BOOSTING

• Research ways to efficiently implement machinelearning algorithms on MIPS/PowerVR • Research possible extensions to MIP

Clinical handover within the emergency care pathway and the potential risks of clinical handover failure (ECHO) : primary research

Background and objectives: Handover and communication failures are a recognised threat to patient safety. Handover in emergency care is a particularly vulnerable activity owing to the high-risk context and overcrowded conditions. In addition, handover frequently takes place across the boundaries of organisations that have different goals and motivations, and that exhibit different local cultures and behaviours. This study aimed to explore the risks associated with handover failure in the emergency care pathway, and to identify organisational factors that impact on the quality of handover. Methods: Three NHS emergency care pathways were studied. The study used a qualitative design. Risks were explored in nine focus group-based risk analysis sessions using failure mode and effects analysis (FMEA). A total of 270 handovers between ambulance and the emergency department (ED), and the ED and acute medicine were audio-recorded, transcribed and analysed using conversation analysis. Organisational factors were explored through thematic analysis of semistructured interviews with a purposive convenience sample of 39 staff across the three pathways. Results: Handover can serve different functions, such as management of capacity and demand, transfer of responsibility and delegation of aspects of care, communication of different types of information, and the prioritisation of patients or highlighting of specific aspects of their care. Many of the identified handover failure modes are linked causally to capacity and patient flow issues. Across the sites, resuscitation handovers lasted between 38 seconds and 4 minutes, handovers for patients with major injuries lasted between 30 seconds and 6 minutes, and referrals to acute medicine lasted between 1 minute and approximately 7 minutes. Only between 1.5% and 5% of handover communication content related to the communication of social issues. Interview participants described a range of tensions inherent in handover that require dynamic trade-offs. These are related to documentation, the verbal communication, the transfer of responsibility and the different goals and motivations that a handover may serve. Participants also described the management of flow of patients and of information across organisational boundaries as one of the most important factors influencing the quality of handover. This includes management of patient flows in and out of departments, the influence of time-related performance targets, and the collaboration between organisations and departments. The two themes are related. The management of patient flow influences the way trade-offs around inner tensions are made, and, on the other hand, one of the goals of handover is ensuring adequate management of patient flows. Conclusions: The research findings suggest that handover should be understood as a sociotechnical activity embedded in clinical and organisational practice. Capacity, patient flow and national targets, and the quality of handover are intricately related, and should be addressed together. Improvement efforts should focus on providing practitioners with flexibility to make trade-offs in order to resolve tensions inherent in handover. Collaborative holistic system analysis and greater cultural awareness and collaboration across organisations should be pursued

Environmental Accounting and the Roles of Economics

Abstract This paper is about green accounting. It contains a beneficial economic model where government pursues optimal economic policies. The aim of the paper is to serve as an indicator of wealth changes, performance of environment policy and sustainable use of natural capital. All the services are outputs from natural capital, the change of values of natural wealth. The paper also indicates the present and future production, and use of ecosystem services to indicate the sustainability of natural resources. Accounting prices of goods and services are constructed and are shown to reflect social securities

Still settling cities: sustainability, governance and change (Keynote Address

Unsettled cities For many people, Australia was 'settled' soon after European occupation, through the actions of hardy, resourceful and sometime foolhardy 'settlers'. This process and these people then somehow departed the narrative of the evolution of people and continent. They faded first from Sydney, which went from 'settlement' to town and then to city, where settlers do not exist. Settlers hung on longer in the bush, but there too they faded away with sufficient permanence and rhythm of human occupation. Once the survey pegs are removed and houses built, settlement ceases. Occasionally other settlers popped up -'new settlers' as another term for migrant 'new Australians' and later alternative lifestylers retreating the deviant, consumptive cities. But overall the modern era put paid to settling, and settlers, settlement and settling are now past tense in the public mind. Three things are wrong here. First, human settlement of the Australian continent began well before white occupation, at least 50,000 years before, and Indigenous settlement is an unfinished story. Second, the presumption that the process of settlement has stopped. Third, the settlement story has mostly overlooked urban Australia -cities as post-settlement phenomena, devoid of settlers. We are still settling Australia, and we are still settling cities and towns as much as the bush. Subdivisions are settlement, as is tree planting in country or city, densification through housing form, discovering something new about our soils and climate, putting in domestic water tanks, building power stations, fencing, and all the rest. Resurrecting the term 'settlement' repositions current debates in a long story of interaction between people and place, of learning and legacies, of deliberate and accidental change creating the future. The process of human settlement imposes change on land and on people, and is impacted by other factors and drivers of change. We are not close to being settled in our relationship with the Australian continent, or fully capable of comprehending and handling the factors that influence us, which have not varied as much over time as many imagine -climate variability, resource availability and scarcity, our political institutions, demographic change, trade flows and shifts, and so on. It took almost three decades to figure how to remove Eucalyptus stumps to allow cultivation, and we have been experimenting with the Australian environment ever since -still settling as we build, learn, progress, regress, plan and try to create better or at least tolerable human landscapes. From empirical evidence it is apparent that we have yet to figure out what comprises a human dwelling suited to the Australian meteorological and hydrological environment. Or that we know how to deliver such dwellings but are constrained from doing so. In a water-scarce land, we use massive quantities of high value, carefully treated water to shift faeces. South Australia saw one of Australia's most celebrated cases of the span of settlement exceeding advised limits of climate, across Goyder's Line late in the 19 th centur