Incorporating Quality Improvement and Problem-solving Into a Unit Safety Huddle

The complex nature of healthcare creates significant risks of harm to patients. Safety huddles are a mechanism some hospitals utilize to raise awareness of safety concerns and minimize risks. Typically occurring at the start of each shift, safety huddles generally take the form of a brief, structured discussion with visual management for information sharing. In addition, safety huddles create a safe space for nursing staff to escalate concerns, supporting a culture of safety. This quality improvement project describes the expansion of a safety huddle process that has become a mere ritual at the start of each shift on a 25-bed medicine unit at a large urban hospital in the Midwest to improve nursing staff engagement. Through a formal quality improvement and problem-solving approach, there is a clear plan of action to elevate issues and a process to engage and empower nursing staff in identifying, achieving, and hardwiring improvements. Margaret Newman\u27s Theory of Health as Expanding Consciousness concepts of pattern recognition, increased awareness, and higher consciousness serves as this project\u27s theoretical foundation. The success of this project will be measured using pre and post- employee engagement scores for questions related to safety, patient experience, and empowerment. In addition, the number of completed projects that meet target conditions and scorecard metrics for falls with harm and patient satisfaction will serve as secondary measures of success of the expanded safety huddle process. Engaging and empowering nursing staff in quality improvement and problem-solving supports a culture of safety, leading to improved patient safety and positive health outcomes

Estimation of Costs of Phosphorus Removal In Wastewater Treatment Facilities: Adaptation of Existing Facilities

As part of a wider enquiry into the feasibility of offset banking schemes as a means to implement pollutant trading within Georgia watersheds, this is the second of two reports addressing the issue of estimating costs for upgrades in the performance of phosphorus removal in point-source wastewater treatment facilities. Earlier, preliminary results are presented in Jiang et al (2004) (Working Paper # 2004-010 of the Georgia Water Planning and Policy Center). The present study is much more detailed and employs an advanced software package (WEST®, Hemmis nv, Kortrijk, Belgium) for simulating a variety of treatment plant designs operating under typical Georgia conditions. Specifically, upgrades in performance, in a single step, from a plant working at an effluent limit of less than 2.0 mg/l phosphorus to one working with limits variously ranging between less than 1.0 mg/l to less than 0.05 mg/l phosphorus are simulated and the resulting costs of the upgrade estimated.Five capacities of plant are considered, from 1 MGD to 100 MGD. Three strategic, alternative designs for the facility are considered: the basic activated sludge (AS) process with chemical addition, the Anoxic/Oxic (A/O) arrangement of the AS process, and the Anaerobic/Aerobic/Oxic (A/A/O) arrangement of the AS process. Upgrades in performance are consistent with the logical alternatives for adapting these options. Cost comparisons are made primarily on the basis of the incremental cost of the upgrade, i.e., from the base-case, reference plant to that performing at the higher level, as expressed through the incremental Total Annual Economic Cost (TAEC; in $) and the marginal unit cost of phosphorus removal, expressed in ($/kg).For the most stringent upgrade, for example, to a plant generating an effluent with less than 0.05 mg/l phosphorus, these marginal costs -- the cost of the additional phosphorus removed as a result of the upgrade -- amount to something of the order of 150-425 $/kg, with the upper bound being associated with the smallest plant configuration (1 MGD). Working Paper Number 2005-001

Optimising the spatial pattern of landscape revegetation

The spatial pattern of landscape reconstruction makes a substantial difference to environmental outcomes. We develop a spatially explicit bio-economic model that optimises the reconstruction of a heavily cleared landscape through revegetation. The model determines the spatial priorities for revegetation that minimises economic costs subject to achieving particular improvements in habitat for 29 woodland-dependent bird species. The study focuses on the Avoca catchment (330 thousand ha) in North-Central Victoria. Our model incorporates spatial pattern and heterogeneity of existing and reconstructed vegetation types. The revegetation priorities are identified as being: sites in the vicinity of existing remnants, riparian areas, and parts of the landscape with diverse land uses and vegetation types. Optimal reconstruction design is affected by opportunity costs due to the loss of agricultural production and the costs of revegetation. 1 Centre for Environmental Economics and Policy, School of Agricultural and Resource Economics, University of Western Australia, Crawley, WA, 6009 2 Department of Primary Industries, Rutherglen, RMB 1145 Chiltern Valley Rd, Rutherglen, Victoria, 3685 3 North Central Catchment Management Authority, PO Box 18, Huntly, Victoria, 3551landscape reconstruction, biodiversity, optimisation, habitat, Environmental Economics and Policy, Land Economics/Use, Q57,

Clinical Geography: A Proposal to Embrace Space, Place and Wellbeing through Person-Centered Practice

This essay envisions how geography can operationalize nuanced understandings of space and place to enrich the lives of individuals across the lifespan. We propose a focused integration of geography into person-centered practice: a clinical geography dedicated to working directly with people to promote optimal physical and mental health outcomes and wellbeing. Our proposal integrates spatial modifications to facilitate access and utility, behavioral interventions to maximize effectiveness in using space, and therapeutic engagement to nurture a deeper sense of ‘being in place’ that enhances wellbeing and quality of life. This focus is timely given societal instability and precariousness resulting from incongruous person-environment situations. In addition to investigating, explaining, and critiquing hazardous and inappropriate conditions, geographers might also directly and more immediately intervene with people who find themselves in such situations

