Quality of child abuse information in emergency department injury surveillance data : linking hospital and child welfare data

Emergency departments (EDs) are often the first point of contact with an abused child. Despite legal mandate, the reporting of definite or suspected abusive injury to child safety authorities by ED clinicians varies due to a number of factors including training, access to child safety professionals, departmental culture and a fear of ‘getting it wrong’. This study examined the quality of documentation and coding of child abuse captured by ED based injury surveillance data and ED medical records in the state of Queensland and the concordance of these data with child welfare records. A retrospective medical record review was used to examine the clinical documentation of almost 1000 injured children included in the Queensland Injury Surveillance Unit database (QISU) from 10 hospitals in urban and rural centres. Independent experts re-coded the records based on their review of the notes. A data linkage methodology was then used to link these records with records in the state government’s child welfare database. Cases were sampled from three sub-groups according to the surveillance intent codes: Maltreatment by parent, Undetermined and Unintentional injury. Only 0.1% of cases coded as unintentional injury were recoded to maltreatment by parent, while 1.2% of cases coded as maltreatment by parent were reclassified as unintentional and 5% of cases where the intent was undetermined by the triage nurse were recoded as maltreatment by parent. Quality of documentation varied across type of hospital (tertiary referral centre, children’s, urban, regional and remote). Concordance of health data with child welfare data varied across patient subgroups. Outcomes from this research will guide initiatives to improve the quality of intentional child injury surveillance systems.

Perceptions of daylight quality delivered by light transport systems

Light Transport Systems (LTS) (e.g lightpipes, fibre optics) can illuminate core areas within buildings with great potential for energy savings. However, they do not provide a clear connection to the outside like windows do, and their effects on people’s physiological and psychological health are not well understood. Furthermore, how people perceive LTS affects users’ acceptance of the device and its performance. The purpose of this research is to understand how occupants perceive and experience spaces illuminated by LTS. Two case studies of commercial buildings with LTS, located in Brisbane, Australia are assessed by qualitative (focus group interviews) and quantitative (measurement of daylight illuminances and luminance) methods. The data from interviews with occupants provide useful insight into the aspects of LTS design that are most relevant to positive perception of the luminous environment. Luminance measurements of the occupied spaces support the perception of the LTS reported by occupants: designs that create high contrast luminous environments are more likely to be perceived negatively.

Talking the talk and walking the walk : how managers can influence the quality of work-life balance in a construction project

Purpose – The construction industry in Australia is characterised by a long work-hours culture, with conditions that make it difficult for staff to balance their work and non-work lives. The objective of this paper is to measure the success of a work-place intervention designed to improve work-life balance (WLB) in an alliance project in the construction industry, and the role the project manager plays in this success. Design/methodology/approach – The paper focuses on an alliance case study. Interviews were conducted at two points in time, several months apart, after the interventions were implemented. Findings – Results showed that staff on the whole were more satisfied with their work experience after the interventions, and indicated the important role that managers' attitudes and behaviours played. Originality/value – Managerial support for work-life initiatives is a critical element in achieving WLB and satisfaction with working arrangements. The fact that the manager “talked the talk and walked the walk” was a major contributing success factor, which has not previously been demonstrated.

Benchmarking clinical indicators of quality for Australian residential aged care facilities

To undertake exploratory benchmarking of a set of clinical indicators of quality care in residential care in Australia, data were collected from 107 residents within four medium-sized facilities (40–80 beds) in Brisbane, Australia. The proportion of residents in each sample facility with a particular clinical problem was compared with US Minimum Data Set quality indicator thresholds. Results demonstrated variability within and between clinical indicators, suggesting breadth of assessment using various clinical indicators of quality is an important factor when monitoring quality of care. More comprehensive and objective measures of quality of care would be of great assistance in determining and monitoring the effectiveness of residential aged care provision in Australia, particularly as demands for accountability by consumers and their families increase. What is known about the topic? The key to quality improvement is effective quality assessment, and one means of evaluating quality of care is through clinical outcomes. The Minimum Data Set quality indicators have been credited with improving quality in United States nursing homes. What does this paper add? The Clinical Care Indicators Tool was used to collect data on clinical outcomes, enabling comparison of data from a small Australian sample with American quality benchmarks to illustrate the utility of providing guidelines for interpretation. What are the implications for practitioners? Collecting and comparing clinical outcome data would enable practitioners to better understand the quality of care being provided and whether practices required review. The Clinical Care Indicator Tool could provide a comprehensive and systematic means of doing this, thus filling a gap in quality monitoring within Australian residential aged care.

