Accessible Target Research Articles

Influenza-associated delays in patient throughput and premature patient departure in emergency departments in New South Wales, Australia: A time series analysis.

Influenza outbreaks cause overcrowding in EDs. We aimed to quantify the impact of influenza on the National Emergency Access Targets and premature patient departure in New South Wales, Australia. This was a retrospective observational study of 11 million presentations to 115 hospitals during 2010-2014, using routinely collected administrative records. A time series generalised additive regression model was used to assess the correlation between weekly influenza activity and the weekly proportion of patients leaving the ED in >4 h and the proportion that departed before commencing or completing treatment ('did not wait'), after controlling for background winter and holiday effects. During 2011-2014, peak annual circulating influenza was associated with the peak weekly proportion of presentations that left in >4 h. The maximum estimated absolute weekly change in that proportion was 3.88 (95% confidence interval 3.02-4.74) percentage points in 2014. For presentations that did not wait, influenza circulation was associated with statistically significant increases in all years, with a maximum weekly value of 2.68 (95% confidence interval 2.31-3.06) percentage points in 2012. Circulating influenza was associated with sustained increases and peaks in delayed patient throughput and premature patient departures. Influenza surveillance information may assist with development of health system and hospital workforce planning and bed management activities.

The National Emergency Access Target performance and all that!!

The National Emergency Access Target performance and all that!!

Effect of the 4-h target on ‘time-to-ECG’ in patients presenting with chest pain to an emergency department: a pilot retrospective observational study

Objectives The aim of this study was to assess the relationship between compliance with time-based Emergency Department (ED) targets (known as NEAT) and the time taken to collect an electrocardiogram (TTE) in patients presenting with chest pain. Methods This was a pilot descriptive retrospective cohort study completed in a large inner city tertiary ED. Patients who presented with active or recent chest pain between July 2014 and June 2015 were eligible for inclusion. Pregnant patients, inter-hospital transfers, and traumatic chest pain were excluded. A random selection of 300 patients from the eligible cohort comprised the final sample. The differences of TTE between categories of NEAT compliance were compared using Kruskal-Wallis test. Also, the factors affecting with the acquisition of ECG within ten minutes of arrival were explored using proportional hazards regression. Results There was a significant inverse association between the percentage of admitted patients leaving the ED within four hours (admitted NEAT) and TTE. As admitted NEAT compliance increased TTE decreased (p=0.004). A number of variables including triage score, arrival time, total NEAT, first location, doctor wait time, and cardiac diagnosis were all significant predictors of TTE. After adjusting for other variables Admitted NEAT remained as an independent predictor of TTE. Conclusion There is likely to be a relationship between NEAT and TTE that is reflective of overall hospital and not just ED functioning; however the exact relationship remains uncertain. Further study in a multisite study is warranted to further explore the relationship between NEAT, TTE and other important clinical metrics of ED performance. What is known about the topic? The 4-h time target or National Emergency Access Target (NEAT) is implemented in Australia to ease crowding and access block. However, little is known of its effect on important clinical endpoints, particularly 'time-to-ECG' (TTE). What does this paper add? This paper demonstrates a complex relationship between measures of time-based targets, such as time to ECG. It is likely that increasing compliance with admitted NEAT shortens TTE, demonstrating the effect of hospital functioning on the ability to deliver quality care in the emergency department. What are the implications for practitioners? Emergency department flow has an effect on the ability of the department to deliver key assessment. There is a relationship between NEAT compliance and TTE, but the exact relationship requires further exploration in larger multicentre studies.

Two Hour Evaluation and Referral Model for Shorter Turnaround Times in the emergency department.

