bluuebunny/crossref_metadata_2025_split huggingface dataset:
Healthcare System Restructuring in New Zealand: problems and proposed solutions
Authors: Gauld Robin 
Published: February 2019

New Zealand’s healthcare system is, like most, in a continual process of restructuring and change. While the country has endured several major system-wide changes in recent decades, more recent change has been incremental and evolutionary. Current changes are in response to a set of challenges, which are not unique to New Zealand. This article overviews the New Zealand healthcare system. It then describes a series of problems facing the system and proposed solutions. These include the need for team care, providing services closer to patients’ homes, focusing on a population of interest, connecting up the system, and engaging patients more closely in care design and delivery.
Abbreviations: DHS – District Health Board;GP – General Practitioner; PHO – Primary Health Organisation.
Identifying and Ranking Areas of Relative Need for New Public Dental Clinics Using a State-of-the-Art Data Simulation Approach
Authors: Dudko Yevgeni , Robey Dennis E , Kruger Estie , Tennant Marc 
Published: February 2019

Background: Lower socioeconomic groups and country residents are more likely to experience dental disease. Previous research has found that it is generally more cost effective to provide subsidised dental care through publically employed dentists when compared to subcontracting the work out to the private sector.
Objective: The primary objective of this study was to identify and rank areas of relative need for new public dental care facilities across Australia. The secondary objective was to gauge how many of these areas arelocated in the vicinity of an existing public hospital (medical) with a view to utilise existing infrastructure for future service rollout.
Methods: Usual resident population, employment status and socioeconomic distribution data was downloaded from the Australian Bureau of Statistics website at Statistical Area 1 level. A mathematical weighing formula was applied to those variables, which subsequently allowed for ranking of the results based on magnitude of the product values. The findings were considered in terms of proximity to existing public health infrastructure.
Results: A total of 49 SA1 areas were identified and preselected as potential sites for new public dental clinics across Australia. Eighty per cent of the identified areas of relative need were located outside metropolitanareas. Fifty per cent of those were found to be in close proximity to an existing public hospital (medical).
Conclusion: Offering subsidised dental care through existing public hospitals may be an option. Such an approach has a potential to improve access to subsidised dental care in regional centres while minimising capitalexpenditure on infrastructure.
Abbreviations: ABS – Australian Bureau of Statistics; ASGS – Australian Statistical Geography Standard; SEIFA – Socio-Economic Indexes for Areas
Entry Points to the Health System: a review of the emerging community models for management of non-life threatening urgent conditions relevant to Australia
Authors: Adie John , Graham Wayne , Wallis Marianne 
Published: February 2019

Problem: The number of presentations to Emergency Departments (EDs) is increasing at levels above population growth rates and these increases are becoming unsustainable.
Objective: To review evidence for emerging entry points to the health system for patients with non-life threatening urgent conditions (NLTUC) in order to consider more effective healthcare services in Australia.
Methods: An in-depth review of the Emerald, Medline, CINAHL, Web of Science, Proquest Business and Medical databases from January 2005 to April 2016 matching ‘acute care’ or ‘urgent care’ with general practice andother health providers found thirteen entry point models with five currently relevant to Australia.
Results: Studies examining five emerging entry points were found including urgent care community pharmacy, new prehospital practitioner community care, advanced nurse enhancement of primary care, designated urgent care clinics and integrated primary care centers. Evidence for these emerging models of community healthcare is presented including emerging initiatives, cost implications, subsequent admission to hospital, satisfaction, mortality, care, treatment time, subsequent referrals, testing and health outcomes.
Conclusion: These emerging models of community healthcare need to be trialed and studied in the Australian context to evaluate whether they provide patients with NLTUC with a safe cost-effective option with similar outcomes to EDs. Implementation of these models can be examined further to determine their effectiveness in potentially reducing the increasing rate of presentation to EDs.
Abbreviations: APCN – Advanced Primary Care Nurse; ECP – Emergency Care Practitioners; ED – Emergency Department; GP – General Practitioner; IPCC – Integrated Primary Care Centre; PP – Paramedic Practitioners; NLTUC – Non-Life Threatening Urgent Conditions; UCC – Urgent Care Clinics; UCCP – Urgent Care Community Pharmacy.
Factors Affecting Motivation and Retention of Village Health Workers and Recommended Strategies: a systematic review from 11 developing countries
Authors: Tshering Dolley , Tejativaddhana Phudit , Briggs David , Wangmo Neyzang 
Published: February 2019

