Background

The emergency medical service (EMS) addresses all chief complaints across all ages in various contexts. Children in EMS present a particular challenge due to their unique anatomical and physical properties, which require specific training that EMS clinicians often report lacking. This combination exposes children to incidents threatening patient safety. The most common method to highlight incidents is the incident reporting system. Studies have shown underreporting of such incidents, highlighting the need for multiple methods to measure and enhance patient safety in EMS for children. Thus, the aim of this study was to modify and adapt the current Ambulance TT for road-based EMS (ATT) to a pediatric version (pATT) with a guide containing definitions of triggers.

Methods

The adaption of the ambulance trigger tool to a version suitable for children followed a stepwise manner, including (1) a review of previous literature to pinpoint areas of risk regarding patient safety among children in EMS. (2) Three sessions of expert panel discussions via video meetings were held to evaluate each trigger of the ATT in terms of clinical relevance, comprehensibility, language and areas of risk regarding patient safety among children in EMS. (3) Clinical use of the pATT along with Retrospective Record Review (RRR). (4) Calculation of Item-level validity index and positive predictive value (PPV) for each trigger. (5) calculate inter-rater reliability between two independent record reviewers.

Results

MethodsThe adaption of the ambulance trigger tool to a version suitable for children followed a stepwise manner, including (1) a review of previous literature to pinpoint areas of risk regarding patient safety among children in EMS. (2) Three sessions of expert panel discussions via video meetings were held to evaluate each trigger of the ATT in terms of clinical relevance, comprehensibility, language and areas of risk regarding patient safety among children in EMS. (3) Clinical use of the pATT along with Retrospective Record Review (RRR). (4) Calculation of Item-level validity index and positive predictive value (PPV) for each trigger. (5) calculate inter-rater reliability between two independent record reviewers.

Conclusion

This study demonstrates the adaptation of an existing trigger tool (ATT) to one suitable for children. It also shows that the trigger tool, along with retrospective record review, is a feasible method to evaluate patient safety in EMS, thus complementing existing methods. 

Society is spinning out of control, moving at an accelerating pace. We rush to keep up, stress over rapidly changing fashion trends, and consume at unprecedented rates, only to discard items moments later. This thesis resists these trends and rejects the urge to follow the crowd.

Through a series of slow textile art and clothing projects, I explore the aesthetics of aversion. The process has been time-consuming, difficult, tangled, and at times boring. It has employed repetition and return as methods, using textiles and garments as materials, and drawing on emotions, memories, and habits as driving forces. These elements aim to forge new relationships with matter, people, and the Earth.

In everyday life, I seek to slow down the relentless push toward novelty. Rather than embracing the faster, easier path, these projects focus on the relational, tactile, and identity-building aspects of textiles and garment-wearing. My goal has been to resist solutions, to avoid quick fixes, and even to turn away from problems altogether. This thesis highlights and discusses many concepts related to the aesthetics of aversion.

The increasing inclusion of digital technology in fashion-design practices challenges the established material ontologies that are the result of fashion’s physical-based history. Materiality in the digital does not inherently come into existence with pre-set properties, behaviours, and expressions. How it appears, behaves, and responds is programmable, which fundamentally questions the causal material thinking commonly found in fashion design. It also introduces a dimension of openness and ambiguity as regards the role, purpose, and interactions of materiality that fashion design as a discipline needs to embrace if it wants to create meaningful content using, and for use in, digital environments.

The research programme that the research presented in this thesis followed involved the formulation of an alternative material ontology in digital fashion design; this was based on practice-based experimental activities, which were informed by agential-realism theory. The ontological approach formulated in the programme shifts the focus away from designing objects and towards designing resolutions (here understood as enacted states of how the body, fabric, and space unfold and become intelligible) of material components within phenomena in fashion design. Phenomena are understood as the basic ontological units, in which the body, fabric, and space exist as entangled components. Rather than designing for the human body, using fabrics, and within three-dimensional spaces, the research programme proposes designing resolutions wherein the roles, purposes, and functions of the body, fabric, and space are expressed based on their material performances and enacted using digital technology. Engaging with digital technology that way changes its purpose, from a tool to be used to being part of the designed phenomenon.

Notions, methods, and tools developed within the research programme shift the focus away from making concrete physical products to be worn on the body within socially constructed spaces, and towards the design of resolutions within material phenomena in which the body, fabric, and space equally constitute the design experience through their performative intra-actions. Phenomena-based fashion here does not rely on causal structures of wearing; instead, it more intimately and immediately involves people in the sense of ‘being’ and ‘being part of’, via performative boundaries of digitally enacted material interventions. In this sense, the research programme not only formulates methods for alternative design practices in fashion with digital technology, but also outlines an alternative material ontology that suggests different ways of experiencing, engaging with, communicating, and ‘being part of’ fashion on a material level.

In (Stanley, 1978), Stanley constructs an example of an Artinian Gorenstein (AG) ring A with non-unimodal H-vector (1,13,12,13,1). Migliore-Zanello show in (Migliore and Zanello, 2017) that for regularity r=4, Stanley's example has the smallest possible codimension c for an AG ring with non-unimodal H-vector.The weak Lefschetz property (WLP) has been much studied for AG rings; it is easy to show that an AG ring with non-unimodal H-vector fails to have WLP. In codimension c=3 it is conjectured that all AG rings have WLP. For c=4, Gondim shows in (Gondim, 2017) that WLP always holds for r≤4 and gives a family where WLP fails for any r≥7, building on Ikeda's example (Ikeda, 1996) of failure for r=5. In this note we study the minimal free resolution of A and relation to Lefschetz properties (both weak and strong) and Jordan type for c=4 and r≤6.

BACKGROUND: To effectively utilize available healthcare resources, integrated care models are recommended. According to such model's, registered nurses have the potential to increase patient access to health care services and alleviate organizational workload. Studies on acute home consultation assessments by registered nurses are sparse. The aim was to describe the reasons and actions for unscheduled same-day face-to-face registered nurse consultation at home offered to patients calling the national telephone helpline for healthcare in Sweden (SHD 1177), according to the integrated Collaborative Health Care model.

METHODS: A descriptive cross-sectional study was designed. Data from registered nurses (n = 259) working within the Collaborative Health Care model, who performed unscheduled consultations at home (n = 615) using a data collection tool from 2017 to 2018 were collected.

RESULTS: Among the 615 unscheduled home consultations performed by registered nurses, > 50% of the patients were managed at home as their health problems were not deemed as requiring a same-day referral to a clinic when assessed by the registered nurses. The most frequent health problems and reasons for contact were urinary tract problems, followed by medical and surgical conditions. Social factors, including living alone, impacted referral. Those living with a partner received care at home to a greater extent than those who lived alone.

CONCLUSION: An integrated model for healthcare involving registered nurses direct assessment, action and accountability seems to be an efficient option for providing integrated care at home and reducing acute clinic visits. © 2024. The Author(s).