Improving the measurement and surveillance of child abuse in Queensland emergency departments

There are no population studies of prevalence or incidence of child maltreatment in Australia. Child protection data gives some understanding but is restricted by system capacity and definitional issues across jurisdictions. Child protection data currently suggests that numbers of reports are increasing yearly, and the child protection system then becomes focussed on investigating all reports and diluting available resources for those children who are most in need of intervention. A public health response across multiple agencies enables responses to child safety across the entire population. All families are targeted at the primary level; examples include ensuring all parents know the dangers of shaking a baby or teaching children to say no if a situation makes them uncomfortable. The secondary level of prevention targets families with a number of risk factors, for example subsidised child care so children aren't left unsupervised after school when both parents have to be at work or home visiting for drug-addicted parents to ensure children are cared for. The tertiary response then becomes the responsibility of the child protection system and is reserved for those children where abuse and neglect are identified. This model requires that child safety is seen in a broader context than just the child protection system, and increasingly health professionals are being identified as an important component in the public health framework. If all injury is viewed as preventable and considered along a continuum of 'accidental' through to 'inflicted', it becomes possible to conceptualise child maltreatment in an injury context. Parental intent may not be to cause harm to the child, but by lack of insight or concern about risk, the potential for injury is high. The mechanisms for unintentional and intentional injury overlap and some suggest that by segregating child abuse (with the possible exception of sexual abuse) from unintentional injury, child abuse is excluded from the broader injury prevention initiative that is gaining momentum in the community. This research uses a public health perspective, specifically that of injury prevention, to consider the problem of child abuse. This study employed a mixed method design that incorporates secondary data analysis, data linkage and structured interviews of different professional groups. Datasets from the Queensland Injury Surveillance Unit (QISU) and The Department of Child Safety (DCS) were evaluated. Coded injury data was grouped according to intent of injury according to those with a code that indicated the ED presentation was due to child abuse, a code indicating that the injury was possibly due to abuse or, in the third group, the intent code indicated that the injury was unintentional and not due to abuse. Primary data collection from ED records was undertaken and information recoded to assess reliability and completeness. Emergency department data (QISU) was linked to Department of Child Safety Data to examine concordance and data quality. Factors influencing the collection and collation of these data were identified through structured interview methodology and analysed using qualitative methods. Secondary analysis of QISU data indicated that codes lacking specific information on the injury event were more likely to also have an intent code indicating abuse than those records where there was specific information on the injury event. Codes for abuse appeared in only 1.2% of the 84,765 records analysed. Unintentional injury was the most commonly coded intent (95.3%). In the group with a definite abuse code assigned at triage, 83% linked to a record with DCS and cases where documentation indicated police involvement were significantly more likely to be associated with a DCS record than those without such documentation. In those coded with an unintentional injury code, 22% linked to a DCS record with cases assigned an urgent triage category more likely to link than those with a triage category for resuscitation and children who presented to regional or remote hospitals more likely to link to a DCS record than those presenting to urban hospitals. Twenty-nine per cent of cases with a code indicating possible abuse linked to a DCS record. In documentation that indicated police involvement in the case, a code for unspecified activity when compared to cases with a code indicating involvement in a sporting activity and children less than 12 months of age compared to those in the 13-17 year old age group were all variables significantly associated with linkage to a DCS record. Only 13% of records contained documentation indicating that child abuse and neglect were considered in the diagnosis of the injury despite almost half of the sample having a code of abuse or possible abuse. Doctors and nurses were confident in their knowledge of the process of reporting child maltreatment but less confident about identifying child abuse and neglect and what should be reported. Many were concerned about implications of reporting, for the child and family and for themselves. A number were concerned about the implications of not reporting, mostly for the wellbeing of the child and a few in terms of their legal obligations as mandatory reporters. The outcomes of this research will help improve the knowledge of barriers to effective surveillance of child abuse in emergency departments. This will, in turn, ensure better identification and reporting practises; more reliable official statistical collections and the potential of flagging high-risk cases to ensure adequate departmental responses have been initiated.

