Antimicrobial stewardship activities : a survey of Queensland hospitals

Objective: In 2011, the Australian Commission on Safety and Quality in Health Care (ACSQHC) recommended that all hospitals in Australia must have an Antimicrobial Stewardship (AMS) program by 2013. Nevertheless, little is known about current AMS activities. This study aimed to determine the AMS activities currently undertaken, and to identify gaps, barriers to implementation and opportunities for improvement in Queensland hospitals. Methods: The AMS activities of 26 facilities from 15 hospital and health services in Queensland were surveyed during June 2012 to address strategies for effective AMS: implementing clinical guidelines, formulary restriction, reviewing antimicrobial prescribing, auditing antimicrobial use and selective reporting of susceptibility results. Results: The response rate was 62%. Nineteen percent had an AMS team (a dedicated multidisciplinary team consisting of a medically trained staff member and a pharmacist). All facilities had access to an electronic version of Therapeutic Guidelines: Antibiotic, with a further 50% developing local guidelines for antimicrobials. One-third of facilities had additional restrictions. Eighty-eight percent had advice for restricted antimicrobials from in-house infectious disease physicians or clinical microbiologists. Antimicrobials were monitored with feedback given to prescribers at point of care by 76% of facilities. Deficiencies reported as barriers to establishing AMS programs included: pharmacy resources, financial support by hospital management, and training and education in antimicrobial use. Conclusions: Several areas for improvement were identified: reviewing antimicrobial prescribing with feedback to the prescriber, auditing, and training and education in antimicrobial use. There also appears to be a lack of resources to support AMS programs in some facilities. What is known about the topic? The ACSQHC has recommended that all hospitals implement an AMS program by 2013 as a requirement of Standard 3 (Preventing and Controlling Healthcare-Associated Infections) of the National Safety and Quality Health Service Standards. The intent of AMS is to ensure appropriate prescribing of antimicrobials as part of the broader systems within a health service organisation to prevent and manage healthcare-associated infections, and improve patient safety and quality of care. This criterion also aligns closely with Standard 4: Medication Safety. Despite this recommendation, little is known about what AMS activities are undertaken in these facilities and what additional resources would be required in order to meet these national standards. What does the paper add? This is the first survey that has been conducted of public hospital and health services in Queensland, a large decentralised state in Australia. This paper describes what AMS activities are currently being undertaken, identifies practice gaps, barriers to implementation and opportunities for improvement in Queensland hospitals. What are the implications for practitioners? Several areas for improvement such as reviewing antimicrobial prescribing with feedback to the prescriber, auditing, and training and education in antimicrobial use have been identified. In addition, there appears to be a lack of resources to support AMS programs in some facilities.

Sense of modern heritage

As the society matures, there was an increasing pressure to preserve historic buildings. The economic cost in maintaining these important heritage legacies has become the prime consideration of every state. Dedicated intelligent monitoring systems supplementing the traditional building inspections will enable the stakeholder to carry out not only timely reactive response but also plan the maintenance in a more vigilant approach; thus, preventing further degradation which was very costly and difficult to address if neglected. The application of the intelligent structural health monitoring system in this case studies of ‘modern heritage’ buildings is on its infancy but it is an innovative approach in building maintenance. ‘Modern heritage’ buildings were the product of technological change and were made of synthetic materials such as reinforced concrete and steel. Architectural buildings that was very common in Oceania and The Pacific. Engineering problems that arose from this type of building calls for immediate engineering solution since the deterioration rate is exponential. The application of this newly emerging monitoring system will improve the traditional maintenance system on heritage conservation. Savings in time and resources can be achieved if only pathological results were on hand. This case study will validate that approach. This publication will serve as a position paper to the on-going research regarding application of (Structural Health Monitoring) SHM systems to heritage buildings in Brisbane, Australia. It will be investigated with the application of the SHM systems and devices to validate the integrity of the recent structural restoration of the newly re-strengthened heritage building, the Brisbane City Hall.

