Travis Review: interim report

The Travis Review was commissioned by the Minister for Health to conduct an independent statewide census of bed and theatre capacity, and to provide recommendations on how to increase the capacity of Victorian hospitals. Terms of reference The terms of reference for the Travis Review are to: 1. Perform a statewide census of hospital capacity including bed, theatre and emergency department capacity and other services that may be substitutes for traditional inpatient care. 2. Consider issues, opportunities and challenges to measuring existing capacity, drawing on local, national and international policy perspectives. 3. Develop recommendations on how to optimise Victoria’s health system capacity in the short term (specifically through allocating additional recurrent funding and minor capital expenditure as required) that can be actioned in the 2015–16 State Budget. 4. Consider the current progress in implementing process redesign methodologies across the Victorian public hospital system and make recommendations on how this can be strengthened to optimise the capacity of hospitals to treat the Victorian community into the future. 5. Call for public submissions from stakeholders for redesign projects or other innovative models of care that increase hospital capacity and make recommendations on their suitability to optimise the capacity of hospitals to treat the Victorian community into the future. 6. Provide an interim report on the census results by end of March 2015 and a final report by the end of June 2015 to the Minister for Health. The interim report This report completes the first three of the above terms of reference, with the remaining items to be completed in the final report due at the end of June 2015. The report contains a number of recommendations for consideration by the Minister for Health

Effectiveness of Clery Act Timely Warnings and Emergency Notifications

The Clery Act (20 USC. § 1092(f)) is a federal law intended to improve campus safety by making information about crime as well as safety and security policies more accessible. Research has shown that the law’s requirements to collect crime statistics and publish annual security reports have limited impact. Little research has examined the effectiveness of the timely warning and emergency notification provisions. This study explored the perceptions of Campus Security Authorities (CSAs) to determine whether timely warning and emergency notification messages are an effective tool for improving campus safety; to what degree they result in unintended harmful effects; and whether current training of CSAs is adequate to develop CSAs’ knowledge and skills related to writing Clery Act message content. A 28-item questionnaire was distributed to a random sample of 5,000 individuals from a national list provided by the Clery Center. The completion rate was 10% (n=514) and the margin of error was +/-5% at the 95% confidence level. The results indicate that CSA’s perceive Clery Act messages to be effective at informing campus communities about crime, influencing safety-related behavior, prompting tips that solve crimes, and deterring crime. However, CSAs also indicated sizeable unintended harmful effects including that messages mislead people to believe that campuses are less safe than they actually are, provoke panic, reinforce racial stereotypes, are victim blaming, expose the identity of victims who report crime, trigger retaliation, re-traumatize victims of past crime, and cause chilling effects on crime reporting. Most CSAs (97%) receive training. However, only 44% reported receiving training that covered best practices for drafting messages that are trauma-informed regarding victims of sexual violence and only 33% reported receiving training that covered best practices for handling information about the race of suspects in crime reports

Efficacy of Clery Act Timely Warning and Emergency Notification Messages

The Clery Act (20 U.S.C. § 1092(f)) was passed following the rape and murder of Jeanne Clery in 1986 at Lehigh University. The intent of the law was to improve campus safety by making information about crime as well as safety and security policies more accessible to students, parents, employees, and others. This study explored the efficacy of the emergency notification and timely warnings provisions of the law. The study found these messages to be useful in promoting campus safety, particularly by informing people about safety issues and impacting people’s behavior related to self-protection. However, safety related behavior changes are perceived to be short-term rather than long-term. Problems were also reported in relation to timeliness of messages, message content and the unintended impacts or consequences that messages can have. Unintended impacts or consequences include the potential for messages to lead to perceptions that a campus is an unsafe campus environment when in fact risks are small; to reinforce racial stereotypes; to be perceived as victim blaming, or revealing information that causes victims who report crime to be outed; or trigger psychological complications. The potential for these issues to cause a “chilling effect” or impede law enforcement efforts were also reported

Determinants Of Computer Anxiety In Business Students

An empirical study was performed to identify significant determinants of computer anxiety among business students.  The results indicate that there are significant differences in computer anxiety levels among students with different academic majors, among students that have taken a different number of computer courses, and among students that have learned a different number of software applications or programming languages.  The study found no significant difference in computer anxiety between male and female students, contrary to earlier studies.  In fact, female students had an overall lower level of computer anxiety than did their male counterparts