Intern underperformance is detected more frequently in emergency medicine rotations

Objective: To determine the frequency and nature of intern underperformance as documented on in-training assessment forms. Methods: A retrospective review of intern assessment forms from a 2 year period (2009–2010) was conducted at a tertiary referral hospital in Brisbane, Queensland. The frequency of interns assessed as ‘requiring substantial assistance’ and/or ‘requires further development’ on mid- or end-of-term assessment forms was determined. Forms were analysed by the clinical rotation, time of year and domain(s) of clinical practice in which underperformance was documented. Results: During 2009 and 2010 the overall documented incidence of intern underperformance was 2.4% (95% CI 1.5–3.9%). Clinical rotation in emergency medicine detected significantly more underperformance compared with other rotations (P < 0.01). Interns predominantly had difficulty with ‘clinical judgment and decision-making skills’, ‘time management skills’ and ‘teamwork and colleagues’ (62.5%, 55% and 32.5% of underperforming assessments, respectively). Time of the year did not affect frequency of underperformance. A proportion of 13.4% (95% CI 9.2–19.0%) of interns working at the institution over the study period received at least one assessment in which underperformance was documented. Seventy-six per cent of those interns who had underperformance identified by mid-term assessment successfully completed the term following remediation. Conclusion: The prevalence of underperformance among interns is low, although higher than previously suggested. Emergency medicine detects relatively more interns in difficulty than other rotations.

Conflict and communication among engineers

The trend of cultural diversity is increasing in all organizations, especially engineering ones, due to globalization, mergers, joint ventures and the movement of the workforce. The collaborative nature of projects in engineering industries requires long-term teamwork between local and international engineers. Research confirms a specific culture among engineering companies that isassumed to have a negative effect on collaboration and communication among co-workers. Multicultural workplaces have been reported as challenging environments in the engineering work culture, which calls for more research among engineering organizations. An everyday challenge for co-workers, especially in culturally diverse contexts, is handling interpersonal conflict. This perceived conflict among individuals can happen because of actual differences in tasks or relationships. Research demonstrates that task conflict at the group level has some positive effects on decision-making and innovation, while it has negative effects on employees’ work attitude and performance. However, relationship conflict at the individual level has only negative effects including frustration, tension, low job satisfaction, high employee turnover and low productivity. Outcomes of both task and relationship conflict at individual level can have long-term negative consequences like damaged organizational commitment. One of the most important sources of differences between individuals, which results in conflict, is their cultural backgrounds. First, this thesis suggests that in culturally diverse workplaces, people perceive more relationship conflict than task conflict. Second, this thesis examines interpersonal communication in culturally diverse work places. Communicating effectively in culturally diverse workplaces is crucial for today’s business. Culture has a large effect on the ways that people communicate with each other. Ineffective communication can escalate interpersonal conflict and cause frustration in the long term. Communication satisfaction, defined as enjoying the communication and feeling that the communication was appropriate and effective, has a positive effect on individuals’ psychological wellbeing. In a culturally diverse workplace, it is assumed that individuals feel less satisfied with their interpersonal communications because of their lack of knowledge about other cultures’ communication norms. To manage interpersonal interactions, many authors suggest that individuals need a specific capability, i.e., cultural intelligence (some studies use cultural competence, global intelligence or intercultural competence interchangeably). Some authors argue that cultures are synergic and convergent and the postmodernist definition of culture is just our dominant beliefs. However, other authors suggest that cultural intelligence is the strongest and most comprehensive competency for managing cross-cultural interactions, because various cultures differ so greatly at the micro level. This thesis argues that individuals with a high level of cultural intelligence perceive less interpersonal conflict and more satisfaction with their interpersonal communication. Third, this thesis also looks at individuals' perception of cultural diversity. It is suggested that level of cultural diversity plays a moderating role on all of the proposed relationships (effect of cultural intelligence on perception of relationship conflict/ communication satisfaction) This thesis examines the relationship among cultural diversity, cultural intelligence, interpersonal conflict and communication by surveying eleven companies in the oil and gas industry. The multicultural nature of companies within the oil and gas industry and the characteristics of engineering culture call for more in-depth research on interpersonal interactions. A total of 286 invitation emails were sent and 118 respondents replied to the survey, giving a 41.26 per cent response rate. All the respondents were engineers, engineering managers or practical technicians. The average age of the participants was 36.93 years and 58.82 per cent were male. Overall, 47.6 per cent of the respondents had at least a master’s degree. Totally, 42.85 per cent of the respondents were working in a country that was not their country of birth. The overall findings reveal that cultural diversity and cultural intelligence significantly influence interpersonal conflict and communication satisfaction. Further, this thesis also finds that cultural intelligence is an effective competency for dealing with the perception of interpersonal relationship conflict and communication satisfaction when the level of cultural diversity is moderate to high. This thesis suggests that cultural intelligence training is necessary to increase the level of this competency among employees in order to help them to have better understanding of other cultures. Human resource management can design these training courses with consideration for the level of cultural diversity within the organization.

