Implementation of Computerized Physician Order Entry for Critical Patients in an Academic Emergency Department is Not Associated with a Change in Mortality Rate

Introduction: There is limited literature on the effect of computerized physician order entry (CPOE) on mortality. The objective of our study was to determine if there was a change in mortality among critically ill patients presenting to the emergency department (ED) after the implementation of a CPOE system. Methods: This was a retrospective study of all critically ill patients in the ED during the year before and the year after CPOE implementation. The primary outcome measures were mortality in the ED, after admission, and overall. Secondary outcome measures included length of stay in the resuscitation area of the ED, length of hospital stay, and disposition following hospitalization. Patient disposition was used as a marker for neurologic function, and patients were grouped as either being discharged to home vs. nursing home, rehabilitation center, or a long-term healthcare facility. We analyzed data using descriptive statistics, chi- square, and Wilcoxon rank sum tests. Results: There were 2,974 critically ill patients in the year preceding CPOE and 2,969 patients in the year following CPOE implementation. There were no differences in mortality between the two groups in the ED, after admission, or overall. The pre- and post-CPOE mortality rate for the ED, hospital, or overall was 2.52% vs. 2.02% (P = 0.19, 95% confidence interval [CI] -0.3 to 1.3), 7.8% versus 8.29% (P = 0.61, 95% CI -1.9 to 0.9), and 10.32% vs. 10.31% (P = .60, 95% CI -1.5 to 1.6), respectively. There was no difference in hospital length of stay between pre- and post- CPOE patients (3 days versus 3 days), a difference of 0.05 days (95% CI -0.47 to 0.57). Length of stay in the ED resuscitation area was longer in the post-CPOE group (31 versus 32 minutes), a difference of -1.96 minutes (95% CI -3.4 to -0.53). More patients were discharged to home in the pre-CPOE group (66.8% versus 64.3%), a difference of 2.54% (95% CI 0.13% to 4.96%). Conclusion: The implementation of CPOE was not associated with a change in mortality of critically ill ED patients, but was associated with a decrease in proportion of patients discharged to home after hospitalization. [West J Emerg Med 2013;14(2):114-120.