The objective of this study was to assess the implementation of a novel ED model of care, which combines clinical streaming, team-based assessment and early senior consultation to reduce length of stay. A pre-post-intervention study was used to compare ED performance following an extensive clinical redesign programme. Clinical teams and work sequences were reconfigured to promote the role of the staff specialist, with a focus on earlier decisions regarding disposition. Primary outcome measures were ED length of stay and National Emergency Access Target (NEAT) compliance. Secondary outcomes included referral and workup times, wait times by triage category, ambulance offload times, ward discharges and unit transfers within 24 h of admission, representation within 48 h, and Medical Emergency Response Team (MERT) calls within 24 h of admission. Two seasonally matched 26 week intervals were compared with adjustment for demographics, triage category and arrival by ambulance. Overall, there was an 18.4% rise in NEAT performance (95% confidence interval (CI): 17.7-19.1) while ED length of stay decreased by a total of 86.8 min (95% CI: 83.6-90.1). Time series analysis did not suggest any preexisting trends to explain these results. The average time to referral decreased by 74.7 min (95% CI: 69.8-79.6) and waiting times decreased across all triage categories. Rates of MERT activation and unplanned representation were unchanged. A facilitated team leader role for senior doctors can help to reduce length of stay by via early disposition, without significant risks to the patient.

Impact of emergency department discharge stream short stay unit performance and hospital bed occupancy rates on access and patient flowmeasures: A single site study.

The ED discharge stream short stay units (EDSSUs) aim to facilitate patient flows through EDs. We investigate the relationship between EDSSU census and hospital bed occupancy rates (BORs) on National Emergency Access Target (NEAT) performance and did-not-wait (DNW) rates at a tertiary metropolitan adult ED in Sydney, Australia. We collated data for all ED presentations between 1 January 2012 and 31 December 2014. Daily ED, EDSSU census and ED-accessible hospital BORs were tabulated with daily ED NEAT performance and DNW rates. Non-parametric regression analyses was conducted on cohorts of appropriate, inappropriate, successful and failed EDSSU admissions based on local admission policies and BOR for NEAT and DNW outcomes. Among all presentations (n = 192 506) during the study period, 43.8% of patients were admitted in hospital including 10.4% for EDSSU (n = 20 081). Analyses reveal modest positive correlation of EDSSU admissions with NEAT performance (τ = 0.35, P < 0.001) and weak negative correlation with DNW rates (τ = -0.29, P < 0.001). These associations were more pronounced on days when BOR >100% (τ = 0.39 and τ = -0.36, P < 0.001). BOR of >100% were associated with reduced EDSSU admits, NEAT performance and increased DNW rates (P < 0.001). Appropriate EDSSU admissions had shorter EDSSU length of stay than inappropriate EDSSU admissions (350 vs 557 min, median difference -158 min, P < 0.001). Appropriate use of EDSSU provides effective conduit for ongoing patients' management beyond mandated timelines. Health systems should focus on reducing hospital BORs to mitigate exclusive ED pressure to deliver NEAT performance targets.

Environmentally sustainable WASH? Current discourse, planetary boundaries and future directions

The significant challenge of achieving safe, reliable and continuous service delivery has been a focus of the water, sanitation and hygiene (WASH) sector in recent years, with less attention given to other important sustainability considerations such as environmental sustainability. The agenda set by the Sustainable Development Goals prompts a wider lens, bringing water resource management and ecosystem conservation together with water and sanitation access targets in one integrated goal. As we grapple with our approach to this new agenda, it is timely to reflect on how we, as a sector, engage with environmental sustainability. This paper reviews recent literature at the intersection of WASH and environmental sustainability to identify current themes and future directions. Analysis of academic and non-academic sources was undertaken and then situated with reference to the planetary boundaries framework as a useful lens to ground the socio-ecological systems and processes upon which environmental sustainability depends. Findings point to both opportunities and gaps within current sector thinking, which can drive leadership from knowledge and research institutions towards better integration of access and environmental sustainability imperatives.

Developing a Set of Core Outcomes for Trials in Hemodialysis: An International Delphi Survey

