Effects of multidisciplinary teamwork on lead times and patient flow in the emergency department: A longitudinal interventional cohort study

BACKGROUND Long waiting times for emergency care are claimed to be caused by overcrowded emergency departments and non-effective working routines. Teamwork has been suggested as a promising solution to these issues. The aim of the present study was to investigate the effects of teamwork in a Swedish emergency department on lead times and patient flow. METHODS The study was set in an emergency department of a university hospital where teamwork, a multi-professional team responsible for the whole care process for a group of patients, was introduced. The study has a longitudinal non-randomized intervention study design. Data were collected for five two-week periods during a period of 1.5 years. The first part of the data collection used an ABAB design whereby standard procedure (A) was altered weekly with teamwork (B). Then, three follow-ups were conducted. At last follow-up, teamwork was permanently implemented. The outcome measures were: number of patients handled within teamwork time, time to physician, total visit time and number of patients handled within the 4-hour target. RESULTS A total of 1,838 patient visits were studied. The effect on lead times was only evident at the last follow-up. Findings showed that the number of patients handled within teamwork time was almost equal between the different study periods. At the last follow-up, the median time to physician was significantly decreased by 11 minutes (p = 0.0005) compared to the control phase and the total visit time was significantly shorter at last follow-up compared to control phase (p = <0.0001; 39 minutes shorter on average). Finally, the 4-hour target was met in 71% in the last follow-up compared to 59% in the control phase (p = 0.0005). CONCLUSIONS Teamwork seems to contribute to the quality improvement of emergency care in terms of small but significant decreases in lead times. However, although efficient work processes such as teamwork are necessary to ensure safe patient care, it is likely not sufficient for bringing about larger decreases in lead times or for meeting the 4-hour target in the emergency department.Åsa Muntlin Athlin, Ulrica von Thiele Schwarz and Nasim Farrohkni

Do multiple fires interact to affect vegetation structure in temperate eucalypt forests?

Fire plays an important role in structuring vegetation in fire-prone regions worldwide. Progress has been made towards documenting the effects of individual fire events and fire regimes on vegetation structure; less is known of how different fire history attributes (e.g., time since fire, fire frequency) interact to affect vegetation. Using the temperate eucalypt foothill forests of southeastern Australia as a case study system, we examine two hypotheses about such interactions: (1) post-fire vegetation succession (e.g., time-since-fire effects) is influenced by other fire regime attributes and (2) the severity of the most recent fire overrides the effect of preceding fires on vegetation structure. Empirical data on vegetation structure were collected from 540 sites distributed across central and eastern Victoria, Australia. Linear mixed models were used to examine these hypotheses and determine the relative influence of fire and environmental attributes on vegetation structure. Fire history measures, particularly time since fire, affected several vegetation attributes including ground and canopy strata; others such as low and sub-canopy vegetation were more strongly influenced by environmental characteristics like rainfall. There was little support for the hypothesis that post-fire succession is influenced by fire history attributes other than time since fire; only canopy regeneration was influenced by another variable (fire type, representing severity). Our capacity to detect an overriding effect of the severity of the most recent fire was limited by a consistently weak effect of preceding fires on vegetation structure. Overall, results suggest the primary way that fire affects vegetation structure in foothill forests is via attributes of the most recent fire, both its severity and time since its occurrence; other attributes of fire regimes (e.g., fire interval, frequency) have less influence. The strong effect of environmental drivers, such as rainfall and topography, on many structural features show that foothill forest vegetation is also influenced by factors outside human control. While fire is amenable to human management, results suggest that at broad scales, structural attributes of these forests are relatively resilient to the effects of current fire regimes. Nonetheless, the potential for more frequent severe fires at short intervals, associated with a changing climate and/or fire management, warrant further consideration

Fire regimes and environmental gradients shape vertebrate and plant distributions in temperate eucalypt forests

Fire is a global driver of ecosystem structure, function, and change. Problems common to fire scientists and managers worldwide include a limited knowledge of how multiple taxonomic groups within a given ecosystem respond to recurrent fires, and how interactions between fire regimes and environmental gradients influence biodiversity. We tested six hypotheses relating to fire regimes and environmental gradients in forest ecosystems using data on birds (493 sites), mammals (175 sites), and vascular plants (615 sites) systematically collected in dry eucalypt forests in southeastern Australia. We addressed each of these hypotheses by fitting species distribution models which differed in the environmental variables used, the spatial extent of the data, or the type of response data. We found (1) as predicted, fire interacted with environmental gradients and shaped species distributions, but there was substantial variation between species; (2) multiple characteristics of fire regimes influenced the distribution of forest species; (3) common to vertebrates and plants was a strong influence of temperature and rainfall gradients, but contrary to predictions, inter‐fire interval was the most influential component of the fire regime on both taxonomic groups; (4) mixed support for the hypothesis that fire would be a stronger influence on species occurrence at a smaller spatial extent; only for vertebrates did scale have an effect in the direction expected; (5) as predicted, vertebrates closely associated with direct measures of habitat structure were those most strongly influenced by fire regimes; and (6) the modeled fire responses for birds were sensitive to the use of either presence–absence or abundance data. These results underscore the important insights that can be gained by modeling how fire regimes, not just fire events, influence biota in forests. Our work highlights the need for management of fire regimes to be complemented by an understanding of the underlying environmental gradients and key elements of habitat structure that influence resource availability for plants and animals. We have demonstrated that there are general patterns in biotic responses to fire regimes and environmental gradients, but landscape management must continue to carefully consider species, scale, and the quality of biodiversity data to achieve biodiversity conservation in fire‐prone forests

Sex Hormones and Cognition : Neuroendocrine influences on memory and learning.

Sex differences in neurological disease extend from incidence, severity, progression and symptoms and may ultimately influence treatment. Cognitive disturbances are frequent in neuropsychiatric disease with men showing greater cognitive impairment in schizophrenia, but women showing more severe dementia and cognitive decline with Alzheimer’s disease. Although there are no overall differences in intelligence between the sexes, men and women demonstrate slight but consistent differences in a number of cognitive domains. These include a male advantage, on average, in some types of spatial abilities and a female advantage on some measures of verbal fluency and memory. Sex differences in traits or behaviors generally indicate the involvement of sex hormones, such as androgens and estrogens. We review the literature on whether adult levels of testosterone and estradiol influence spatial ability in both males and females from rodent models to humans. We also include information on estrogens and their ability to modulate verbal memory in men and women. Estrone and progestins are common components of hormone therapies, and we also review the existing literature concerning their effects on cognition. We also review the sex differences in the hippocampus and prefrontal cortex as they relate to cognitive performance in both rodents and humans. There has been greater recognition in the scientific literature that it is important to study both sexes but also to analyze study findings with sex as a variable. Only by examining these sex differences can we progress to finding treatments that will improve the cognitive health of both men and women.Arts, Faculty ofMedicine, Faculty ofPsychology, Department ofReviewedFacultyGraduat