Introduction: Motivation and retention of village health workers (VHWs) are crucial for the continuity, sustainability, and success of health programs. VHWs are the first point of contact for rural communities, providing health services to improve access and health coverage which, for a variety of logistical reasons, cannot be reached by the district health care system. Thus VHWs are critical for ultimately ensuring universal health coverage. However, systematic review revealed that there are numerous factors that affects their motivation and retention, leading to high dropout rates and hampering the delivery of health services to the community. This review intends to examine contextual factors affecting motivation and retention of VHWs in their roles and identify recommendations and strategies to motivate and retain them in the systems.
Method: Five electronic databases and two search engines were accessed. Nineteen studies met the inclusion criteria for the final review. An in-depth reading of all the articles was undertaken to gather and compile the relevant themes. Content analysis was done based on the list of specific categories that are relevant to motivation and retention.
Result: Findings from the systematic review revealed different levels of factor affecting motivation and retention of village health workers. It was finally contextualized and categorized into four main domains such as individual, family, social or community and organizational or systems levels. Financial incentives under the organizational factors was highlighted for the demotivation and the discontentment for the VHWs.
Conclusion: Financial factors under the organization were often key in the studies reviewed. However, there were also many other factors, sometimes surprising or unintuitive, influencing the motivation and retention of village health workers.
Adverse Events Sustained by Children in The Intensive Care Unit: Guiding local quality improvement
Authors: James Christopher , Delzoppo Carmel , Tibballs James , Namachivayam Siva , Butt Warwick 
Published: February 2019

Objective: To determine the frequency, nature and consequence of adverse events sustained by children admitted to a combined general and cardiac paediatric intensive care unit (PICU).
Design: Retrospective analysis of data collected between January 1st 2008 and December 31st 2017 from PICU.
Setting: The Royal Children’s Hospital, a paediatric tertiary referral centre in Melbourne, Victoria, Australia. The PICU has thirty beds.
Results: During the study period, PICU received 15208 admissions, of which 73% sustained at least one adverse event with a frequency of 67 adverse events per 100 PICU-days and 3 per admission. One adverse event was sustained for every 35 hours of care. The risk of an adverse event was highest in children less than a month of age, or if mechanically ventilated, a high Pediatric Index of Mortality (PIM2) score, longer PICU length of stay, had a pre-existing disability or a high risk adjustment for congenital heart surgery (RACHS) score. Those patients who sustained an adverse event, as compared to those who did not, were mechanically ventilated for longer (80 hrs Vs. 7 hrs, p=<0.001), had a longer PICU length of stay (131 hrs Vs. 35 hrs, p=<0.001), had a longer hospital length of stay (484 hrs Vs. 206 hrs, p=<0.001) and had a higher mortality rate (3% vs. 0.1%, p=<0.001).
Conclusion: Whilst admission to PICU is an essential aspect of care for many patients, the risk of adverse events is high and is associated with significant clinical consequences. Monitoring of adverse events as part of quality improvement enables targeted intervention to improve patient safety.
The Common Barriers and Facilitators for a Healthcare Organization Becoming a High Reliability Organization
Authors: Karalis Elina , Barbery Gaery 
Published: February 2019

