Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments.

Executive summary Objective: The aims of this study were to identify the impact of Pandemic (H1N1) 2009 Influenza on Australian Emergency Departments (EDs) and their staff, and to inform planning, preparedness, and response management arrangements for future pandemics, as well as managing infectious patients presenting to EDs in everyday practice. Methods This study involved three elements: 1. The first element of the study was an examination of published material including published statistics. Standard literature research methods were used to identify relevant published articles. In addition, data about ED demand was obtained from Australian Government Department of Health and Ageing (DoHA) publications, with several state health departments providing more detailed data. 2. The second element of the study was a survey of Directors of Emergency Medicine identified with the assistance of the Australasian College for Emergency Medicine (ACEM). This survey retrieved data about demand for ED services and elicited qualitative comments on the impact of the pandemic on ED management. 3. The third element of the study was a survey of ED staff. A questionnaire was emailed to members of three professional colleges—the ACEM; the Australian College of Emergency Nursing (ACEN); and the College of Emergency Nursing Australasia (CENA). The overall response rate for the survey was 18.4%, with 618 usable responses from 3355 distributed questionnaires. Topics covered by the survey included ED conditions during the (H1N1) 2009 influenza pandemic; information received about Pandemic (H1N1) 2009 Influenza; pandemic plans; the impact of the pandemic on ED staff with respect to stress; illness prevention measures; support received from others in work role; staff and others’ illness during the pandemic; other factors causing ED staff to miss work during the pandemic; and vaccination against Pandemic (H1N1) 2009 Influenza. Both qualitative and quantitative data were collected and analysed. Results: The results obtained from Directors of Emergency Medicine quantifying the impact of the pandemic were too limited for interpretation. Data sourced from health departments and published sources demonstrated an increase in influenza-like illness (ILI) presentations of between one and a half and three times the normal level of presentations of ILIs. Directors of Emergency Medicine reported a reasonable level of preparation for the pandemic, with most reporting the use of pandemic plans that translated into relatively effective operational infection control responses. Directors reported a highly significant impact on EDs and their staff from the pandemic. Growth in demand and related ED congestion were highly significant factors causing distress within the departments. Most (64%) respondents established a ‘flu clinic’ either as part of Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments. the ED operations or external to it. They did not note a significantly higher rate of sick leave than usual. Responses relating to the impact on staff were proportional to the size of the colleges. Most respondents felt strongly that Pandemic (H1N1) 2009 Influenza had a significant impact on demand in their ED, with most patients having low levels of clinical urgency. Most respondents felt that the pandemic had a negative impact on the care of other patients, and 94% revealed some increase in stress due to lack of space for patients, increased demand, and filling staff deficits. Levels of concern about themselves or their family members contracting the illness were less significant than expected. Nurses displayed significantly higher levels of stress overall, particularly in relation to skill-mix requirements, lack of supplies and equipment, and patient and patients’ family aggression. More than one-third of respondents became ill with an ILI. Whilst respondents themselves reported taking low levels of sick leave, respondents cited difficulties with replacing absent staff. Ranked from highest to lowest, respondents gained useful support from ED colleagues, ED administration, their hospital occupational health department, hospital administration, professional colleges, state health department, and their unions. Respondents were generally positive about the information they received overall; however, the volume of information was considered excessive and sometimes inconsistent. The media was criticised as scaremongering and sensationalist and as being the cause of many unnecessary presentations to EDs. Of concern to the investigators was that a large proportion (43%) of respondents did not know whether a pandemic plan existed for their department or hospital. A small number of staff reported being redeployed from their usual workplace for personal risk factors or operational reasons. As at the time of survey (29 October –18 December 2009), 26% of ED staff reported being vaccinated against Pandemic (H1N1) 2009 Influenza. Of those not vaccinated, half indicated they would ‘definitely’ or ‘probably’ not get vaccinated, with the main reasons being the vaccine was ‘rushed into production’, ‘not properly tested’, ‘came out too late’, or not needed due to prior infection or exposure, or due to the mildness of the disease. Conclusion: Pandemic (H1N1) 2009 Influenza had a significant impact on Australian Emergency Departments. The pandemic exposed problems in existing plans, particularly a lack of guidelines, general information overload, and confusion due to the lack of a single authoritative information source. Of concern was the high proportion of respondents who did not know if their hospital or department had a pandemic plan. Nationally, the pandemic communication strategy needs a detailed review, with more engagement with media networks to encourage responsible and consistent reporting. Also of concern was the low level of immunisation, and the low level of intention to accept vaccination. This is a problem seen in many previous studies relating to seasonal influenza and health care workers. The design of EDs needs to be addressed to better manage infectious patients. Significant workforce issues were confronted in this pandemic, including maintaining appropriate staffing levels; staff exposure to illness; access to, and appropriate use of, personal protective equipment (PPE); and the difficulties associated with working in PPE for prolonged periods. An administrative issue of note was the reporting requirement, which created considerable additional stress for staff within EDs. Peer and local support strategies helped ensure staff felt their needs were provided for, creating resilience, dependability, and stability in the ED workforce. Policies regarding the establishment of flu clinics need to be reviewed. The ability to create surge capacity within EDs by considering staffing, equipment, physical space, and stores is of primary importance for future pandemics.