Survival and quality of life for patients on hemodialysis therapy remain poor despite substantial research efforts. Existing trials often report surrogate outcomes that may not be relevant to patients and clinicians. The aim of this project was to generate a consensus-based prioritized list of core outcomes for trials in hemodialysis. In a Delphi survey, participants rated the importance of outcomes using a 9-point Likert scale in round 1 and then re-rated outcomes in rounds 2 and 3 after reviewing other respondents' scores. For each outcome, the median, mean, and proportion rating as 7 to 9 (critically important) were calculated. 1,181 participants (202 [17%] patients/caregivers, 979 health professionals) from 73 countries completed round 1, with 838 (71%) completing round3. Outcomes included in the potential core outcome set met the following criteria for both patients/caregivers and health professionals: median score≥ 8, mean score≥ 7.5, proportion rating the outcome as critically important≥ 75%, and median score in the forced ranking question<10. Patients/caregivers rated 4 outcomes higher than health professionals: ability to travel, dialysis-free time, dialysis adequacy, and washed out after dialysis (mean differences of 0.9, 0.5, 0.3, and 0.2, respectively). Health professionals gave a higher rating for mortality, hospitalization, decrease in blood pressure, vascular access complications, depression, cardiovascular disease, target weight, infection, and potassium (mean differences of 1.0, 1.0, 1.0, 0.9, 0.9, 0.8, 0.7, 0.4, and 0.4, respectively). The Delphi survey was conducted online in English and excludes participants without access to a computer and internet connection. Patients/caregivers gave higher priority to lifestyle-related outcomes than health professionals. The prioritized outcomes for both groups were vascular access problems, dialysis adequacy, fatigue, cardiovascular disease, and mortality. This process will inform a core outcome set that in turn will improve the relevance, efficiency, and comparability of trial evidence to facilitate treatment decisions.

Development and Evaluation of a Novel Curved Biopsy Device for CT-Guided Biopsy of Lesions Unreachable Using Standard Straight Needle Trajectories.

To evaluate the feasibility of a novel curved CT-guided biopsy needle prototype with shape memory to access otherwise not accessible biopsy targets. A biopsy needle curved by 90° with specific radius was designed. It was manufactured using nitinol to acquire shape memory, encased in a straight guiding trocar to be driven out for access of otherwise inaccessible targets. Fifty CT-guided punctures were conducted in a biopsy phantom and 10 CT-guided punctures in a swine corpse. Biposies from porcine liver and muscle tissue were separately gained using the biopsy device, and histological examination was performed subsequently. Mean time for placement of the trocar and deployment of the inner biopsy needle was ~205±69 and ~93±58s, respectively, with a mean of ~4.5±1.3 steps to reach adequate biopsy position. Mean distance from the tip of the needle to the target was ~0.7±0.8 mm. CT-guided punctures in the swine corpse took relatively longer and required more biopsy steps (~574±107 and ~380±148s, 8±2.6 steps). Histology demonstrated appropriate tissue samples in nine out of ten cases (90%). Targets that were otherwise inaccessible via standard straight needle trajectories could be successfully reached with the curved biopsy needle prototype. Shape memory and preformed size with specific radius of the curved needle simplify the target accessibility with a low risk of injuring adjacent structures.

Abstract No. 227 - Percutaneous transesophageal gastrostomy (PTEG): indications, technique, and outcomes

PTEG technique is a rare palliative procedure performed in patients with a contraindication to percutaneous gastrostomy.We sought to evaluate our experience at a tertiary care center in 14 patients. This IRB approved, HIPAA-compliant study involved a search of the department’s electronic database to identify all PTEG procedures from 2014-2016.Electronic medical records were used to identify demographics, clinical history, cross-sectional imaging and outcomes for each patient.All available CT, US and procedural fluoroscopy images were reviewed to evaluate variations in technique.Procedures were performed under general anesthesia for airway protection;a 20 mm angioplasty balloon was used as a target for percutaneous access of the esophagus for placement of a 45cm,14F multipurpose drain. Between 2014-2016, PTEG was attempted in 14 patients (7M,7F) with an average age of 53(range 27-72) for gastric venting from malignant bowel obstruction.Average ECOG scores were 2 (range 1-4).Patients had metastatic disease originating from the ovary (28.7%), stomach (28.7%), pancreas (7.1%), liver (7.1%), colon (7.1%), appendix (7.1%), small bowel (7.1%), and lung (7.1%).The most common indication was peritoneal carcinomatosis (57.2%) followed by ascites (35.7%) and invasive gastric cancer (7.1%).Technical success of PTEG was 93% (n = 13).In 1 patient, fibrotic changes due to radiation therapy precluded access to the esophagus.Intraprocedural complication included aspiration during esophageal balloon inflation (n = 2; 15.4%).Immediate post-PTEG symptoms included throat pain (n = 5; 36%) which was resolved with oral viscous lidocaine.Long-term complications (n = 3; 21%)included occlusion of the PTEG (n = 1), aspiration (n = 1) and PTEG site cutaneous infection (n = 1).There was 1 death resulting from aspiration pneumonitis.No association between ECOG score and major/minor complications (p>0.05).Using the Edmonton Symptom Assessment Scale (ESAS)and the Karnofsky Performance Scale, patency rates and relief of obstructive symptoms were 100% at 7 and 14 days post-procedure (p<0.05). PTEG can provide dramatic symptomatic relief to palliative patients; ESAS and KPS scores were 100% up to 14 days post-placement.