The QUT Training Model for Peer Leader Capacity Building

QUT has enacted a university-wide Peer Program’s Strategy which aims to improve student success and graduate outcomes. A component of this strategy is a training model providing relevant, quality-assured and timely training for all students who take on leadership roles. The training model is designed to meet the needs of the growing scale and variety of peer programs, and to recognise the multiple roles and programs in which students may be involved during their peer leader journey. The model builds peer leader capacity by offering centralised, beginning and ongoing training modules, delivered by in-house providers, covering topics which prepare students to perform their role safely, inclusively, accountably and skilfully. The model also provides efficiencies by differentiating between ‘core competency' and ‘program-specific’ modules, thus avoiding training duplication across multiple programs, and enabling training to be individually and flexibly formatted to suit the specific and unique needs of each program.

Overcoming acculturation: Physical education recruits' experiences of an alternative pedagogical approach to games teaching

Background Physical education teacher education (PETE) programmes have been identified as a critical platform to encourage the exploration of alternative teaching approaches by pre-service teachers. However, the socio-cultural constraint of acculturation or past physical education and sporting experiences results in the maintenance of the status quo of a teacher-driven, reproductive paradigm. Previous studies have reported successfully overcoming the powerful influence of acculturation, resulting in a change in PETE students’ custodial teaching beliefs and receptiveness to alternative teaching approaches. However, to date, limited information has been reported about how PETE students’ acculturation shaped their receptiveness to an alternative teaching approach. This is particularly the case for PETE recruits identified in the literature as most resistant to change. Purpose To explore the features and experiences of an alternative games teaching approach that appealed to PETE recruits’ identified as most resistant to change, requiring a specific sample of PETE recruits with strong, custodial, traditional physical education teaching beliefs, and whom are high achieving sporting products of this traditional culture. The alternative teaching approach explored in this study is the constraints-led approach (CLA), which is similar operationally to TGfU, but distinguished by a neurobiological theoretical framework (nonlinear pedagogy) that informs learning design. Participants and Setting A purposive sample of 10 Australian PETE students was recruited for the study. All participants initially had strong, custodial, traditional physical education teaching beliefs, and were successful sporting products of this teaching approach. After experiencing the CLA as learners during a games unit, participants demonstrated receptiveness to the alternative pedagogy. Data Collection and Analysis Semi-structured interviews and written reflections were sources of data collection. Each participant was interviewed separately, once prior to participation in the games unit to explore their positive physical education experiences, and then again after participation to explore the specific games unit learning experiences that influenced their receptiveness to the alternative pedagogy. Participants completed written reflections about their personal experiences after selected practical sessions. Data were qualitatively analysed using grounded theory. Findings: Thorough examination of the data resulted in establishment of two prominent themes related to the appeal of the CLA for the participants: (i) psychomotor (effective in developing skill), and (ii), inclusivity (included students of varying skill level). The efficacy of the CLA in skill development was clearly an important mediator of receptiveness for highly successful products of a traditional culture. This significant finding could be explained by three key factors: the acculturation of the participants, the motor learning theory underpinning the alternative pedagogy and the unit learning design and delivery. The inclusive nature of the CLA provided a solution to the problem of exclusion, which also made the approach attractive to participants. Conclusion PETE educators could consider these findings when introducing an alternative pedagogy aimed at challenging PETE recruits’ custodial, traditional teaching beliefs. To mediate receptiveness, it is important that the learning theory underpinning the alternative approach is operationalised in a research-informed pedagogical learning design that facilitates students’ perceptions of the effectiveness of the approach through experiencing and or observing it working.

Empirical reference points for Bernstein’s model of pedagogic rights: Recontextualising the reconciliation agenda to Australian schooling

In this chapter we use Bernstein’s (2000) model of pedagogic rights to examine the learning experiences for non-Indigenous teachers in two reconciliation projects. In the context within which we write, reconciliation is the process of establishing a culture of mutual respect between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. In 1991, the Royal Commission into Aboriginal Deaths in Custody linked the continuation of racism in Australian society to the weak coverage of Aboriginal and Torres Strait Islander content in the school curriculum (Reconciliation Australia 2010). Nearly two decades later, the Melbourne Declaration on Educational Goals for Young Australians issued by the council of Federal, State and Territory Ministers of Education proclaimed that curriculum should enable all students to ‘understand and acknowledge the value of Indigenous cultures and possess the knowledge, skills and understanding to contribute to, and benefit from reconciliation between Indigenous and non-Indigenous Australians’ (MCEETYA 2008, 9). Education holds out promise not only of better life chances for Indigenous young people, but also of replacing myths with understanding and tackling prejudice and racism within the non-Indigenous population. Bernstein’s (2000) model of pedagogic rights promises some purchase on this pedagogic work by providing concepts for looking systematically at the participation of non-Indigenous teachers in education. As observed by Frandji and Vitale (Chapter 2, this volume), the model is not sufficient to achieve a democratic reality, ‘but simply provides a basis for problematizing reality and considering possibilities’.