Communication patterns within social networks : a case study of Australian women

Based on the perception that “individual bonds to one another is the essence of society” (Fischer, 1982a, p. 2), this paper examines contemporary networks of friends: friendworks, of adult women in an Australian sea change community. Communication patterns are examined drawing on findings from a case study of 26 women aged 35-76 years. Among the case study participants, many have undertaken a ‘sea change’ as adults, which in most cases has led to a significant reconstruction of their friendworks. Location and lifestyle are identified as impacting factors on communication patterns with friends; face-to-face interactions are by far the most frequent and preferred method of communication among the participants. The landline telephone and internet are the main communication methods used to maintain friendships with distant loved ones, while the mobile phone is reported as the communication method employed the least. The infrequency of mobile phone use can be attributed to cost issues, highlighting a discrepancy between these women’s social and communication needs and the current Australian mobile phone policy.

Beyond discovery : a case study of teacher interaction, young children and computer tasks

The integration of computer technologies into everyday classroom life continues to provide pedagogical challenges for school systems, teachers and administrators. Data from an exploratory case study of one teacher and a multiage class of children in the first years of schooling in Australia show that when young children are using computers for set tasks in small groups, they require ongoing support from teachers, and to engage in peer interactions that are meaningful and productive. Classroom organization and the nature of teacher-child talk are key factors in engaging children in set tasks and producing desirable learning and teaching outcomes.

What's cooking for dietetics? A review of the literature

Aim: There has been no systematic research on the role of cooking skills for improving dietary intakes in Australia. Cooking skills are proposed to be declining and/or being devalued. If cooking skills have been devalued and declining, then what evidence is there for this decline and what impact might this have on dietary intakes? The aim of the present paper is to explore these assumptions with particular reference to Australia. The objectives of the present paper are to define the terms cooking and cooking skills, discuss evidence on levels of cooking skills in Australia and describe the evidence linking cooking skills to dietary intakes.---------- Methods: A review of the peer-reviewed literature using multiple databases from 1990 to September 2009.---------- Results: Cooking skills are complex and require a range of processes for people to develop efficiency or confidence in food preparation. There is little evidence on the level of cooking skills in the Australian population and how this relates to dietary intakes. The Australian Bureau of Statistic’s latest Time Use Survey and Household Expenditure Survey suggest that cooking is still a gendered activity and that the time devoted to cooking has changed little in the past 15 years, but there is an increasing use of foods prepared outside the home.---------- Conclusion: Further research is required to examine the prevalence of different types and levels of cooking skills in Australia as well as their potential effects on dietary intakes. Dietitians need evidence about the level of cooking skills people require for healthy dietary intakes.