Enolesters as chain end‐functionalizing agents for the living ring opening metathesis polymerization

ABSTRACTFunctional enolethers have previously been used to introduce functional end groups at the chain end of ruthenium carbene complex initiated living ring opening metathesis polymers. Here, we investigated whether the weaker π‐donating enolesters could equally be used in regio selective reactions with ruthenium carbene complexes and thus as polymer end‐functionalization reagents. Enolesters such as vinyl acetate, butenyl acetate, 3‐(4‐(tert‐butoxy)phenyl)propenyl acetate and 6‐(((benzyloxy)carbonyl)amino)hex‐1‐en‐1‐yl acetate were used as living ROMP terminating agents. All gave the expected end groups proving that enolesters are synthetically easily accessible targets for living ROMP end‐functionalization. © 2017 Wiley Periodicals, Inc. J. Polym. Sci., Part A: Polym. Chem. 2017, 55, 2983–2990

Continuous Palliative Sedation for Existential Distress? A Survey of Canadian Palliative Care Physicians' Views.

Palliative sedation can be used for refractory symptoms during end-of-life care. However, continuous palliative sedation (CPS) for existential distress remains controversial due to difficulty determining when this distress is refractory. The aim was to determine the opinions and practices of Canadian palliative care physicians regarding CPS for existential distress. A survey focusing on experience and views regarding CPS for existential distress was sent to 322 members of the Canadian Society of Palliative Care Physicians. Eighty-one surveys returned (accessible target, 314), resulting in a response rate of 26%. One third (31%) of the respondents reported providing CPS for existential distress. On a 5-point Likert-type scale, 40% of participants disagreed, while 43% agreed that CPS could be used for existential distress alone. Differing opinions exist regarding this complex and potentially controversial issue, necessitating the education of health-care professionals and increased awareness within the general public.

Dorsal longitudinal foreskin cut is associated with reduced risk of HIV, syphilis and genital herpes in men: a cross‐sectional study in Papua New Guinea

Introduction: Various forms of penile foreskin cutting are practised in Papua New Guinea. In the context of an ecological association observed between HIV infection and the dorsal longitudinal foreskin cut, we undertook an investigation of this relationship at the individual level.Methods: We conducted a cross-sectional study among men attending voluntary confidential HIV counselling and testing clinics. Following informed consent, participants had a face-to-face interview and an examination to categorize foreskin status. HIV testing was conducted on site and relevant specimens collected for laboratory-based Herpes simplex type-2 (HSV-2), syphilis, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) testing.Results: Overall, 1073 men were enrolled: 646 (60.2%) were uncut; 339 (31.6%) had a full dorsal longitudinal cut; 72 (6.7%) a partial dorsal longitudinal cut; and 14 (1.3%) were circumcised. Overall, the prevalence of HIV was 12.3%; HSV-2, 33.6%; active syphilis, 12.1%; CT, 13.4%; NG, 14.1%; and TV 7.6%. Compared with uncut men, men with a full dorsal longitudinal cut were significantly less likely to have HIV (adjusted odds ratio [adjOR] 0.25, 95%CI: 0.12, 0.51); HSV-2 (adjOR 0.60, 95%CI: 0.41, 0.87); or active syphilis (adjOR 0.55, 95%CI: 0.31, 0.96). This apparent protective effect was restricted to men cut prior to sexual debut. There was no difference between cut and uncut men for CT, NG or TV.Conclusions: In this large cross-sectional study, men with a dorsal longitudinal foreskin cut were significantly less likely to have HIV, HSV-2 and syphilis compared with uncut men, despite still having a complete (albeit morphologically altered) foreskin. The protective effect of the dorsal cut suggests that the mechanism by which male circumcision works is not simply due to the removal of the inner foreskin and its more easily accessible HIV target cells. Exposure of the penile glans and inner foreskin appear to be key mechanisms by which male circumcision confers protection.Further research in this unique setting will help improve our understanding of the fundamental immunohistologic mechanisms by which male circumcision provides protection, and may lead to new biomedical prevention strategies at the mucosal level.

