The appropriateness of patients' visits to an emergency department.

Aim: The appropriateness of patient visits to an emergency unit was investigated in this study. Method: This descriptive study included 2968 patient cards from the National District Hospital, Bloemfontein emergency unit during 2003. Patient information was evaluated according to predetermined criteria to determine whether a visit was appropriate or not. Results: The patient's ages varied between 0 to 97 years (median 29 year) and 50.8% was female. Informal residencies presented 26.4% of patient's neighbourhoods. The most common chronic condition was hypertension (7.9%). Only 8.4% of patients already used medication for their presenting condition. Most (72.4%) patients presented after hours and 36.6% presented during weekends. The total number of injuries was 22.9% and 75.6% were examined for medical or surgical problems. The criterion with the most visits was the trauma category (21.8%). The criterion with the least patients (0.3%) was the criterion for significant bleeding. According to the results more than a third (35.4% ; 95% CI 33.7% ; 37.2%) of the patient visits can be seen as inappropriate. Conclusion: The emergency unit is used inappropriately South African Family Practice Vol. 49 (4) 2007: pp. 1

The perceptions of nurse educators regarding the use of high-fidelity simulation in nursing education at a South African private nursing college

Although Nurse Educators are aware of the advantages of simulation-based training, some still feel uncomfortable to use technology or lack the motivation to learn how to use the technology. The aging population of nurse educators cause frustration and anxiety. They struggle with how to include these tools, particularly in the light of faculty shortages. Nursing education programmes are increasingly adopting simulation in both undergraduate and graduate curricula. Scoping literature reviews show that nursing practice has changed in recent years, placing demands on nurse educators to utilise different approaches in education. The fact that nurse educators are an aging population needs to be taken into consideration and acknowledge that many of them did not grow up with computers and lag behind in technological skills. The aim of this study was to investigate the perceptions of nurse educators regarding the use of high-fidelity simulation in nursing education at a South African Private Nursing College in order to be able to determine why High-fidelity Simulators (HFS) have not yet been embraced by nurse educators and students. A national survey of nurse educators and clinical training specialists was completed with 128 participants; but only 79 completed the survey. In addition to background information, participants were questioned about their use of simulators. They were asked to complete the Technology Readiness Index. Information was also obtained regarding their perceptions of the use of HFS. Findings included indications that everyone is at the same level as far as technology readiness is concerned; this, however, does not play a large role in the use of HFS. This finding supports the educators’ need for training to adequately prepare them to use simulation equipment. Recommendations for further study include research to determine what other factors play a role in the use of HFS, studies to determine whether the benefits of HFS are superior to other teaching strategies warranting the time and financial commitment. The results of this study can be used as guidelines for other institutions to prepare their teaching staff for the use of HFS

Non-compliance with treatment by epileptic patients at George Provincial Hospital

Non-compliance with anti-epileptic drug treatment in the George area, resulting in recurrent seizures and visits to the emergency department of the George Provincial Hospital, has been identified as a social and economic problem. The aim of this study was to determine the socio-economic and medical factors, the information given to patients by healthcare workers, and the understanding of patients living with epilepsy who presented to the emergency department with seizures. Methods A descriptive study design was employed and the data-collection tools were a questionnaire and structured interview. Results The median age of the study population was 32 years. The patients had suffered from epilepsy for a median of two years and visited a clinic for a median of seven times a year. The median education level was primary school and three quarters had no employment or government grant. The majority did not understand the disease, the side effects of the medication and why they should be on medication. In addition, it became apparent from patient reports that healthcare workers showed a lack of counselling skills, time and appropriate knowledge. Conclusions There is a general lack of understanding of epilepsy by the patient. Not only were the patients uninformed, but they also showed apathy towards the management of their condition.South African Family Practice Vol. 49 (9) 2007: pp. 1

How Low Can We Go? The Implications of Delayed Ratcheting and Negative Emissions Technologies on Achieving Well Below 2 °C

Pledges embodied in the nationally determined contributions (NDCs) represent an interim step from a global “no policy” path towards an optimal long-term global mitigation path. However, the goals of the Paris Agreement highlight that current pledges are insufficient. It is, therefore, necessary to ratchet-up parties’ future mitigation pledges in the near-term. The ambitious goals of remaining well below 2 °C and pursuing reductions towards 1.5 °C mean that any delay in ratcheting-up commitments could be extremely costly or may even make the targets unachievable. In this chapter, we consider the impacts of delaying ratcheting until 2030 on global emissions trajectories towards 2 °C and 1.5 °C, and the role of offsets via negative emissions technologies (NETs). The analysis suggests that delaying action makes pursuing the 1.5 °C goal especially difficult without extremely high levels of negative emissions technologies (NETs), such as carbon capture and storage combined with bioenergy (BECCS). Depending on the availability of biomass, other NETs beyond BECCS will be required. Policymakers must also realise that the outlook for fossil fuels are closely linked to the prospects for NETs. If NETs cannot be scaled, the levels of fossil fuels suggested in this analysis are not compatible with the Paris Agreement goals i.e. there are risks of lock-in to a high fossil future. Decision makers must, therefore, comprehend fully the risks of different strategies

