The process and utility of classification and regression tree methodology in nursing research

Aim: This paper presents a discussion of classification and regression tree analysis and its utility in nursing research. Background: Classification and regression tree analysis is an exploratory research method used to illustrate associations between variables not suited to traditional regression analysis. Complex interactions are demonstrated between covariates and variables of interest in inverted tree diagrams. Design: Discussion paper. Data sources: English language literature was sourced from eBooks, Medline Complete and CINAHL Plus databases, Google and Google Scholar, hard copy research texts and retrieved reference lists for terms including classification and regression tree* and derivatives and recursive partitioning from 1984-2013. Discussion: Classification and regression tree analysis is an important method used to identify previously unknown patterns amongst data. Whilst there are several reasons to embrace this method as a means of exploratory quantitative research, issues regarding quality of data as well as the usefulness and validity of the findings should be considered. Implications for Nursing Research: Classification and regression tree analysis is a valuable tool to guide nurses to reduce gaps in the application of evidence to practice. With the ever-expanding availability of data, it is important that nurses understand the utility and limitations of the research method. Conclusion: Classification and regression tree analysis is an easily interpreted method for modelling interactions between health-related variables that would otherwise remain obscured. Knowledge is presented graphically, providing insightful understanding of complex and hierarchical relationships in an accessible and useful way to nursing and other health professions

Effect of patient sex on triage for ischaemic heart disease and treatment onset times: a retrospective analysis of Australian emergency department data

AbstractTime between emergency department (ED) presentation and treatment onset is an important, but little-researched phase within the revascularization process for ischaemic heart disease (IHD).ObjectiveTo determine if sex influences triage score allocation and treatment onset for patients with IHD in the ED.MethodsRetrospective data for patients 18–85years presenting to EDs from 2005 to 2010 for acute myocardial infarction (AMI), unstable and stable angina, and chest pain were analysed collectively and separately for AMI.ResultsProportionately more men (61% of males) were triaged correctly for AMI than women (51.4% of females; P<0.001). Across all triage categories, average treatment time was faster for men than women with AMI (P<0.001). When incorrectly triaged for AMI, treatment time for men was faster than for women (P=0.04). When correctly triaged for AMI, there was no difference in mean treatment time between men and women (P=0.538).ConclusionsSubstantial undertriage of AMI occurred for both sexes, but was worse in women. Incorrect triage led to prolonged treatment times for AMI, with women’s treatment delays longer than men’s. When triaged correctly, both sexes were treated early for AMI, emphasising the need for all patients to be accurately triaged for this time-sensitive disease

The Critical Role of Communities of Practice and Peer Learning in Scaling

Significant effort has been put into advancing the use and usability of information products to support adaptation to drought and climate variability, particularly for the water supply sector. Evidence and experience show that advancing the usability of information through processes such as coproduction is time consuming for both providers and users of information. One challenge for boundary organizations and researchers interested in enhancing the usability of their information is how such processes might &lsquo;&lsquo;scale&rsquo;&rsquo; to all the potential organizations and individual managers that might possibly be able to benefit from improved climate information. This paper examines information use preferences and practices specifically among managers of small water systems in the Upper Colorado River basin, with an eye toward identifying newopportunities to effectively scale information usability and uptake among all water managers&mdash;regardless oflocation or capacity&mdash;in a resource-constrained world. We find that boundary organizations and other usablescience efforts would benefit from capitalizing on the communities of practice that bind water managerstogether. Specifically, strategic engagement with larger, well-respected water systems as early adopters,supporting dissemination of successes and experiences with new information products among a broadercommunity of water managers, and increasing well-respected water systems&rsquo; capacity to engage directly withrural systems may all serve as useful strategies to promote widespread distribution, access, and adoption ofinformation.</p