Decision and reasons for calling an ambulance : patients’ perspective

Background: Demand for pre-hospital emergency care is increasing in Australia as in many other countries. Using posthoc criteria such as triage, diagnosis and admission status, some authors view a considerable number of these as "inappropriate". Yet, calling an ambulance at the time of emergency is rarely studied from the patients’ or their carers’ perspective. This study interviewed patients about the decision, circumstances surrounding and reasons for calling an ambulance in Queensland, Australia. Methods: A cross-sectional survey of patients attending a sample of eight public hospital emergency departments in Queensland was undertaken between March and May 2011. In total, 911 questionnaires were collected (response rate: 67%), of whom 226 (24.8%) had arrived by ambulance. Results: In 35.6% of ambulance arrivals, the decision to request an ambulance was made by the patient; 25% by a doctor; 20% by a family member, friend or carer. Other callers included nurse, people at work or school, and passers-by. Reasons to request an ambulance included urgency (87%) and severity (84%) of the condition. Other reasons included requiring special care (76%), getting higher priority at the emergency department (34%), not having a car (34%), and financial concerns (17%). Decision to request an ambulance varied significantly according to the time of illness onset (e.g. on the day, week before), and location (e.g. home, outside). Conclusion: The decision to call an ambulance is made mostly by non-medical professionals in a perceived emergency situation. They call the ambulance for different reasons but mainly take into account the patient’s welfare and safety. Better understanding of these reasons will affect the direction and effectiveness of demand management strategies.

The growing demand for emergency healthcare

Emergency health is a critical component of health systems; one increasingly congested from growing demand and blocked access to care. The Emergency Health Services Queensland (EHSQ) study aimed to identify the factors driving increased demand for emergency healthcare. This study examined data on patients treated by the ambulance service and Emergency Departments across Queensland. Data was derived from the Queensland Ambulance Service’s (QAS) Ambulance Information Management System and electronic Ambulance Report Form and from the Emergency Department Information System (EDIS). Data was obtained for the period 2001-02 through to 2009-10. A snapshot of users for the 2009-10 year was used to describe the characteristics of users and comparisons made with the year 2003-04 to identify trends. Per capita demand for EDs has increased by 2% per annum over the decade and for ambulance by 3.7% per annum. The growth in ED demand is most significant in more urgent triage categories with decline in less urgent patients. The growth is most prominent amongst patients suffering injuries and poisoning, amongst both men and women and across all age groups. Patients from lower socioeconomic areas appear to have higher utilisation rates and the utilisation rate for indigenous people exceeds those of other backgrounds. The utilisation rates for immigrant people is less than Australian born however it has not been possible to eliminate the confounding impact of age and socioeconomic profiles. These findings contribute to an understanding of the growth in demand for emergency health. It is evident that the growth is amongst patients in genuine need of emergency healthcare and public rhetoric that congested emergency health services is due to inappropriate attendees is unsustainable. The growth in demand over the last decade reflects not only on changing demographics of the Australian population but also changes in health status, standards of acute health care and other social factors.