The impact of near-term climate policy choices on technology and emission transition pathways

This paper explores the implications of delays (to 2030) in implementing optimal policies for long-term transition pathways to limit climate forcing to 450 ppm CO2e on the basis of the AMPERE Work Package 2 model comparison study. The paper highlights the critical importance of the period 2030-2050 for ambitious mitigation strategies. In this period, the most rapid shift to low greenhouse gas emitting technology occurs. In the delayed response emission mitigation scenarios, an even faster transition rate in this period is required to compensate for the additional emissions before 2030. Our physical deployment measures indicate that the availability of CCS technology could play a critical role in facilitating the attainment of ambitious mitigation goals. Without CCS, deployment of other mitigation technologies would become extremely high in the 2030-2050 period. Yet the presence of CCS greatly alleviates the challenges to the transition particularly after the delayed climate policies, lowering the risk that the long-term goal becomes unattainable. The results also highlight the important role of bioenergy with CO2 capture and storage (BECCS), which facilitates energy production with negative carbon emissions. If BECCS is available, transition pathways exceed the emission budget in the mid-term, removing the excess with BECCS in the long term. Excluding either BE or CCS from the technology portfolio implies that emission reductions need to take place much earlier

An energy vision for a planet under pressure

Worldwide, global energy systems face an array of challenges, from access for the poor to reliability and security. Meanwhile, the provision of energy creates local human and ecological health impacts as well as dangerous global climate change. Addressing these issues simultaneously will require a fundamental transformation of the energy system. Recent assessments show that such a transformation is achievable in technological and economic terms, but it will present formidable supply- and demand-side challenges as well as problems of governance, transparency and reliability across scales. This policy brief presents a long-term vision for the energy system and describes the elements required for the transition towards this vision. To succeed, this transformation must integrate several key components, including a focus on high levels of energy efficiency and the scale up of investments in technology deployment as well as research, development and demonstration (RD&D)

Evaluating Process-Based Integrated Assessment Models of Climate Change Mitigation

Process-based integrated assessment models (IAMs) analyse transformation pathways to mitigate climate change. Confidence in models is established by testing their structural assumptions and comparing their behaviour against observations as well as other models. Climate model evaluation is concerted, and prominently reported in a dedicated chapter in the IPCC WG1 assessments. By comparison, evaluation of process-based IAMs tends to be less visible and more dispersed among modelling teams, with the exception of model inter-comparison projects. We contribute the first comprehensive analysis of process-based IAM evaluation, drawing on a wide range of examples across eight different evaluation methods testing both structural and behavioural validity. For each evaluation method, we compare its application to process-based IAMs with its application to climate models, noting similarities and differences, and seeking useful insights for strengthening the evaluation of process-based IAMs. We find that each evaluation method has distinctive strengths and limitations, as well as constraints on their application. We develop a systematic evaluation framework combining multiple methods that should be embedded within the development and use of process-based IAMs

Energy Security of China, India, the E.U. and the U.S. under Long-term Scenarios: Results from Six IAMs

This paper assesses energy security in three long-term energy scenarios (a business as usual development, a projection of Copenhagen commitments, and a 450 ppm stabilization scenario) as modeled in six integrated assessment models: GCAM, IMAGE, MESSAGE, ReMIND, TIAM-ECN and WITCH. We systematically evaluate potential long-term vulnerabilities of vital energy systems of four major economies: China, the European Union, India and the U.S., as expressed by several characteristics of energy trade, resource extraction, and diversity of energy options. Our results show that climate policies are likely to lead to significantly lower global energy trade and reduce energy imports of major economies, decrease the rate of resource depletion, and increase the diversity of energy options, particularly in the especially vulnerable transportation sector. China, India and the E.U. will derive particularly strong benefits from climate policies, whereas the U.S. may forego some opportunities to export fossil fuels in the second half of the century

Locked into Copenhagen pledges - Implications of short-term emission targets for the cost and feasibility of long-term climate goals

This paper provides an overview of the AMPERE modeling comparison project with focus on the implications of near-term policies for the costs and attainability of long-term climate objectives. Nine modeling teams participated in the project to explore the consequences of global emissions following the proposed policy stringency of the national pledges from the Copenhagen Accord and Cancun Agreements to 2030. Specific features compared to earlier assessments are the explicit consideration of near-term 2030 emission targets as well as the systematic sensitivity analysis for the availability and potential of mitigation technologies. Our estimates show that a 2030 mitigation effort comparable to the pledges would result in a further "lock-in" of the energy system into fossil fuels and thus impede the required energy transformation to reach low greenhouse-gas stabilization levels (450 ppm CO2e). Major implications include significant increases in mitigation costs, increased risk that low stabilization targets become unattainable, and reduced chances of staying below the proposed temperature change target of 2 degrees C in case of overshoot. With respect to technologies, we find that following the pledge pathways to 2030 would narrow policy choices, and increases the risks that some currently optional technologies, such as carbon capture and storage (CCS) or the large-scale deployment of bioenergy, will become "a must" by 2030