Food literacy : time for a new term or just another buzzword?

Eating is an essential everyday life activity that has fascinated, captivated and defined society since time began. We currently exist in a society where over-consumption of food is an established risk factor chronic disease, the rate of which is increasing alarmingly. 'Food literacy' is an emerging term used to describe what we, as individuals and as a community know and understand about food and how to use it to meet our need, and thus potentially support and empower citizens to make healthy food choices. What exactly the components of food literacy are and how they influence food choice are poorly defined and understood, but increasingly gaining interest among health professionals, policy makers, community workers, educators and members of the public. This paper will build the argument for why concepts of 'food literacy' need to extend beyond existing terms and measures used in the literature to describe the food skills and knowledge needed to make use of public health nutrition messages.

Treating an unhealthy organisational culture : the implications of the Bundaberg Hospital inquiry for managerial ethical decision making

This paper explores the interplay between individual values, espoused organisational values and the values of the organisational culture in practice in light of a recent Royal Commission in Queensland, Australia, which highlighted systematic failures in patient care. The lack of congruence among values at these levels impacts upon the ethical decision making of health managers. The presence of institutional ethics regimes such as the Public Sector Ethics Act 1994 (Qld) and agency codes of conduct are not sufficient to counteract the negative influence of informal codes of practice that undermine espoused organisational values and community standards. The ethical decision-making capacity of health care managers remains at the front line in the battle against unethical and unprofessional practice. What is known about the topic? Value congruence theory focusses on the conflicts between individual and organisational values. Congruence between individual values, espoused values and values expressed in everyday practice can only be achieved by ensuring that such shared values are an ever-present factor in managerial decision making. What does this paper add? The importance of value congruence in building and sustaining a healthy organisational culture is confirmed by the evidence presented in the Bundaberg Hospital Inquiry. The presence of strong individual values among staff and strong espoused values in line with community expectations and backed up by legislation and ethics regimes were not, in themselves, sufficient to ensure a healthy organisational culture and prevent unethical, and possibly illegal, behaviour. What are the implications for practitioners? Managers must incorporate ethics in decision making to establish and maintain the nexus between individual and organisational values that is a vital component of a healthy organisational culture.

‘Universities are not the safe places we would like to think they are, but they are getting safer’: Indigenous women academics in higher education

This paper outlines some of the experiences of Indigenous women academics in higher education. The author offers these experiences, not to position Indigenous women academics as victims, but to expose the problematic nature of racism, systemic marginalisation, white race privilege and radicalised subjectivity played out within Australian higher education institutions. By utilising the experiences and examples she seeks to bring the theoretical into the everyday world of being Indigenous within academe. In analysing these examples, the author reveals the relationships between oppression, white race privilege, institutional privilege and the epistemology that maintains them. She argues that, in moving from a position of being silent to speaking about what she has witnessed and experienced, she is able to move from the position of object to subject and gain a form of liberated voice (hooks 1989: 9) for herself and other Indigenous women. She seeks to challenge the practices within universities that continue to subjugate Indigenous women academics.

Damaged goods: riskiness and LGBT young peoples’ interactions with police

For some time now, research has suggested lesbian, gay, bisexual and transgender (LGBT) young people are ‘at-risk’ of victimisation and legally ‘risky’. Relatively few studies have examined how ‘risk factor’ research influences the everyday lives of LGBT young people. This paper reports how the experiences of police by 35 LGBT young people in Brisbane, Queensland reflected discourses about LGBT riskiness and how danger informed their interactions with police in public spaces. The participants specifically note how looking at-risk or looking risky affected their experiences of policing. The paper will conclude with recommendations for improved future policing practice.