Intertrial unconditioned stimuli differentially impact trace conditioning

Three experiments assessed how appetitive conditioning in rats changes over the duration of a trace conditioned stimulus (CS) when unsignaled unconditioned stimuli (USs) are introduced into the intertrial interval. In Experiment 1, a target US occurred at a fixed time either shortly before (embedded), shortly after (trace), or at the same time (delay) as the offset of a 120-s CS. During the CS, responding was most suppressed by intertrial USs in the trace group, less so in the delay group, and least in the embedded group. Unreinforced probe trials revealed a bell-shaped curve centered on the normal US arrival time during the trace interval, suggesting that temporally-specific learning occurred both with and without intertrial USs. Experiments 2a and 2b confirmed that the bulk of the trace CS became inhibitory when intertrial USs were scheduled, as measured by summation and retardation tests, even though CS offset evoked a temporally precise conditioned response. Thus, an inhibitory CS may give rise to new stimuli specifically linked to its termination, which were excitatory. A modification to the micostimulus temporal difference model is offered to account for the data

Automated Isolation of Translational Efficiency Bias that Resists the Confounding Effect of GC(AT)-Content

Genomic sequencing projects are an abundant source of information for biological studies ranging from the molecular to the ecological in scale; however, much of the information present may yet be hidden from casual analysis. One such information domain, trends in codon usage, can provide a wealth of information about an organism\u27s genes and their expression. Degeneracy in the genetic code allows more than one triplet codon to code for the same amino acid, and usage of these codons is often biased such that one or more of these synonymous codons is preferred. Detection of this bias is an important tool in the analysis of genomic data, particularly as a predictor of gene expressivity. Methods for identifying codon usage bias in genomic data that rely solely on genomic sequence data are susceptible to being confounded by the presence of several factors simultaneously influencing codon selection. Presented here is a new technique for removing the effects of one of the more common confounding factors, GC(AT)-content, and of visualizing the search-space for codon usage bias through the use of a solution landscape. This technique successfully isolates expressivity-related codon usage trends, using only genomic sequence information, where other techniques fail due to the presence of GC(AT)-content confounding influences

Isoform-specific subcellular localization and function of protein kinase A identified by mosaic imaging of mouse brain.

Protein kinase A (PKA) plays critical roles in neuronal function that are mediated by different regulatory (R) subunits. Deficiency in either the RIβ or the RIIβ subunit results in distinct neuronal phenotypes. Although RIβ contributes to synaptic plasticity, it is the least studied isoform. Using isoform-specific antibodies, we generated high-resolution large-scale immunohistochemical mosaic images of mouse brain that provided global views of several brain regions, including the hippocampus and cerebellum. The isoforms concentrate in discrete brain regions, and we were able to zoom-in to show distinct patterns of subcellular localization. RIβ is enriched in dendrites and co-localizes with MAP2, whereas RIIβ is concentrated in axons. Using correlated light and electron microscopy, we confirmed the mitochondrial and nuclear localization of RIβ in cultured neurons. To show the functional significance of nuclear localization, we demonstrated that downregulation of RIβ, but not of RIIβ, decreased CREB phosphorylation. Our study reveals how PKA isoform specificity is defined by precise localization

Signatures of Subacute Potentially Catastrophic Illness in the ICU: Model Development and Validation

Objectives: Patients in ICUs are susceptible to subacute potentially catastrophic illnesses such as respiratory failure, sepsis, and hemorrhage that present as severe derangements of vital signs. More subtle physiologic signatures may be present before clinical deterioration, when treatment might be more effective. We performed multivariate statistical analyses of bedside physiologic monitoring data to identify such early subclinical signatures of incipient life-threatening illness. Design: We report a study of model development and validation of a retrospective observational cohort using resampling (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis type 1b internal validation) and a study of model validation using separate data (type 2b internal/external validation). Setting: University of Virginia Health System (Charlottesville), a tertiary-care, academic medical center. Patients: Critically ill patients consecutively admitted between January 2009 and June 2015 to either the neonatal, surgical/trauma/burn, or medical ICUs with available physiologic monitoring data. Interventions: None. Measurements and Main Results: We analyzed 146 patient-years of vital sign and electrocardiography waveform time series from the bedside monitors of 9,232 ICU admissions. Calculations from 30-minute windows of the physiologic monitoring data were made every 15 minutes. Clinicians identified 1,206 episodes of respiratory failure leading to urgent unplanned intubation, sepsis, or hemorrhage leading to multi-unit transfusions from systematic individual chart reviews. Multivariate models to predict events up to 24 hours prior had internally validated C-statistics of 0.61-0.88. In adults, physiologic signatures of respiratory failure and hemorrhage were distinct from each other but externally consistent across ICUs. Sepsis, on the other hand, demonstrated less distinct and inconsistent signatures. Physiologic signatures of all neonatal illnesses were similar. Conclusions: Subacute potentially catastrophic illnesses in three diverse ICU populations have physiologic signatures that are detectable in the hours preceding clinical detection and intervention. Detection of such signatures can draw attention to patients at highest risk, potentially enabling earlier intervention and better outcomes