Background: Implementing high reliability organization principles can enhance quality and safety in healthcare. Evidence-based instructions on how to effectively change the organizational culture in healthcare setting are required.
Objectives: A systematic review investigating methods, facilitators, and barriers to assist healthcare organizations in becoming a high reliability organization.
Method: Literature searches were performed in PubMed, MEDLINE, CINAHL-Complete, EMBASE, and Scopus for articles published between January 2012 and October 2017. The included articles were case reports, case studies, and protocol development studies on implementing high reliability organization principles. The articles were appraised using a modified Critical Appraisal Skills Programme tool. Thematic synthesis was conducted using manual coding.
Results: Of the 14 eligible articles nine were case studies, four were case reports, and one was a framework development report. The study populations varied from whole healthcare systems to a single department of a hospital. The most common methods were supportive leadership, staff education, and analysing the safety events and sharing the knowledge. Cost was one of the barriers. Remuneration came in reduction of safety events and costs avoided.
Conclusion Implementing high reliability organization principles in healthcare settings is slow and challenging, but doing so improves quality, resilience, and safety, thus increasing productivity.
Evaluation of the State-Wide Implementation of an Allied Health Workforce Redesign System: Utilisation of the Calderdale Framework
Authors: Pain Tilley , Patterson Sarah , Kuipers Pim , Cornwell Petrea 
Published: February 2019

Background: Increasing demand for allied health services is driving workforce redesign towards greater productivity within budgetary constraints. To date, there has been limited research into workforce redesign tools at an organisational level. The aim of this article was to evaluate an implementation of The Calderdale Framework for state-wide service delivery workforce redesign within allied health settings across Queensland.
Method: A multi-phase methodology with mixed methods of data collection was used. This included analysis of documents, staff surveys, and semi-structured, in-depth interviews with staff from work units utilising the Framework across the state.
Findings: The primary mechanisms for implementation were staff training and provision of centralised resources. Across the state, all health services engaged in training and most completed associated workforce redesign projects. However, the number and type of projects varied across the state as did the successful projects. Feedback from staff indicated the structured nature of the framework was viewed positively, but was time intensive to perform. Local contextual factors heavily influenced workforce redesign success.
Conclusion: Key factors pertaining to state-wide workforce redesign include: providing coordinated and centralised systems to support staff, ensuring adequate training, prioritising the development of key local staff, and proactively managing local contextual factors.
DESIGN OF THEMATIC INTEGRATIVE LEARNING BASED ON LOCAL ADVANTAGE IN ELEMENTRY SCHOOL
Authors: Utaminingsih Sri , Zuliana Eka 
Published: February 2019

The purpose of this research is to create the integrated thematic learning design based on local advantage in Demak municipality for 3rd grade with traditional game theme. The research design with first step: preparing for the experiment consist of : : (1) literatur study anda FGD with teacher to identify core competences and local advantage, (2) designing the model with scientific approach: (observing, questioning, experimenting, associating, dan communicating), (3) planning for learning implementation, (4) planning for evaluation process by using authentics assesment and (5)Test showed an increase in the quality of the instructional design of learning; (6). FGD with the expert to discuss early design so that can be get valid design. The result of this research can be get the design of model: integrated thematic learning based on local advantage in Demak municipalitythat can improve the quality of learning of elementary school students
Assessment of the flocculating potentials of Alcaligenes faecalis Isolated from the Estuary of Sodwana Bay
Authors: Ugbenyen Anthony M. , Madonsela Thandakile A. , Simonis John J. , Basson Albertus K. 
Published: February 2019

Abstract

Alcaligenes faecalis was previously isolated from Sodwana Bay, South Africa and was shown to be a bioflocculant producing microorganism. The bioflocculant production potential was further assessed through the optimization of the standardized culture media. The production of biofloculant as well as the flocculation was evaluated using different variables such as the size of inoculum, sources of carbon and nitrogen, time course and pH. Through optimization A. faecalis showed an improvement in the production of its bioflocculant and also flocculating activity for the following factors: flocculating activity of 71% for an inoculum size of 1%. The bioflocculant produced when maltose was used as source of carbon, showed flocculating activity of 91%, urea, as the most efficient nitrogen source, showed a flocculating activity of 97%, the optimum pH was 9. The time courses analysis between 60 and 72 hours showed the peak for flocculation and by implication highest level of bioflocculant production.
Evaluation of Formants of Cityscape Identity using Fractal Analysis (Kaunas Case)
Authors: Povilaitienė Ingrida , Kamičaitytė-Virbašienė Jūratė , Zaleckis Kęstutis 
Published: February 2019