The embodied hybrid space : designing ubiquitous computing towards an amplification of situated real world experiences

The emergence of mobile and ubiquitous computing technology has created what is often referred to as the hybrid space – a virtual layer of digital information and interaction opportunities that sit on top of and augment the physical environment. Embodied media materialise digital information as observable and sometimes interactive parts of the physical environment. The aim of this work is to explore ways to enhance people’s situated real world experience, and to find out what the role and impact of embodied media in achieving this goal can be. The Edge, an initiative of the State Library of Queensland in Brisbane, Australia, and case study of this thesis, envisions to be a physical place for people to meet, explore, experience, learn and teach each other creative practices in various areas related to digital technology and arts. Guided by an Action Research approach, this work applies Lefebvre’s triad of space (1991) to investigate the Edge as a social space from a conceived, perceived and lived point of view. Based on its creators’ vision and goals on the conceived level, different embodied media are iteratively designed, implemented and evaluated towards shaping and amplifying the Edge’s visitor experience on the perceived and lived level.

The Australian Palliative Care Outcomes Collaboration (PCOC) : measuring the quality and outcomes of palliative care on a routine basis

Australia is leading the way in establishing a national system (the Palliative Care Outcomes Collaboration – PCOC) to measure the outcomes and quality of specialist palliative care services and to benchmark services across the country. This article reports on analysis of data collected routinely at point-of-care on 5939 patients treated by the first fifty one services that voluntarily joined PCOC. By March 2009, 111 services have agreed to join PCOC, representing more than 70% of services and more than 80% of specialist palliative care patients nationally. All states and territories are involved in this unique process that has involved extensive consultation and infrastructure and close collaboration between health services and researchers. The challenges of dealing with wide variation in outcomes and practice and the progress achieved to date are described. PCOC is aiming to improve understanding of the reasons for variations in clinical outcomes between specialist palliative care patients and differences in service outcomes as a critical step in an ongoing process to improve both service quality and patient outcomes. What is known about the topic? Governments internationally are grappling with how best to provide care for people with life limiting illnesses and how best to measure the outcomes and quality of that care. There is little international evidence on how to measure the quality and outcomes of palliative care on a routine basis. What does this paper add? The Palliative Care Outcomes Collaboration (PCOC) is the first effort internationally to measure the outcomes and quality of specialist palliative care services and to benchmark services on a national basis through an independent third party. What are the implications for practitioners? If outcomes and quality are to be measured on a consistent national basis, standard clinical assessment tools that are used as part of everyday clinical practice are necessary.

Urban informatics

The increasing ubiquity of digital technology, internet ser-vices and social media in our everyday lives allows for a seamless transitioning between the visible and the invisible infrastructure of cities: road systems, building complexes, information and communication technology, and people networks create a buzzing environment that is alive and exciting. Driven by curiosity, initiative and interdiscipli-nary exchange, the Urban Informatics Research Lab at Queensland University of Technology (QUT), Brisbane, Australia, is an emerging cluster of people interested in research and development at the intersection of people, place and technology with a focus on cities, locative media and mobile technology. This paper seeks to define, for the first time, what we mean by ‘urban informatics’ and outline its significance as a field of study today. It describes the relevant background and trends in each of the areas of peo-ple, place and technology, and highlights the relevance of urban informatics to the concerns and evolving challenges of CSCW. We then position our work in academia juxta-posed with related research concentrations and labels, fol-lowed by a discussion of disciplinary influences. The paper concludes with an exposé of the three current research themes of the lab around augmented urban spaces, urban narratives, and environmental sustainability in order to illustrate specific cases and methods, and to draw out distinctions that our affiliation with the Creative Industries Faculty affords.