Synergies and goal conflicts for climate change policy and spatial planning

The purpose of this paper is to identify goal conflicts – both actual and potential – between climate and social policies in government strategies in response to the growing significance of climate change as a socioecological issue (IPCC 2007). Both social and climate policies are political responses to long-term societal trends related to capitalist development, industrialisation, and urbanisation (Koch, 2012). Both modify these processes through regulation, fiscal transfers and other measures, thereby affecting conditions for the other. This means that there are fields of tensions and synergies between social policy and climate change policy. Exploring these tensions and synergies is an increasingly important task for navigating genuinely sustainable development. Gough et al (2008) highlight three potential synergies between social and climate change policies: First, income redistribution – a traditional concern of social policy – can facilitate use of and enhance efficiency of carbon pricing. A second area of synergy is housing, transport, urban policies and community development, which all have potential to crucially contribute towards reducing carbon emissions. Finally, climate change mitigation will require substantial and rapid shifts in producer and consumer behaviour. Land use planning policy is a critical bridge between climate change and social policy that provides a means to explore the tensions and synergies that are evolving within this context. This paper will focus on spatial planning as an opportunity to develop strategies to adapt to climate change, and reviews the challenges of such change. Land use and spatial planning involve the allocation of land and the design and control of spatial patterns. Spatial planning is identified as being one of the most effective means of adapting settlements in response to climate change (Hurlimann and March, 2012). It provides the instrumental framework for adaptation (Meyer, et al., 2010) and operates as both a mechanism to achieve adaptation and a forum to negotiate priorities surrounding adaptation (Davoudi, et al., 2009). The acknowledged role of spatial planning in adaptation however has not translated into comparably significant consideration in planning literature (Davoudi, et al., 2009; Hurlimann and March, 2012). The discourse on adaptation specifically through spatial planning is described as ‘missing’ and ‘subordinate’ in national adaptation plans (Greiving and Fleischhauer, 2012),‘underrepresented’ (Roggema, et al., 2012)and ‘limited and disparate’ in planning literature (Davoudi, et al., 2009). Hurlimann and March (2012) suggest this may be due to limited experiences of adaptation in developed nations while Roggema et al. (2012) and Crane and Landis (2010) suggest it is because climate change is a wicked problem involving an unfamiliar problem, various frames of understanding and uncertain solutions. The potential for goal conflicts within this policy forum seem to outweigh the synergies. Yet, spatial planning will be a critical policy tool in the future to both protect and adapt communities to climate change.

Defining sustainability requirements for design-build (DB) contractor selection in public sector projects

The design-build (DB) delivery system is an effective means of delivering a green construction project and selecting an appropriate contractor is critical to project success. Moreover, the delivery of green buildings requires specific design, construction and operation and maintenance considerations not generally encountered in the procurement of conventional buildings. Specifying clear sustainability requirements to potential contractors is particularly important in achieving sustainable project goals. However, many client/owners either do not explicitly specify sustainability requirements or do so in a prescriptive manner during the project procurement process. This paper investigates the current state-of-the-art procurement process used in specifying the sustainability requirements of the public sector in the USA construction market by means of a robust content analysis of 40 design-build requests for proposals (RFPs). The results of the content analysis indicate that the sustainability requirement is one of the most important dimensions in the best-value evaluation of DB contractors. Client/owners predominantly specify the LEED certification levels (e.g. LEED Certified, Silver, Gold, and Platinum) for a particular facility, and include the sustainability requirements as selection criteria (with specific importance weightings) for contractor evolution. Additionally, larger size projects tend to allocate higher importance weightings to sustainability requirements.This study provides public DB client/owners with a number of practical implications for selecting appropriate design-builders for sustainable DB projects.