High-throughput bone and cartilage micropellet manufacture, followed by assembly of micropellets into biphasic osteochondral tissue

Engineered biphasic osteochondral tissues may have utility in cartilage defect repair. As bone-marrow-derived mesenchymal stem/stromal cells (MSC) have the capacity to make both bone-like and cartilage-like tissues, they are an ideal cell population for use in the manufacture of osteochondral tissues. Effective differentiation of MSC to bone-like and cartilage-like tissues requires two unique medium formulations and this presents a challenge both in achieving initial MSC differentiation and in maintaining tissue stability when the unified osteochondral tissue is subsequently cultured in a single medium formulation. In this proof-of-principle study, we used an in-house fabricated microwell platform to manufacture thousands of micropellets formed from 166 MSC each. We then characterized the development of bone-like and cartilage-like tissue formation in the micropellets maintained for 8–14 days in sequential combinations of osteogenic or chondrogenic induction medium. When bone-like or cartilage-like micropellets were induced for only 8 days, they displayed significant phenotypic changes when the osteogenic or chondrogenic induction medium, respectively, was swapped. Based on these data, we developed an extended 14-day protocol for the pre-culture of bone-like and cartilage-like micropellets in their respective induction medium. Unified osteochondral tissues were formed by layering 12,000 osteogenic micropellets and 12,000 chondrogenic micropellets into a biphasic structure and then further culture in chondrogenic induction medium. The assembled tissue was cultured for a further 8 days and characterized via histology. The micropellets had amalgamated into a continuous structure with distinctive bone-like and cartilage-like regions. This proof-of-concept study demonstrates the feasibility of micropellet assembly for the formation of osteochondral-like tissues for possible use in osteochondral defect repair.

Anatomical modelling of the pregnant radiotherapy patient

This study aimed to take existing anatomical models of pregnant women, currently used for radiation pro-tection and nuclear medicine dose calculations, and adapt them for use in the calculation of fetal dose from external beam radiotherapy (EBRT). The models investigated were ‘KATJA’, which was provided as an MCNPX geometry file, and ‘RPI-P6’, which was provided in a simple, voxelized bina-ry format. In-house code was developed, to convert both mod-els into an `egsphant’ format, suitable for use with DOSXYZnrc. The geometries and densities of the resulting phantoms were evaluated and found to accurately represent the source data. As an example of the use of the phantoms, the delivery of a cranial EBRT treatment was simulated using the BEAMnrc and DOSXYZnrc Monte Carlo codes and the likely out-of-field doses to the fetus in each model was calculated. The results of these calculations showed good agreement (with-in one standard deviation) between the doses calculated in KATJA and PRI-P6, despite substantial anatomical differ-ences between the two models. For a 36 Gy prescription dose to a 233.2 cm3 target in the right brain, the mean doses calcu-lated in a region of interest covering the entire uterus were 1.0 +/- 0.6 mSv for KATJA and 1.3 +/- 0.9 mSv for RPI-P6. This work is expected to lead to more comprehensive studies of EBRT treatment plan design and its effects on fetal dose in the future.

Use of 3D printed materials as tissue-equivalent phantoms

This study used the specific example of 3D printing with acrylonitrile butadiene styrene (ABS) as a means to investigate the potential usefulness of benchtop rapid prototyping as a technique for producing patient specific phantoms for radiotherapy dosimetry. Three small cylinders and one model of a human lung were produced via in-house 3D printing with ABS, using 90%, 50%, 30% and 10% ABS infill densities. These phantom samples were evaluated in terms of their geometric accuracy, tissue equivalence and radiation hardness, when irradiated using a range of clinical radiotherapy beams. The measured dimensions of the small cylindrical phantoms all matched their planned dimensions, within 1mm. The lung phantom was less accurately matched to the lung geometry on which it was based, due to simplifications introduced during the phantom design process. The mass densities, electron densities and linear attenuation coefficients identified using CT data, as well as the results of film measurements made using megavoltage photon and electron beams, indicated that phantoms printed with ABS, using infill densities of 30% or more, are potentially useful as lung- and tissue-equivalent phantoms for patient-specific radiotherapy dosimetry. All cylindrical 3D printed phantom samples were found to be unaffected by prolonged radiation and to accurately match their design specifications. However, care should be taken to avoid oversimplifying anatomical structures when printing more complex phantoms.