Primary students' success on the structured number line

Number lines are part of our everyday life (e.g., thermometers, kitchen scales) and are frequently used in primary mathematics as instructional aids, in texts and for assessment purposes on mathematics tests. There are two major types of number lines; structured number lines, which are the focus of this paper, and empty number lines. Structured number lines represent mathematical information by the placement of marks on a horizontal or vertical line which has been marked into proportional segments (Figure 1). Empty number lines are blank lines which students can use for calculations (Figure 2) and are not discussed further here (see van den Heuvel-Panhuizen, 2008, on the role of empty number lines). In this article, we will focus on how students’ knowledge of the structured number line develops and how they become successful users of this mathematical tool.

Consuming authentic neighborhood : an autoethnography of experiencing a neighborhood's new beginnings and origins within its servicescapes

Purpose - This chapter examines individual and collective quests for authenticity, as experienced through consumption activities within an urban neighbourhood. It investigates the interplay between consumption experiences as authenticating acts and authoritative performances (Arnould and Price 2000), and considers the implications with regard to Zukin’s (2010) theories on urban authenticity, and how it may be experienced as new beginnings and origins. Methodology - The chapter is based on autoethnographic research that explores how interaction and identity definition within servicescapes can work to construct place-based community. Findings - It describes how a servicescape of new beginnings offered opportunities for individual authentication that also enabled personal identification with a specific cultural group. This authentication drew on the cultural capital embedded in such locations, including their association with gentrification. This is contrast with the collective identification offered by a servicescape operating as a place of exposure. This site of origins displayed the social practices of a different demographic, which worked to highlight a relational link between the authentication practices of the broader neighbourhood. These sites also worked cumulatively, to highlight the inauthenticities within my identification practices and offer opportunities for redress. Through this interplay it was possible to establish an authentic sense of neighbourhood that drew on its new beginnings and its origins, and was both individual and collective. Originality - Through the combination of urban and consumption-based perspectives of authenticity, and an autoethnographic methodology, this chapter offers a different insight into the ways identification with, and attachment to, a neighbourhood can develop through consumption experiences.

Augmenting public urban spaces : the impact of the digital future on the design of public urban spaces

Social media digital and technologies surround us. We are moving into an age of ubiquitous (that is everywhere) computing. New media and information and communication technologies already impact on many aspects of everyday life including work, home and leisure. These new technologies are influencing the way that we develop social networks; understand places and location; how we navigate our cities; how we provide information about utilities and services; developing new ways to engage and participate in our communities, in planning, in governance and other decisions. This paper presents the initial findings of the impacts that digital communication technologies are having on public urban spaces. It develops a contextual review the nexus between urban planning and technological developments with examples and case studies from around the world to highlight some of the potential directions for urban planning in Queensland and Australia. It concludes with some thought provoking discussion points for urban planners, architects, designers and placemakers on the future of urban informatics and urban design, questions such as: how technology can enhance ‘place’, how technology can be used to improve public participation, and how technology will change our requirements of public places?

Mapping the Australian networked public sphere

This article reports on a research program that has developed new methodologies for mapping the Australian blogosphere and tracking how information is disseminated across it. The authors improve on conventional web crawling methodologies in a number of significant ways: First, the authors track blogging activity as it occurs, by scraping new blog posts when such posts are announced through Really Simple Syndication (RSS) feeds. Second, the authors use custom-made tools that distinguish between the different types of content and thus allow us to analyze only the salient discursive content provided by bloggers. Finally, the authors are able to examine these better quality data using both link network mapping and textual analysis tools, to produce both cumulative longer term maps of interlinkages and themes, and specific shorter term snapshots of current activity that indicate current clusters of heavy interlinkage and highlight their key themes. In this article, the authors discuss findings from a yearlong observation of the Australian political blogosphere, suggesting that Australian political bloggers consistently address current affairs, but interpret them differently from mainstream news outlets. The article also discusses the next stage of the project, which extends this approach to an examination of other social networks used by Australians, including Twitter, YouTube, and Flickr. This adaptation of our methodology moves away from narrow models of political communication, and toward an investigation of everyday and popular communication, providing a more inclusive and detailed picture of the Australian networked public sphere.