Prioritising investment to enhance biodiversity in an agricultural landscape

The removal, alteration and fragmentation of habitat are key threats to the biodiversity of terrestrial ecosystems. Investment to protect biodiversity assets (e.g. restoration of native vegetation) in dominantly agricultural landscapes usually results in a loss of agricultural production. This can be a significant cost that is often overlooked or poorly addressed in analyses to prioritise such investments. Accounting for this trade-off is important for more successful, realistically feasible and cost-effective biodiversity conservation. We developed a spatially explicit bio-economic optimisation model that simulates the effect of conservation effort on the diversity of woodland-dependent birds in the Avoca catchment (330 thousand ha) in North-Central Victoria. The model minimises opportunity cost of agricultural production and cost of biodiversity conservation effort on a catchment level subject to achieving different levels of biodiversity outcome. We identify the locations and spatial arrangement of conservation efforts that offers the best value for money.Environmental Economics and Policy,

The Community Nurse in Australia. Who are they? A rapid systematic review.

AimTo profile the community nurse in Australia.BackgroundThe need for nurses in the community health care sector is increasing in response to shorter hospital stays, an ageing population and chronic disease. The increase in demand has not been followed by appropriate workforce planning, leading to structural issues and lack of qualified nursing workforce in the community sector.EvaluationMEDLINE and ProQuest Public Health and grey literature were searched for records published between 2010-2020 relative to the profile of the community nurse in Australia. Twenty-five records (21 publications, two databases and two reports) were included in the review. Abstracted data followed the principles of workforce planning, and included demographics, qualifications and roles.Key issuesInconsistent definitions, self-reported data and a focus on practice nurses have contributed to data irregularities. Little is known about the specific aspects of community nursing work.ConclusionA lack of concrete data has over-shadowed a community nursing workforce crisis with implications for patients' health and safety across the lifespan.Implications for nursing managementThere is urgent need for nurse managers globally to refocus nursing recruitment to the community sector to maintain quality and ensure sustainability of the nursing workforce

From Zironyl Chloride to Zirconia Ceramics, a Plant Operation Perspective

The differences between two hydrous zirconium filter cakes manufactured at pH 3 and 12 were studied and further processing consistent with industrial procedures was undertaken. The loss on drying was found to be approximately 23% for both filter cakes, however for the loss on ignition the ph 3 sample was found to have a 12% higher loss at 33%. The specific surface area (SSA) was found to be 238 m2/g for the pH 3 sample and 312 m2/g for pH 12. The pH 12 sample showed a linear decrease of SSA with calcination temperature and both samples achieved the same SSA after 1000 oC. The pH 3 sample took 29 hours to attrition mill to a target D90 of less than 2 m, the pH 12 sample achievedthe same target in 26 hours. X-ray diffraction revealed that both samples had crystallite sizes in the order of 30 nm and greater than 90% monoclinic phase. Both samples achieved approximately 86% theoretical density when uniaxially pressed and sintered, corresponding with 20% linear shrinkage. The pH 3 sample had greater statistical variability in most results, indicating it would be harder to control. Differences in appearance when tape cast were also noted for the two powders

Industrial precipitation of yttrium chloride and zirconyl chloride: effect of pH on ceramic properties for yttria partially stabilised zirconia

Two 3 mol% partially stabilised zirconia (P-SZ) samples suitable for the SOFC market were manufactured from solutions through to ceramics using a method similar to a known industrial process. The only difference in preparation of the two 3 mol% P-SZ samples was the pH of precipitation which was set at pH 3 or 12. Particle size measurements by dynamic light scattering were used to characterise the precipitate and the filtration rates were investigated. Five point N2-BET was used to investigate the specific surface area before and after calcination with the response to temperature tracked. Similarly TGA/DTA investigation was used to determine the calcination point during all of these tests and it was found that both powders behaved similarly. XRD-Rietveld analysis incorporating in situ and ex situ calcination revealed that the pH 3 sample had more monoclinic phase present after calcination and sintering as a ceramic. Ceramic testing incorporating hardness (Vickers), toughness (K1C), MOR, density and grain sizing was carried out, all determined that the material produced at pH 12was superior for SOFC applications than the pH 3 sample. Further investigation using TEM-EDS revealed that the processing of the pH 3 powder had allowed a lower concentration of the yttrium which was incorporated at approximately 2 mol% instead of the required 3. ICP-OES of the after filter liquor indicated that high concentrations of yttrium (797 ppm) were found in the solution with the wash solution having 149ppm yttrium. In contrast the pH 12 samples had 7ppm in both the after filter liquor andwash indicating that the yttrium is bound within the matrix more completely at the higher pH

The effect of processing parameters on particle size in ammonia-induced precipitation of zirconyl chloride under industrially relevant conditions

The effect of pH of precipitation, starting solution concentration, and agitation levels on the particle size of hydrous zirconia precipitates have been investigated. It was found that all three variables affect the particle size of the hydrous zirconia. The smallest particle size is produced by a 0.81 M starting solution, precipitated at pH 12 with a high agitation level. The pH of precipitation was also found to have a significant impact on the type of hydrous zirconia produced. TGA/DTA, micro combustion and TEM / EDS were used to investigate the difference in the powders produced at pH 3 and 12. This work suggests that powders produced at pH 3 will have a structure similar to Zr[OH]4 whilst those at pH 12 are more likely ZrO[OH]2. XRD and micro-combustion suggest that the powders produced at pH 3 retained ammonium chloride whilst those produced at pH 12 did not. The filtration rates for the pH 3 product were significantly faster than that of the powders made at pH 12 which is significant in the industrial production of these materials