Emergency department presentations by older people for mental health or drug and alcohol conditions: A multicentre retrospective audit

© 2017 College of Emergency Nursing Australasia Purpose Emergency department presentations by older people associated with mental health and drug and alcohol related conditions are increasing. However, the characteristics of presentations by older people in Australia are largely unknown. The aim of this research was to explore the characteristics of older people presenting with mental health and drug and alcohol conditions. Procedures We used a retrospective electronic medical record audit to explore all emergency department presentations by older people 65 years and over for mental health and drug and alcohol related conditions over a 12 month period. Data were described using descriptive statistics. Finidngs There were 40,093 presentations; 2% (n = 900) were related to mental health or drug and alcohol related conditions. Presentations were mainly associated with primary mental or medical symptoms. The majority were female (n = 471; 53%). Predominate conditions were cognitive impairment (n = 234; 26%) and affective disorders (n = 233; 26.0%). Sixty-three percent of patients were admitted to a hospital ward. Over the study period 106 patients (242 episodes of care) represented. Principle conclusions Given the ageing population and increasing prevalence for mental health and drug and alcohol conditions, strategies are required to better recognise these conditions to reduce the burden on the health care system and improve health for older people

Brick Walls and AdS/CFT

We discuss the relationship between the bulk-boundary correspondence in Rehren's algebraic holography (and in other 'fixed-background' approaches to holography) and in mainstream 'Maldacena AdS/CFT'. Especially, we contrast the understanding of black-hole entropy from the viewpoint of QFT in curved spacetime -- in the framework of 't Hooft's 'brick wall' model -- with the understanding based on Maldacena AdS/CFT. We show that the brick-wall modification of a Klein Gordon field in the Hartle-Hawking-Israel state on 1+2-Schwarzschild AdS (BTZ) has a well-defined boundary limit with the same temperature and entropy as the brick-wall-modified bulk theory. One of our main purposes is to point out a close connection, for general AdS/CFT situations, between the puzzle raised by Arnsdorf and Smolin regarding the relationship between Rehren's algebraic holography and mainstream AdS/CFT and the puzzle embodied in the 'correspondence principle' proposed by Mukohyama and Israel in their work on the brick-wall approach to black hole entropy. Working on the assumption that similar results will hold for bulk QFT other than the Klein Gordon field and for Schwarzschild AdS in other dimensions, and recalling the first author's proposed resolution to the Mukohyama-Israel puzzle based on his 'matter-gravity entanglement hypothesis', we argue that, in Maldacena AdS/CFT, the algebra of the boundary CFT is isomorphic only to a proper subalgebra of the bulk algebra, albeit (at non-zero temperature) the (GNS) Hilbert spaces of bulk and boundary theories are still the 'same' -- the total bulk state being pure, while the boundary state is mixed (thermal). We also argue from the finiteness of its boundary (and hence, on our assumptions, also bulk) entropy at finite temperature, that the Rehren dual of the Maldacena boundary CFT cannot itself be a QFT and must, instead, presumably be something like a string theory.Comment: 54 pages, 3 figures. Arguments strengthened in the light of B.S. Kay `Instability of Enclosed Horizons' arXiv:1310.739

Suicide in older people, attitudes and knowledge of emergency nurses: A multi-centre study

© 2019 Introduction: Suicide in older people is a public health concern. Emergency nurses are ideally placed to identify suicide risk. Therefore, the aim of this research was to explore emergency nurses’ knowledge, confidence and attitudes about suicide in older people. Methods: This descriptive exploratory study was conducted in four emergency departments in Sydney, Australia. Data were collected using a 28-item survey from a convenience sample of emergency nurses. Descriptive quantitative statistics and conventional content analysis were performed. Ethics approval was provided. Results: The response rate was 58% (n = 136); the majority were female with an average of seven years emergency experience. The majority (n = 124, 91%) reported that they frequently managed suicidal behaviour and recognized suicide as a common event (80%). 51% (n = 69) recognized that suicide was a common event for older people. Only 16% (n = 22) reported receiving suicide prevention training with 11% feeling confident in managing suicidal behaviour. Conclusion: The findings contribute to the discourse on how suicide in older people is recognised by emergency nurses. Few nurses considered it a problem for older people and were not confident about their knowledge. There is a need for suicide prevention training as a priority particularly to identify risks in older people

Economic evidence for the prevention and treatment of atopic eczema: a protocol for a systematic review

