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Actions to reduce greenhouse gas emissions are required from all actors. Adopting plug-in electric vehicles (EV) would reduce light motor vehicle travel emissions, a significant and rising emissions source. To encourage EV uptake, many governments have implemented policies which may be less effective than desired. Using New Zealand as a case study, we surveyed private motorists. The results show that consumers are heterogeneous, with varying car-buying motivations, perceptions, attitudes to EVs and awareness of policies. Uniquely, we segmented motorists into four attitudinal groups to ascertain characteristics potentially affecting EV readiness to provide evidence to improve policies and aid social marketing. Our results show the next-most-ready to buy EVs are early mainstream consumers—designated the EV Positives—who were most concerned about vehicle range, perceptions of EV expense, charging-related inconvenience and the unknown value proposition of batteries, and were relatively unaware of incentives compared to EV Owners. The EV Positives favored incentives designed to effect purchase price reductions and increase nation-wide fast-charger deployment. To increase awareness of EVs and shift perceptions of EV expense and inconvenience, we suggest policies that potentially increase EV adoption rates and suggest reframing the language to appeal to EV Positives through information programs. Increasing EV procurement by organizations could increase opportunities for positive information dissemination via employees. [ABSTRACT FROM AUTHOR]

Aim: Hospital HealthPathways is an online database of local clinical guidelines produced by a dedicated team for use within Canterbury District Health Board (CDHB) hospitals. A 'Practice Point'-a bullet point making explicit a recommendation within the body of a clinical guideline-was added to the guideline for acute pancreatitis, instructing users to avoid serial measurements of serum amylase levels. The aim was to explore whether the addition of this Practice Point affected compliance with the amylase measurement recommendations., Method: The number of serum amylase tests requested for patients admitted with acute pancreatitis by GPs and doctors working in the emergency department, general surgery and other departments was audited using the CDHB's online clinical information system. A data set from a six-month period ending three months prior to the addition of the Practice Point, collected for a previous study, was used with the author's permission as a control group. A new data set from a six-month period starting three months after the addition of the Practice Point formed the experimental group., Results: Compliance rose by 13% after the addition of the Practice Point. Before the Practice Point was added to the guideline, 82 of 126 total patients (65%) had amylase measured only once, on admission, in compliance with the Hospital HealthPathway guideline. After the addition of the Practice Point, 142 of 182 patients (78%) had one measurement of amylase. This improvement was seen where patients were referred directly by their GP to the general surgical teams and patients managed by other specialties. Variation in compliance seen over the six-month experimental group period was significant, but did not show a clear trend of either improvement or decay in compliance., Conclusion: This supports the hypothesis that the simple intervention of clarifying a key point within a clinical guideline can have a significant positive effect on compliance. This is an important consideration for guideline authors and institutions publishing clinical guidelines, as poor compliance by clinicians is reported in studies. The intervention in this study is a simple change for guidelines based online, and the significant effect could contribute to improvement in patient-centred, financial and clinical domains., Competing Interests: Nil.

Background: Efforts to safely reduce length of stay for emergency department patients with symptoms suggestive of acute coronary syndrome (ACS) have had mixed success. Few system-wide efforts affecting multiple hospital emergency departments have ever been evaluated. We evaluated the effectiveness of a nationwide implementation of clinical pathways for potential ACS in disparate hospitals., Methods: This was a multicenter pragmatic stepped-wedge before-and-after trial in 7 New Zealand acute care hospitals with 31 332 patients investigated for suspected ACS with serial troponin measurements. The implementation was a clinical pathway for the assessment of patients with suspected ACS that included a clinical pathway document in paper or electronic format, structured risk stratification, specified time points for electrocardiographic and serial troponin testing within 3 hours of arrival, and directions for combining risk stratification and electrocardiographic and troponin testing in an accelerated diagnostic protocol. Implementation was monitored for >4 months and compared with usual care over the preceding 6 months. The main outcome measure was the odds of discharge within 6 hours of presentation RESULTS: There were 11 529 participants in the preimplementation phase (range, 284-3465) and 19 803 in the postimplementation phase (range, 395-5039). Overall, the mean 6-hour discharge rate increased from 8.3% (range, 2.7%-37.7%) to 18.4% (6.8%-43.8%). The odds of being discharged within 6 hours increased after clinical pathway implementation. The odds ratio was 2.4 (95% confidence interval, 2.3-2.6). In patients without ACS, the median length of hospital stays decreased by 2.9 hours (95% confidence interval, 2.4-3.4). For patients discharged within 6 hours, there was no change in 30-day major adverse cardiac event rates (0.52% versus 0.44%; P =0.96). In these patients, no adverse event occurred when clinical pathways were correctly followed., Conclusions: Implementation of clinical pathways for suspected ACS reduced the length of stay and increased the proportions of patients safely discharged within 6 hours., Clinical Trial Registration: URL: https://www.anzctr.org.au/ (Australian and New Zealand Clinical Trials Registry). Unique identifier: ACTRN12617000381381., (© 2017 American Heart Association, Inc.)