Abstract
Cityscape identity might be objective and subjective. Still, it is more often analysed from person’s perspective, and analysis of urban fabric itself is not considered sufficiently. Thus, this research aims to find out if fractal analysis method could be used to fill that gap. Kaunas city was chosen for the case study. The research was conducted in three stages: qualitative assessment (designation of the zones with different semantic load in Kaunas), quantitative assessment (calculation of fractal indexes of panoramic and streetscape views from previously established zones), and comparison of these approaches. To sum up, the research confirmed that there is a relationship between the results of different approaches. Thus, fractal analysis could be used as one of the tools for quantitative assessment of cityscape identity.
The Demonstration Model of an Electromagnetic Accelerator Gun
Authors: Molnar Andras 
Published: February 2019

Abstract
These days a lot can be heard about special weapons which accelerate the projectile not based on the traditional, chemical energy release, but providing the muzzle velocity with the help of electromagnets. In English terminology, many descriptions can be read about these devices, referred to as “coilgun”. There are so many hobbyist and amateurs who make these devices [1,2] and publish their results on the internet [3,4]. The purpose of the project is dual. On one hand, features, advantages, disadvantages and the limits of the electromagnetically accelerated weapons can be found by building an experimental tool. On the other hand, it was intended to point out the fact that anybody can build such a tool using commercially available commercial components. Although the muzzle energy of the device presented in this paper is not more than 6.8J, but it can cause serious injury. The paper also points out that in a similar way, still not using special components, a weapon can be made with a larger (10-20J) muzzle energy.
Assessment of sea buckthorn (Hippophaë rhamnoides L.) long distance dispersal on the internal waste heap of the Bełchatów lignite mine
Authors: Bolibok Leszek , Kubiak Monika , Michalski Sebastian 
Published: February 2019

Abstract
Long distance dispersal is a key process occurring in plant communities and is particularly important for pioneer species like sea-buckthorn (Hippophaë rhamnoides L.) which survival strongly depends on colonizing newly created post-disturbance habitats. Sea-buckthorn, a cluster-forming shrub, is commonly used in Poland in the reclamation of soil-less areas devastated the by mining industry and for these areas a generative expansion of planted populations is usually observed. The main objective of this study was to assess the long-distance dispersal of this species in areas previously disturbed by industrial activity. Our observations were made on a 223.75 ha large section of the internal waste heap of the Bełchatów lignite mine, Central Poland. The area was colonized by sea-buckthorn specimens originating from a population planted on the nearby external waste heap. During the search for newly established sea-buckthorn clusters, their position and size were recorded and the preferences for specific site conditions were assessed using the Ivlev’s electivity index. New specimen were observed at distances between 600 m and 3600 m from their potential seed source. The mean cluster density was 1.37 ha−1. The observed pattern of long distance dispersal is linked with to behavior of frugivorous birds. The largest cluster densities were observed along ditches (9.83 ha−1) and on open areas with less developed plant cover, while the lowest cluster density occurred in afforested areas (0.51 ha−1). Poor sandy substrate reduced the probability of plant establishment compared to richer loamy sands. There appeared to be no influence of slope aspect on the probability of sea-buckthorn establishment.
Arsinoitherium (Embrithopoda) and other large mammals and plants from the Oligocene of Tunisia
Authors: Pickford Martin 
Published: February 2019