Characteristics of Patients with Atrial Fibrillation Presenting to an Emergency Department at a Tertiary, Metropolitan Centre

Background: Atrial fibrillation (AF) represents a significant portion of cardiac presentations to Emergency Departments (ED). We investigated how these patients are processed in ED and the rate of re-presentation to identify areas of service improvement. Methods: An audit was conducted of the past 100 patients presenting to a tertiary, metropolitan centre in early 2017 using coding data to identify people with AF or atrial flutter listed as their primary diagnosis. We recorded patient age; postcode; gender; triage category; discharge status; and arrival, triage, and discharge times. Results: The majority (64%) of patients were female, with a median age of 71 years. Only 10% were aged under 50. The average triage category was 3. After being reviewed on average 20.21 minutes post-triage, the National Emergency Access Target of 240 minutes was met 63% of the time. The average period spent in ED was 241 minutes. The most common (64%) discharge destination was Short Stay Unit (SSU). Another 19% went home, 16% were admitted as inpatients, and 1 went to theatre for a comorbid condition. There were 10 re-presentations with an average time to re-presentation of 7.6 days. Conclusion: A large cohort of patients with a primary diagnosis of AF are admitted to SSU. Despite rapid assessment by emergency physicians, the NEAT was still breached 37% of the time. Further investigation into the ultimate destination of patients admitted to SSU and the outcomes of patients admitted under various medical units will be conducted to continue optimisation of service provision.

National Emergency Access Targets and Psychiatric Risk Assessment in Emergency Departments: Implications for Involving Family or Carers

National Emergency Access Targets and Psychiatric Risk Assessment in Emergency Departments: Implications for Involving Family or Carers

An investigation of the low-ΔV near-Earth asteroids (341843) 2008 EV5 and (52381) 1993 HA

Context. The Asteroid Redirect Mission (ARM) under development by NASA is being planned to collect a multi-meter boulder from a near-Earth asteroid (NEA), and to bring it to the cis-lunar space in the mid-2020’s for future study and exploitation by a crewed mission. The MarcoPolo-M5 project is being proposed in 2016 for the M5 mission opportunity by ESA, to bring back to Earth a sample from a very primitive D-type NEA. As D-types are very rare within the NEA population, considerable effort is still in progress to characterize easily accessible targets with unknown surface composition, in order to discover further asteroids that belong to this taxonomic group. Aims. We aim to further characterize the physical properties of two optimal targets for sample return space missions, the low-ΔV NEAs (341843) 2008 EV5 and (52381) 1993 HA. The asteroid 2008 EV5 is the baseline target of ARM, but only one spectrum of this object exists in the literature. The asteroid 1993 HA is a very favourable target for a space mission based on its dynamical properties: here we intend to assess if it is a suitable target for MarcoPolo-M5. Methods. We obtained visible spectroscopy of 2008 EV5 with the FORS2 instrument at ESO-VLT (Paranal, Chile), at different rotational phases. We also obtained visible and near-infrared spectroscopy of 1993 HA, using the EFOSC2 and SOfI instruments at ESO-NTT (La Silla, Chile). Visible photometry of 1993 HA was carried out within the IMPACTON project at the Observatório Astronômico do Sertão de Itaparica (Itacuruba, Brazil). Results. Our new observations are in agreement with the C-type classification of 2008 EV5, which is a requirement for the ARM mission. We obtained five visible spectra which do not show any variability within the limits of noise, suggesting a homogeneous surface. We obtained the first ever spectroscopic dataset (~0.4–1.6 μm) for 1993 HA, finding a featureless, red-sloped behaviour typical of D-types (a T or X classification is also possible, with decreasing confidence). We also found that the synodic rotation period of 1993 HA is 4.107 ± 0.002 h, a value that is optimal for the execution of a sample return mission. The derived lightcurve also suggests an elongated shape (axis ratio a/b ≥ 1.71). At this stage 1993 HA does indeed seem to be the most favourable target for MarcoPolo-M5, though future observations are necessary to study it further.