How Experiences of Climate Extremes Motivate Adaptation Among Water Managers

As water systems are likely to experience mounting challenges managing for climate variability and extremes as well as a changing climate, there is increasing interest in what motivates systems to implement adaptive measures. While extreme events have been hypothesized to stimulate organization change and act as "windows of opportunity" and "pacemakers" driving toward adaptation, they do not always seem to do so. We therefore sought to understand the responses and motivations for organizational behavior in the wake of two significant droughts across five smaller water systems in Western Colorado, USA. We conducted interviews and focus groups across these systems to understand whether and why significant droughts in 2002 and 2012 prompted adaptive change. Results indicate that systems did not uniformly decide to change their policies in the wake of drought, and even well-prepared systems were driven to change policies by other pressures, such as peer-system pressure and political pressure from residents. We find that organizational worldviews were important mediators of how the experience of drought manifest, or not, in organizational changes. These findings have implications for assumptions about what might drive organizational learning and change among water managers for climate adaptation in the future.</p

Relational aggression and physical aggression among adolescent Cook Islands students

Both physical and relational aggression are characterised by the intent to harm another. Physical aggression includes direct behaviours such as hitting or kicking; relational aggression involves behaviours designed to damage relationships, such as excluding others, spreading rumours, and delivering threats and verbal abuse. This study extended research conducted in New Zealand Te manako ra tona au taeake e koia tikai aia, ia matou ra, e kite kore aia. Kare paa tona au taeke e kite ana e, te tamaemae ra aia i te tangata. Ka akaranga au e, e tangata viivii e te kino tikai aia. His friends think he is awesome but we think he is dumb. I don&apos;t think his friends realise he is hurting people. I am going to describe him as cruel

HLA-G 14bp Polymorphism in Autism

Autism Spectrum Disorder (ASD) is a neurodevelopment disorder characterized by deficits in communicative and social behaviors (Meltzer, 2017) . As of 2012 the CDC reported that 1 of 68 children born in the U.S. have ASD (Christensen, 2016). The immune systems of mother and child can be important in ASD. A signaling molecule, HLA-G, helps regulate maternal natural killer cell interaction with the fetus. A defect in HLA-G could increase NK cell activity, leading to abnormal neurodevelopment in the fetus (Carosella, 2008). Our study focuses on a 14 base pair insertion/deletion found in the HLA-G gene of autistic subjects and their mothers, previously examined in an Italian population by Guerini (2014). We are also expanding to look at HLA-G and intellectual disability (ID) in ASD. HLA-DRB1, another gene in the HLA region of chromosome 6, has been linked to ASD and impaired ID (IQ\u3c80, Wang, 2013)

Constructing a grounded theory of critical illness survivorship; the dualistic worlds of survivors and family members

Aim of the study: To understand the critical illness trajectory from patient and relative perspectives. Background: In the context of increasing survivorship from critical illness, it is important to enhance our understanding of the subjective experience of survivors and their families. The need to consider the legacy of critical care beyond physiological survival is imperative. Methods: Using a constructivist grounded theory methodology, in‐depth interviews were undertaken with survivors of critical illness (n = 16) and family members (n = 15). Constant comparative analysis and data collection occurring concurrently with theoretical sampling commencing from the outset. EQUATOR guidelines for qualitative research (COREQ) applied. Findings: Survivors of critical illness invariably experienced vivid, hallucinatory experiences which placed them in a different world or liminal space. The core difficulty can be summarised as follows: Survivors have little recall of the factual events of their critical illness but relatives have lived the whole event in a very real and ingraining manner. This can result in family members and survivors experiencing different versions of the critical illness episode. Conclusion: Survivors of critical illness, together with family members, experience challenges when endeavouring to readjust to life post critical care. This study has identified a middle range theory of dualistic worlds between and within the survivor and family member experiences. Exploring the dynamic interplay between intrapersonal, interpersonal and societal factors has provided theoretical insights with practice implications in relation to surviving critical illness. Relevance to clinical practice: The findings from this study highlight the need for a rehabilitation infrastructure following critical illness to support the existing UK national guidance, ensuring the individual and holistic needs of survivors and their families are met. Conversations with survivors and their families around critical illness survivorship are frequently absent and needed early in the recovery period