Abstract
Palaeogene large mammals are poorly represented in Tunisia, in contrast to Morocco, Algeria, Libya and Egypt, where abundant and diverse faunas are known. Oligocene proboscideans have been recorded from four localities in Tunisia (Djebel Bou Gobrine, Oued Bazina, Bled Mellaha and Djebel Touila) but little else from this period is known from the country. For this reason it is worth recording the discovery of an arsinoithere tooth fragment from the divide between Oued Cherichera and Oued Grigema, Central Tunisia. This discovery confirms the presence of continental Oligocene strata in the region, and the palaeodistribution of Arsinoitherium 1,300 km to the north-northwest of its previously established range. Arsinoitheres are now known to have been widespread throughout the Afro-Arabian continent. Although palaeoclimatic data for the Oligocene of Tunisia is still scarce, fossil plants suggest that, during the Oligocene, the country enjoyed a tropical to sub-tropical humid climate, in accordance with the presence of Arsinoitherium, Phiomia and an anthracothere, taxa that are also present in the classic Fayum faunas of Egypt and the Ashawq faunas of Oman.
The mammalian fauna of Barová Cave (Moravian Karst, the Czech Republic)
Authors: Roblíčková Martina , Káňa Vlastislav , Fišáková Miriam Nývltová 
Published: February 2019

Abstract
Barová Cave is located in the central part of the Moravian Karst (the Czech Republic), on the right slope of Josefovské Valley; it is the outflow part of Rudické propadání (Rudice Sink) – Býčí skála (Bull Rock) cave system. Even since its discovery by A. Sobol in 1947, Barová Cave has been known as important palaeontological site, with well-preserved fauna of the Late Pleistocene. In the summer of 2011, a landslide of sediments revealed yet unexamined fossiliferous positions, and started the current research activity. There were discovered skeletal remains of these 21 taxa of vertebrates between 2011 – 2017 in Barová Cave: bear from the cave bear group (Ursus ex gr. spelaeus), cave lion (Panthera spelaea), wolf (Canis lupus), cave hyena (Crocuta crocuta spelaea), brown bear (Ursus arctos), lynx (Lynx lynx), wolverine (Gulo gulo), fox, probably red (Vulpes cf. vulpes), marten (Martes cf. martes), alpine ibex (Capra ibex), chamois (Rupicapra rupicapra), aurochs or bison (Bos primigenius/Bison priscus), reindeer (Rangifer tarandus), red deer (Cervus elaphus), horse (Equus sp.), woolly rhinoceros (Coelodonta antiquitatis), hare (Lepus sp.), lemming (Dicrostonyx sp.), bank vole (Myodes sp.), jackdaw (Corvus monedula) and probably northern pintail (Anas aff. acuta). Animal osteological material from sectors 2, 3, 4 and R4 from the Under the Ladder test pit in Barová Cave is analysed in detail in this paper. Bears from the group of cave bears completely dominate, the total sum of bones determined as bear bones make up nearly 95% of all determined material. The cave lion bones comprise nearly 3% of the determined osteological material; bones of a wolf represent about 1.2%, bones of cave hyena approximately 0.5% and bones of ungulates approximately 0.2% of all determined material (Tab. 1). From the MNI point of view the bears from the cave bear group dominate too. Bear bones belonged to at least 40 individuals (70.2% of all minimally present individuals) of all age categories (Tabs 1, 2). The predominance of bones of bears from the cave bear group in Barová Cave shows that the cave was mainly used as a bear wintering site. The presence of bear cub bones proved that the cave also served females as a birthing place. Some bones of bears from the group of cave bears and several bones of cave lions, cave hyenas and wolves also show evidence of bite and gnawing marks by carnivores or scavengers (cave lions, cave hyenas, wolves and perhaps cave bears). This suggests that hibernating bears, and more often the cadavers or isolated bones of dead individuals sometimes served as a food source. The seasonality analysis indicates that the time of death varied most frequently near the end of wintering season (spring/summer). The large amount of bear bone material leads to the consideration that the bears from the cave bear group used Barová Cave over a period longer than thousand years.