Understanding communication networks in the emergency department

<p>Abstract</p> <p>Background</p> <p>Emergency departments (EDs) are high pressure health care settings involving complex interactions between staff members in providing and organising patient care. Without good communication and cooperation amongst members of the ED team, quality of care is at risk. This study examined the problem-solving, medication advice-seeking and socialising networks of staff working in an Australian hospital ED.</p> <p>Methods</p> <p>A social network survey (Response Rate = 94%) was administered to all ED staff (n = 109) including doctors, nurses, allied health professionals, administrative staff and ward assistants. Analysis of the network characteristics was carried out by applying measures of density (the extent participants are concentrated), connectedness (how related they are), isolates (how segregated), degree centrality (who has most connections measured in two ways, in-degree, the number of ties directed to an individual and out-degree, the number of ties directed from an individual), betweenness centrality (who is important or powerful), degree of separation (how many ties lie between people) and reciprocity (how bi-directional are interactions).</p> <p>Results</p> <p>In all three networks, individuals were more closely connected to colleagues from within their respective professional groups. The problem-solving network was the most densely connected network, followed by the medication advice network, and the loosely connected socialising network. ED staff relied on each other for help to solve work-related problems, but some senior doctors, some junior doctors and a senior nurse were important sources of medication advice for their ED colleagues.</p> <p>Conclusions</p> <p>Network analyses provide useful ways to assess social structures in clinical settings by allowing us to understand how ED staff relate within their social and professional structures. This can provide insights of potential benefit to ED staff, their leaders, policymakers and researchers.</p

Perspectives on the Ethics of Sociometric Research with Children: How Children, Peers, and Teachers Help to Inform the Debate

Perceptions of children and teachers were examined to address concerns regarding children’s welfare following sociometric testing. Third-graders (N = 91) were interviewed; teachers also reported on each child’s responses to the testing. Results indicate that children were not hurt or upset by the testing, most enjoyed the procedures, did not feel that their peers treated them any differently following the testing, and understood their research rights. There were no relations between social preference as determined by peer nominations and teacher- and self-reported responses to sociometric testing. The implications of these results for the design and implementation of careful, ethical sociometric research with children are discussed

Stream Measurements Locate Thermogenic Methane Fluxes in Groundwater Discharge in an Area of Shale-Gas Development

The environmental impacts of shale-gas development on water resources, including methane migration to shallow groundwater, have been difficult to assess. Monitoring around gas wells is generally limited to domestic water-supply wells, which often are not situated along predominant groundwater flow paths. A new concept is tested here: combining stream hydrocarbon and noble-gas measurements with reach mass-balance modeling to estimate thermogenic methane concentrations and fluxes in groundwater discharging to streams and to constrain methane sources. In the Marcellus Formation shale-gas play of northern Pennsylvania (U.S.A.), we sampled methane in 15 streams as a reconnaissance tool to locate methane-laden groundwater discharge: concentrations up to 69 μg L^–1 were observed, with four streams ≥5 μg L^–1. Geochemical analyses of water from one stream with high methane (Sugar Run, Lycoming County) were consistent with Middle Devonian gases. After sampling was completed, we learned of a state regulator investigation of stray-gas migration from a nearby Marcellus Formation gas well. Modeling indicates a groundwater thermogenic methane flux of about 0.5 kg d^–1 discharging into Sugar Run, possibly from this fugitive gas source. Since flow paths often coalesce into gaining streams, stream methane monitoring provides the first watershed-scale method to assess groundwater contamination from shale-gas development

Needed research on the terrestrial effects of coal gasification and liquefaction technologies

The Terrestrial Effects panel discussed the needed direction and techniques for future research in the terrestrial effects of new coal conversion technologies. Panel members concurred on the need for changes in emphasis, approach, and even attitude in environmental research. The following are the basic perceptions of the panel: Our goal is to provide for environmentally amenable technologies in coal conversion and product distribution, especially focusing on pollutants entering pathways to man. Highest research priority, therefore, should be given to solid wastes, and especially their leachates. A shift in research emphasis is needed. Whereas we have been accustomed to investigating acute effects of pollutants immediately surrounding their source, we should now explore the sublethal, long-term effects of pollutants carried farther from their source. These may in fact become the more dangerous of the two through bioconcentration. Research of this kind should help us to predict deleterious effects before they are felt. Another needed reverse in typical environmental research strategy is to perform biological characterization before source characterization. Time for the needed research is running out. In order to make meaningful progress within a short time frame, we will have to narrow the focus of our research to include only the most serious effects and only their most likely causes. To investigate these, just a few best alternative modes of operation could be selected and then constructed on a full commercial scale. Perhaps more than ever before, cooperation between disciplines is essential. Ecologists, biologists, engineers, and statisticians must pool their knowledge and ideas in solving these problems. The panel was encouraged by the success of their own cross-disciplinary efforts as reflected in this summary