Open up the building : architectural relevance of building-users and their participations

As buildings have become more advanced and complex, our ability to understand how they are operated and managed has diminished. Modern technologies have given us systems to look after us but it appears to have taken away our say in how we like our environment to be managed. The aim of this paper is to discuss our research concerning spaces that are sensitive to changing needs and allow building-users to have a certain level of freedom to understand and control their environment. We discuss why, what we call the Active Layer, is needed in modern buildings; how building inhabitants are to interact with it; and the development of interface prototypes to test consequences of having the Active Layer in our environment.

Private hospital emergency departments in Australia : challenges and opportunities

BACKGROUND: Public hospital EDs in Australia have become increasingly congested because of increasing demand and access block. Six per cent of ED patients attend private hospital EDs whereas 45% of the population hold private health insurance. OBJECTIVES: This study describes the patients attending a small selection of four private hospital EDs in Queensland and Victoria, and tests the feasibility of a private ED database. METHODS: De-identified routinely collected patient data were provided by the four participating private hospital and amalgamated into a single data set. RESULT: The mean age of private ED patients was 52 years. Males outnumbered females in all age groups except > 80 years. Attendance was higher on weekends and Mondays, and between 08.00 and 20.00 h. There were 6.6% of the patients triaged as categories 1 and 2, and 60% were categories 4 or 5. There were 36.4% that required hospital admission. Also, 96% of the patients had some kind of insurance. Furthermore, 72% were self-referred and 12% were referred by private medical practitioners. Approximately 25% arrived by ambulance. There were 69% that completed their ED treatment within 4 h. CONCLUSION: This study is the first public description of patients attending private EDs in Australia. Private EDs have a significant role to play in acute medical care and in providing access to private hospitals which could alleviate pressure on public EDs. This study demonstrates the need for consolidated data based on a consistent data set and data dictionary to enable system-wide analysis, benchmarking and evaluation

Proteomics science and society :the role of knowledge translation in moving towards clinical applications

Gaining support for proteomics science requires effective knowledge translation. Knowledge translation (KT) processes turn the evidence generated by scientific discovery into recommendations for clinical applications, funding priorities, and policy/regulatory reforms. Clinicians, regulators, and funders need to understand why emerging proteomics knowledge is relevant, and what are the potential applications of that knowledge. A lack of clarity remains about what KT means.

Redefining and leading the academic discipline in Australian universities

Disciplines have emerged as an alternative administrative structure to departments or schools in Australian universities. We presently investigate the pattern of discipline use and by way of case study examine a role for distributed leadership in discipline management. Over forty per cent of Australian universities currently employ disciplines, especially within faculties of sciences, engineering and medicine. No trend is observed according to institutional age, state, or historical origins. Effective planning, retention of corporate knowledge and good communication are important during the transition period. Moreover, it is vital that professional staff continue to work closely alongside academics as extended members of the discipline. Distributed leadership encourages this interaction. The duties of a discipline leader can be similar to those faced by a head of department. Universities should therefore establish clear policies, position descriptions and appropriate remuneration packages in order to recruit, train and retain staff within this emerging academic management role.

International tax and the Australian wine industry: Is your client’s product destined to sail the seven seas?