Background: Eczema, synonymous with atopic eczema or atopic dermatitis, is a chronic skin disease that has a similar impact on health-related quality of life as other chronic diseases. The proposed research aims to provide a comprehensive systematic assessment of the economic evidence base available to inform economic modelling and decision making on interventions to prevent and treat eczema at any stage of the life course. Whilst the Global Resource of Eczema Trials (GREAT) database collects together the effectiveness evidence for eczema there is currently no such systematic resource on the economics of eczema. It is important to gain an overview of the current state of the art of economic methods in the field of eczema in order to strengthen the economic evidence base further. Methods/design: The proposed study is a systematic review of the economic evidence surrounding interventions for the prevention and treatment of eczema. Relevant search terms will be used to search MEDLINE, EMBASE, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, Health Technology Assessment, Cumulative Index to Nursing and Allied Health Literature, Econ Lit, Scopus, Cost-Effectiveness Analysis Registry and Web of Science in order to identify relevant evidence. To be eligible for inclusion studies will be primary empirical studies evaluating the cost, utility or full economic evaluation of interventions for preventing or treating eczema. Two reviewers will independently assess studies for eligibility and perform data abstraction. Evidence tables will be produced presenting details of study characteristics, costing methods, outcome methods and quality assessment. The methodological quality of studies will be assessed using accepted checklists. Discussion: The systematic review is being undertaken to identify the type of economic evidence available, summarise the results of the available economic evidence and critically appraise the quality of economic evidence currently available to inform future economic modelling and resource allocation decisions about interventions to prevent or treat eczema. We aim to use the review to offer guidance about how to gather economic evidence in studies of eczema and/or what further research is necessary in order to inform this

Changes in lower limb rotation after soft tissue surgery in spastic diplegia: 3-dimensional gait analysis in 28 children

Background and purpose Rotational osteotomies are usually necessary to correct pronounced rotational deformities in ambulant children with cerebral palsy. The effects of soft tissue surgery on such deformities are unclear. In this retrospective study, we determined whether multilevel soft tissue surgery, performed to correct deformities in the sagittal plane, would also have an effect on rotational parameters

Fractures of the bilateral distal radius and scaphoid: a case report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Leadership, the logic of sufficiency and the sustainability of education

The notion of sufficiency has not yet entered mainstream educational thinking, and it still has to make its mark upon educational leadership. However, a number of related concepts – particularly those of sustainability and complexity theory – are beginning to be noticed. This article examines these two concepts and uses them to critique the quasi-economic notion of efficiency, before arguing that the concept of sufficiency arises naturally from this discussion. This concept, originally derived from environmental thinking, has both metaphorical and practical impact for educational organizations and their leadership. An examination of three possible meanings suggests that while an embrace of an imperative concept of sufficiency seems increasingly necessary, its adoption would probably lead to a number of other problems, as it challenges some fundamental societal values and assumptions. Nevertheless, the article argues that these need to be addressed for the sake of both sustainable leadership and a sustainable planet

ULEARN: Personalised Learner’s Profile Based On Dynamic Learning Style Questionnaire

The file attached to this record is the author's final peer reviewed version.E-Learning recommender system effectiveness re- lies upon their ability to recommend appropriate learning con- tents according to the learner learning style and preferences. An effective approach to handle the learner preferences is to build an efficient learner profile in order to gain adaptation and individualisation of the learning environment. It is usually necessary to know learning style and preferences of the learner on a domain before adapting the learning process and course content. This study focuses on identifying the learning styles of students in order to adapt the learning process and course content. ULEARN is an adaptive recommender learning system designed to provide learners with personalised learning environment such as course learning objects that match their adaptive profile. This paper presents the algorithm used in ULEARN to reduce dynamically the number of questions in Felder-Silverman learning style ques- tionnaire used to initialise the adaptive learner profile. Firstly, the questionnaire is restructured into four groups, one for each learning style dimension; and a study is carried out to determine the order in which questions will be asked in each dimension. Then an algorithm is built upon this ranking of questions to calculate dynamically the initial learning style of the user as they go through the questionnaire

Temporal and Spatial Patterns of Ambient Endotoxin Concentrations in Fresno, California

BackgroundEndotoxins are found in indoor dust generated by human activity and pets, in soil, and adsorbed onto the surfaces of ambient combustion particles. Endotoxin concentrations have been associated with respiratory symptoms and the risk of atopy and asthma in children.ObjectiveWe characterized the temporal and spatial variability of ambient endotoxin in Fresno/Clovis, California, located in California's Central Valley, to identify correlates and potential predictors of ambient endotoxin concentrations in a cohort of children with asthma [Fresno Asthmatic Children's Environment Study (FACES)].MethodsBetween May 2001 and October 2004, daily ambient endotoxin and air pollutants were collected at the central ambient monitoring site of the California Air Resources Board in Fresno and, for shorter time periods, at 10 schools and indoors and outdoors at 84 residences in the community. Analyses were restricted to May-October, the dry months during which endotoxin concentrations are highest.ResultsDaily endotoxin concentration patterns were determined mainly by meteorologic factors, particularly the degree of air stagnation. Overall concentrations were lowest in areas distant from agricultural activities. Highest concentrations were found in areas immediately downwind from agricultural/pasture land. Among three other measured air pollutants [fine particulate matter, elemental carbon (a marker of traffic in Fresno), and coarse particulate matter (PMc)], PMc was the only pollutant correlated with endotoxin. Endotoxin, however, was the most spatially variable.ConclusionsOur data support the need to evaluate the spatial/temporal variability of endotoxin concentrations, rather than relying on a few measurements made at one location, in studies of exposure and and respiratory health effects, particularly in children with asthma and other chronic respiratory diseases