Traffic and climate change impacts on water quality : measuring build-up and wash-off of heavy metals and petroleum hydrocarbons

Understanding the impacts of traffic and climate change on water quality helps decision makers to develop better policy and plans for dealing with unsustainable urban and transport development. This chapter presents detailed methodologies developed for sample collection and testing for heavy metals and total petroleum hydrocarbons, as part of a research study to investigate the impacts of climate change and changes to urban traffic characteristics on pollutant build-up and wash-off from urban road surfaces. Cadmium, chromium, nickel, copper, lead, iron, aluminium, manganese and zinc were the target heavy metals, and selected gasoline and diesel range organics were the target total petroleum hydrocarbons for this study. The study sites were selected to encompass the urban traffic characteristics of the Gold Coast region, Australia. An improved sample collection method referred to as ‘the wet and dry vacuum system’ for the pollutant build-up, and an effective wash-off plan to incorporate predicted changes to rainfall characteristics due to climate change, were implemented. The novel approach to sample collection for pollutant build-up helped to maintain the integrity of collection efficiency. The wash-off plan helped to incorporate the predicted impacts of climate change in the Gold Coast region. The robust experimental methods developed will help in field sample collection and chemical testing of different stormwater pollutants in build-up and wash-off.

Derivation of motor vehicle tailpipe particle emission factors suitable for modelling urban fleet emissions and air quality assessments

Background, aim, and scope Urban motor vehicle fleets are a major source of particulate matter pollution, especially of ultrafine particles (diameters < 0.1 µm), and exposure to particulate matter has known serious health effects. A considerable body of literature is available on vehicle particle emission factors derived using a wide range of different measurement methods for different particle sizes, conducted in different parts of the world. Therefore the choice as to which are the most suitable particle emission factors to use in transport modelling and health impact assessments presented as a very difficult task. The aim of this study was to derive a comprehensive set of tailpipe particle emission factors for different vehicle and road type combinations, covering the full size range of particles emitted, which are suitable for modelling urban fleet emissions. Materials and methods A large body of data available in the international literature on particle emission factors for motor vehicles derived from measurement studies was compiled and subjected to advanced statistical analysis, to determine the most suitable emission factors to use in modelling urban fleet emissions. Results This analysis resulted in the development of five statistical models which explained 86%, 93%, 87%, 65% and 47% of the variation in published emission factors for particle number, particle volume, PM1, PM2.5 and PM10 respectively. A sixth model for total particle mass was proposed but no significant explanatory variables were identified in the analysis. From the outputs of these statistical models, the most suitable particle emission factors were selected. This selection was based on examination of the statistical robustness of the statistical model outputs, including consideration of conservative average particle emission factors with the lowest standard errors, narrowest 95% confidence intervals and largest sample sizes, and the explanatory model variables, which were Vehicle Type (all particle metrics), Instrumentation (particle number and PM2.5), Road Type (PM10) and Size Range Measured and Speed Limit on the Road (particle volume). Discussion A multiplicity of factors need to be considered in determining emission factors that are suitable for modelling motor vehicle emissions, and this study derived a set of average emission factors suitable for quantifying motor vehicle tailpipe particle emissions in developed countries. Conclusions The comprehensive set of tailpipe particle emission factors presented in this study for different vehicle and road type combinations enable the full size range of particles generated by fleets to be quantified, including ultrafine particles (measured in terms of particle number). These emission factors have particular application for regions which may have a lack of funding to undertake measurements, or insufficient measurement data upon which to derive emission factors for their region. Recommendations and perspectives In urban areas motor vehicles continue to be a major source of particulate matter pollution and of ultrafine particles. It is critical that in order to manage this major pollution source methods are available to quantify the full size range of particles emitted for traffic modelling and health impact assessments.