Progress on Broadband Access to the Internet and Use of Mobile Devices in the United States.

Healthy People 2020 (HP2020) aims to improve population health outcomes through several objectives, including health communication and health information technology. We used 7 administrations of the Health Information National Trends Survey to examine HP2020 goals toward access to the Internet through broadband and mobile devices (N = 34 080). We conducted descriptive analyses and obtained predicted marginals, also known as model-adjusted risks, to estimate the association between demographic characteristics and use of mobile devices. The HP2020 target (7.7% of the US population) for accessing the Internet through a cellular network was surpassed in 2014 (59.7%), but the HP2020 target (83.2%) for broadband access fell short (63.8%). Sex and age were associated with accessing the Internet through a cellular network throughout the years (Wald F test, P <.05). The increase in the percentage of people accessing the Internet through mobile devices presents an opportunity for technology-based health interventions that should be explored.

Noninvasive in vivo multispectral optoacoustic imaging of apoptosis in triple negative breast cancer using indocyanine green conjugated phosphatidylserine monoclonal antibody.

Noninvasive and nonradioactive imaging modality to track and image apoptosis during chemotherapy of triple negative breast cancer is much needed for an effective treatment plan. Phosphatidylserine (PS) is a biomarker transiently exposed on the outer surface of the cells during apoptosis. Its externalization occurs within a few hours of an apoptotic stimulus by a chemotherapy drug and leads to presentation of millions of phospholipid molecules per apoptotic cell on the cell surface. This makes PS an abundant and accessible target for apoptosis imaging. In the current work, we show that PS monoclonal antibody tagged with indocyanine green (ICG) can help to track and image apoptosis using multispectral optoacoustic tomography <italic<in vivo</italic<. When compared to saline control, the doxorubicin treated group showed a significant increase in uptake of ICG-PS monoclonal antibody in triple negative breast tumor xenografted in NCr nude female mice. Day 5 posttreatment had the highest optoacoustic signal in the tumor region, indicating maximum apoptosis and the tumor subsequently shrank. Since multispectral optoacoustic imaging does not involve the use of radioactivity, the longer the circulatory time of the PS antibody can be exploited to monitor apoptosis over a period of time without multiple injections of commonly used imaging probes such as Tc-99m Annexin V or F-18 ML10. The proposed apoptosis imaging technique involving multispectral optoacoustic tomography, monoclonal antibody, and near-infrared absorbing fluorescent marker can be an effective tool for imaging apoptosis and treatment planning.

Nucleosome dynamics: HMGB1 facilitates nucleosome restructuring and collaborates in estrogen-responsive gene expression

AbstractThe genome in the human cell is extraordinarily compacted in the nucleus. As a result, much of the DNA is inaccessible and functionally inert. Notwithstanding the highly efficient packaging, mechanisms have evolved to render DNA sites accessible that then enable a multitude of factors to carry out ongoing and vital functions. The compaction is derived from DNA complexation within nucleosomes, which can further consolidate into a higher-order chromatin structure. The nucleosome and nucleosomal DNA are not static in nature, but are dynamic, undergoing structural and functional changes as the cell responds to stresses and/or metabolic or environmental cues. We are only beginning to understand the forces and the complexes that engage the nucleosome to unearth the tightly bound and inaccessible DNA sequences and provide an opening to more accessible target sites. In many cases, current findings support a major role for the action of ATP-dependent chromatin remodeling complexes (CRCs) in providing an avenue to factor accessibility that leads to the activation of transcription. The estrogen receptor α (ERα) does not bind to the estrogen response element (ERE) in the canonical nucleosome. However, evidence will be presented that HMGB1 restructures the nucleosome in an ATP-independent manner and also facilitates access and strong binding of ERα to ERE. The features that appear important in the mechanism of action for HMGB1 will be highlighted, in addition to the characteristic features of the restructured nucleosome. These findings, together with previous evidence, suggest a collaborative role for HMGB1 in the step-wise transcription of estrogen-responsive genes. In addition, alternate mechanistic pathways will be discussed, with consideration that “HMGB1 restructuring” of the nucleosome may generally be viewed as a perturbation of the equilibrium of an ensemble of nearly isoenergetic nucleosome states in an energy landscape that is driven by conformational selection by HMGB1.