The export market for Australian wine continues to grow at a rapid rate, with imported wines also playing a role in market share in sales in Australia. It is estimated that over 60 per cent of all Australian wine is exported, while 12 per cent of wine consumed in Australia has overseas origins. In addition to understanding the size and direction (import or export) of wines, the foreign locales also play an important role in any tax considerations. While the export market for Australian produced alcohol continues to grow, it is into the Asian market that the most significant inroads are occurring. Sales into China of bottled wine over $7.50 per litre recently overtook the volume sold our traditional partners of the United States and Canada. It is becoming easier for even small to medium sized businesses to export their services or products overseas. However, it is vital for those businesses to understand the tax rules applying to any international transactions. Specifically, one of the first tax regimes that importers and exporters need to understand once they decide to establish a presence overseas is transfer pricing. These are the rules that govern the cross-border prices of goods, services and other transactions entered into between related parties. This paper is Part 2 of the seminar presented on transfer pricing and international tax issues which are particularly relevant to the wine industry. The predominant focus of Part 2 is to discuss four key areas likely to affect international expansion. First, the use of the available transfer pricing methodologies for international related party transactions is discussed. Second, the affects that double tax agreements will have on taking a business offshore are considered. Third, the risks associated with aggressive tax planning through tax information exchange agreements is reviewed. Finally, the paper predicts future ‘trip-wires’ and areas to ‘watch out for’ for practitioners dealing with clients operating in the international arena.

ASICS : authenticated key exchange security incorporating certification systems

Most security models for authenticated key exchange (AKE) do not explicitly model the associated certification system, which includes the certification authority (CA) and its behaviour. However, there are several well-known and realistic attacks on AKE protocols which exploit various forms of malicious key registration and which therefore lie outside the scope of these models. We provide the first systematic analysis of AKE security incorporating certification systems (ASICS). We define a family of security models that, in addition to allowing different sets of standard AKE adversary queries, also permit the adversary to register arbitrary bitstrings as keys. For this model family we prove generic results that enable the design and verification of protocols that achieve security even if some keys have been produced maliciously. Our approach is applicable to a wide range of models and protocols; as a concrete illustration of its power, we apply it to the CMQV protocol in the natural strengthening of the eCK model to the ASICS setting.

Count-min sketches for estimating password frequency within Hamming distance two

The count-min sketch is a useful data structure for recording and estimating the frequency of string occurrences, such as passwords, in sub-linear space with high accuracy. However, it cannot be used to draw conclusions on groups of strings that are similar, for example close in Hamming distance. This paper introduces a variant of the count-min sketch which allows for estimating counts within a specified Hamming distance of the queried string. This variant can be used to prevent users from choosing popular passwords, like the original sketch, but it also allows for a more efficient method of analysing password statistics.

Heritability and genome-wide linkage analysis of migraine in the genetic isolate of Norfolk Island

Migraine is a common neurovascular disorder with a complex envirogenomic aetiology. In an effort to identify migraine susceptibility genes, we conducted a study of the isolated population of Norfolk Island, Australia. A large portion of the permanent inhabitants of Norfolk Island are descended from 18th Century English sailors involved in the infamous mutiny on the Bounty and their Polynesian consorts. In total, 600 subjects were recruited including a large pedigree of 377 individuals with lineage to the founders. All individuals were phenotyped for migraine using International Classification of Headache Disorders-II criterion. All subjects were genotyped for a genome-wide panel of microsatellite markers. Genotype and phenotype data for the pedigree were analysed using heritability and linkage methods implemented in the programme SOLAR. Follow-up association analysis was performed using the CLUMP programme. A total of 154 migraine cases (25%) were identified indicating the Norfolk Island population is high-risk for migraine. Heritability estimation of the 377-member pedigree indicated a significant genetic component for migraine (h2 = 0.53, P = 0.016). Linkage analysis showed peaks on chromosome 13q33.1 (P = 0.003) and chromosome 9q22.32 (P = 0.008). Association analysis of the key microsatellites in the remaining 223 unrelated Norfolk Island individuals showed evidence of association, which strengthen support for the linkage findings (P ≤ 0.05). In conclusion, a genome-wide linkage analysis and follow-up association analysis of migraine in the genetic isolate of Norfolk Island provided evidence for migraine susceptibility loci on chromosomes 9q22.22 and 13q33.1.