Evaluation on service quality of railway timetable

From the business viewpoint, the railway timetable is a list of the products presented by the railway transportation operators to the customers, specifying the schedules of all the train services on a railway line or network. In order to evaluate the quality of the train service schedules, a number of indices are proposed in this paper. These indices primarily take the passengers’ needs, such as waiting time, transfer time and transport capacity into consideration. Delay rate is usually used in post-evaluation. In this study, we propose to give an evaluation on the probability that the scheduled train services are likely to be delayed and the recovery ability of the timetable after delay has occurred. The evaluation identifies the possible problems in the services, such as excessive waiting time, non-seamless transfer, and high possibility of delay. This paper also discusses the improvement of these problems through certain adjustments on the timetable. The indices for evaluation and the adjustment method on timetable are then applied to a case study on the Hu-Ning-Hang railway in China, followed by the discussions of the merits of the proposed indices for timetable evaluation and possible improvement.

The influence of family ownership on the quality of accounting information

This article explores the quality of accounting information in listed family firms. The authors exploit the features of the Italian equitymarket characterizd by high ownership concentration across all tpes of firms to disentangle the effects of family ownership from other major block holders on the quality of accounting information. The findings document that family firms convey financial information of higher quality compared to the nonfamily peers. Furthermore the authors provide evidence that the determinants of accounting quality differ across family and nonfamily firms.

Cultural influences on IS service quality perceptions

While Information services function’s (ISF) service quality is not a new concept and has received considerable attention for over two decades, cross-cultural research of ISF’s service quality is not very mature. The author argues that the relationship between cultural dimensions and the ISF’s service quality dimensions may provide useful insights for how organisations should deal with different cultural groups. This paper will show that ISF’s service quality dimensions vary from one culture to another. The study adopts Hofstede’s (1980, 1991) typology of cultures and the “zones of tolerance” (ZOT) service quality measure reported by Kettinger & Lee (2005) as the primary commencing theory-base. In this paper, the author hypothesised and tested the influences of culture on users’ service quality perceptions and found strong empirical support for the study’s hypotheses. The results of this study indicate that as a result of their cultural characteristics, users vary in both their overall service quality perceptions and their perceptions on each of the four dimensions of ZOT service quality.

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.

An investigation of the relationship between subjective sleep quality, loneliness and mood in an Australian sample: Can daily routine explain the links?

Background: Loneliness and low mood are associated with significant negative health outcomes including poor sleep, but the strength of the evidence underlying these associations varies. There is strong evidence that poor sleep quality and low mood are linked, but only emerging evidence that loneliness and poor sleep are associated. Aims: To independently replicate the finding that loneliness and poor subjective sleep quality are associated and to extend past research by investigating lifestyle regularity as a possible mediator of relationships, since lifestyle regularity has been linked to loneliness and poor sleep. Methods: Using a cross-sectional design, 97 adults completed standardized measures of loneliness, lifestyle regularity, subjective sleep quality and mood. Results: Loneliness was a significant predictor of sleep quality. Lifestyle regularity was not a predictor of, nor associated with, mood, sleep quality or loneliness. Conclusions: This study provides an important independent replication of the association between poor sleep and loneliness. However, the mechanism underlying this link remains unclear. A theoretically plausible mechanism for this link, lifestyle regularity, does not explain the relationship between loneliness and poor sleep. The nexus between loneliness and poor sleep is unlikely to be broken by altering the social rhythm of patients who present with poor sleep and loneliness.