UiT’s researcher attitudes and practices towards Open Access: With focus on the University Repository, Munin

Open access targets at enabling anyone who has access to the internet to have access, read and use scientific documents, such as articles. In line with Horizon 2020’s new guidelines that open access publication of research results is an obligation, UiT The Arctic University of Norway aims to be an institution advancing free scholarly information and knowledge about how to find it, read it and use it. Through the open repository called Munin, UiT has since 2006 made, as much as possible, the scholarly documents produced by its researchers and graduate students openly available. Free access to scholarly information is one of the university's strategic goals, and researchers are recommended to save the files of their research articles to be openly available.The objective of this study is to find out researcher’s attitudes at the UiT The Arctic University of Norway regarding Open Access of research articles. Specifically, the study investigates the researchers’ attitudes, especially when it comes to archiving final drafts of their accepted manuscripts or journal articles in Munin, including their perceptions towards open access publication. Such information was mainly obtained through a survey questionnaire addressed to all researchers at UiT. For triangulation purposes, literature archives, record, reports and other publication documents were also used. SPSS statistical package was used for data analysis.Preliminary results shows that 93% of the researchers at UiT support OA publication principles, but only 46% are currently submitting to the OA university repository, Munin. Researchers indicate that the majority either do not know Munin well (60%) or they do not know it at all (12%). This portrays a need for information and clarification of what Munin is all about and processes for making the produced scholarly documents available openly. Already, 74.5% of the UiT researchers indicate willingness to archive their final draft in Munin. This implies that the output is already there and what is required is to sensitising researchers on why, who and how their research should be published openly in Munin, while making clear to them who’s responsibility it is to check the archiving permission; a point many researchers indicate being ignorant of. There is need to make available, in the Library information-desk, the information about how to publish and access the documents in Munin. In so doing, OA principles are encouraged, but it also acts as a means through which the quality of research is enhanced. And thereby also encouraging and supporting EU Horizon 2020 current projects, where the funding comes with strict rules in order to secure free sharing of research results and open access. As Msomphora (2016) notes, open access allow research results to be transparent, meaning that secrecy should be avoided in order to permit criticism of the knowledge produced. But, more so, it enhances global availability of quality knowledge, even in developing countries, and that taxpayers are able to get value for money. However, certain researchers criticise open access publication because it tends to discriminate against authors who cannot afford the article processing charges. Not everyone have the support of their institution as the UiT researchers have. Therefore, through the current survey and documented literature, this study produces arguments for improving the manageability, visibility and accessibility of scholarly documents in Munin at UiT, and for the growing research community worldwide.

Analysing the emergency department patient journey: Discovery of bottlenecks to emergency department patient flow.

Despite significant workflow reform to comply with the federally mandated National Emergency Access Target (NEAT), Australian public hospitals continue to face significant barriers in achieving good ED patient flow. This study was undertaken to identify and analyse the impact of individual waypoints on an ED patient's journey and identify which waypoints act as bottlenecks to a hospital's 4 h ED disposition performance. This study involves retrospective analysis and simulation employing 2 years of ED administrative data from a sample of two major and two large metropolitan hospitals in Queensland, Australia. The main outcome measures included waypoint wait times (Treatment Delay and Departure Delay), ED length of stay (EDLOS) and compliance with the NEAT target, measured for all (overall NEAT) and admitted (Admitted NEAT) patients. Variations in outcome measures were analysed as functions of hour of day, day of week, departure status and triage category. Simulations identified the impact of potential ED workflow changes in the context of NEAT performance. Departure Delay accounted for 60 and 20% of EDLOS across large and major metropolitan hospitals, respectively. Higher gains in NEAT compliance are associated with improvements in departure delay rather than treatment delay. Simulation identified that halving Departure Delay improves Admitted NEAT by up to 22 and 4% at large and major metropolitan hospitals, respectively. The results reinforces the need for a whole-of-hospital effort to address flow bottlenecks, and identify moving a patient from emergency to inpatient care as the critical bottleneck in ED system performance.