Clinical outcomes in residential care : setting benchmarks for quality

Aim Australian residential aged care does not have a system of quality assessment related to clinical outcomes, or comprehensive quality benchmarking. The Residential Care Quality Assessment was developed to fill this gap; and this paper discusses the process by which preliminary benchmarks representing high and low quality were developed for it. Methods Data were collected from all residents (n = 498) of nine facilities. Numerator–denominator analysis of clinical outcomes occurred at a facility-level, with rank-ordered results circulated to an expert panel. The panel identified threshold scores to indicate excellent and questionable care quality, and refined these through Delphi process. Results Clinical outcomes varied both within and between facilities; agreed thresholds for excellent and poor outcomes were finalised after three Delphi rounds. Conclusion Use of the Residential Care Quality Assessment provides a concrete means of monitoring care quality and allows benchmarking across facilities; its regular use could contribute to improved care outcomes within residential aged care in Australia.

Business Process Quality Management

Process modeling is a central element in any approach to Business Process Management (BPM). However, what hinders both practitioners and academics is the lack of support for assessing the quality of process models – let alone realizing high quality process models. Existing frameworks are highly conceptual or too general. At the same time, various techniques, tools, and research results are available that cover fragments of the issue at hand. This chapter presents the SIQ framework that on the one hand integrates concepts and guidelines from existing ones and on the other links these concepts to current research in the BPM domain. Three different types of quality are distinguished and for each of these levels concrete metrics, available tools, and guidelines will be provided. While the basis of the SIQ framework is thought to be rather robust, its external pointers can be updated with newer insights as they emerge.

Factors influencing quality of life in patients with benign primary brain tumors : prior to and following surgery

Goals: Few studies have repeatedly evaluated quality of life and potentially relevant factors in patients with benign primary brain tumor. The purpose of this study was to explore the relationship between the experience of the symptom distress, functional status, depression, and quality of life prior to surgery (T1) and 1 month post-discharge (T2). ---------- Patients and methods: This was a prospective cohort study including 58 patients with benign primary brain tumor in one teaching hospital in the Taipei area of Taiwan. The research instruments included the M.D. Anderson Symptom Inventory, the Functional Independence Measure scale, the Hospital Depression Scale, and the Functional Assessment of Cancer Therapy-Brain.---------- Results: Symptom distress (T1: r=−0.90, p<0.01; T2: r=−0.52, p<0.01), functional status (T1: r=0.56, p<0.01), and depression (T1: r=−0.71, p<0.01) demonstrated a significant relationship with patients' quality of life. Multivariate analysis identified symptom distress (explained 80.2%, Rinc 2=0.802, p=0.001) and depression (explained 5.2%, Rinc 2=0.052, p<0.001) continued to have a significant independent influence on quality of life prior to surgery (T1) after controlling for key demographic and medical variables. Furthermore, only symptom distress (explained 27.1%, Rinc 2=0.271, p=0.001) continued to have a significant independent influence on quality of life at 1 month after discharge (T2).---------- Conclusions: The study highlights the potential importance of a patient's symptom distress on quality of life prior to and following surgery. Health professionals should inquire about symptom distress over time. Specific interventions for symptoms may improve the symptom impact on quality of life. Additional studies should evaluate symptom distress on longer-term quality of life of patients with benign brain tumor.

Enhancing the use of Internet and Web services for quality learning : an action research

Internet and Web services have been used in both teaching and learning and are gaining popularity in today’s world. E-Learning is becoming popular and considered the latest advance in technology based learning. Despite the potential advantages for learning in a small country like Bhutan, there is lack of eServices at the Paro College of Education. This study investigated students’ attitudes towards online communities and frequency of access to the Internet, and how students locate and use different sources of information in their project tasks. Since improvement was at the heart of this research, an action research approach was used. Based on the idea of purposeful sampling, a semi-structured interview and observations were used as data collection instruments. 10 randomly selected students (5 girls and 5 boys) participated in this research as the controlled group. The study findings indicated that there is a lack of educational information technology services, such as e-learning at the college. Internet connection being very slow was the main barrier to learning using e-learning or accessing Internet resources. There is a strong relationship between the quality of written task and the source of the information, and between Web searching and learning. The source of information used in assignments and project work is limited to books in the library which are often outdated and of poor quality. Project tasks submitted by most of the students were of poor quality.