A 4D automatic simulation tool for construction resource planning: A case study

Purpose Traditional construction planning relies upon the critical path method (CPM) and bar charts. Both of these methods suffer from visualization and timing issues that could be addressed by 4D technology specifically geared to meet the needs of the construction industry. This paper proposed a new construction planning approach based on simulation by using a game engine. Design/methodology/approach A 4D automatic simulation tool was developed and a case study was carried out. The proposed tool was used to simulate and optimize the plans for the installation of a temporary platform for piling in a civil construction project in Hong Kong. The tool simulated the result of the construction process with three variables: 1) equipment, 2) site layout and 3) schedule. Through this, the construction team was able to repeatedly simulate a range of options. Findings The results indicate that the proposed approach can provide a user-friendly 4D simulation platform for the construction industry. The simulation can also identify the solution being sought by the construction team. The paper also identifies directions for further development of the 4D technology as an aid in construction planning and decision-making. Research limitations/implications The tests on the tool are limited to a single case study and further research is needed to test the use of game engines for construction planning in different construction projects to verify its effectiveness. Future research could also explore the use of alternative game engines and compare their performance and results. Originality/value The authors proposed the use of game engine to simulate the construction process based on resources, working space and construction schedule. The developed tool can be used by end-users without simulation experience.

Green procurement framework for the Malaysian construction industry

Construction projects have a negative impact on the environment. As Malaysia is planning more construction projects to cater for its current and future development needs, practitioners are urged to undertake greener approaches to construction. One of the efforts is the introduction of green procurement, which is promoted under the Malaysian Government’s MyHijau initiative. Construction procurement is recognised as a tool to shift the construction business into a greener industry. However, the implementation of green procurement in Malaysia is still in its infancy and faces a number of challenges, such as the lack of knowledge. A significant gap has been found between policy formulation and actual project delivery as there are no practical guidelines for stakeholders to procure environmental-friendly construction projects. To address this problem, the present research (as part of an ongoing PhD project) aims to develop a green procurement framework that guides stakeholders in procuring green projects in Malaysia. This article highlights the concept of green procurement in Malaysia, the work carried out to date to achieve the research objectives and the preliminary framework that has been established. It is hoped that this research will help academics and practitioners to further explore the potential of green procurement to improve sustainability in the current construction industry practices.

The opportunity for implementing Islamic project financing to the Indonesian infrastructure development

Purpose: This chapter discusses the opportunity of Islamic project financing implementation for public infrastructure development in Indonesia. Design/Methodology/Approach: This chapter, firstly, reviewed existing literature on Islamic finance to explore the applicability of Islamic financing in infrastructure development. Interviews were conducted as the first stage of Delphi method approach. This was then followed by reviewing Indonesia’s government policies and regulations in infrastructure industry and Islamic financing. Findings: This chapter enlightens the implementation of Islamic financing on infrastructure project financing in Indonesia. The findings indicate that the government policies and regulations on both infrastructure investment and Islamic financing support the implementation of Islamic project financing, whereas, an improvement is still needed in order to overarch infrastructure business and Islamic financing investment. Research: Financing framework development for Indonesia infrastructure projects. Limitations/Implications: The result reported comprises the preliminary study of Islamic project paper written based on published research papers and interviews. Furthermore, the data collected for the study are limited to the case of Indonesian infrastructure projects. Practical Implication: Islamic financing in Indonesia infrastructure projects development has not been optimally implemented. Therefore, this chapter serves as a catalyst to explore alternative financial scheme such as Islamic financing for infrastructure development. Originality/Value: This chapter highlights possibilities and obstacles in applying Islamic scheme to infrastructure project financing. This provides a framework to analyse the steps to implement Islamic financing successfully in infrastructure development.

Cost estimating practice incorporating Building Information Modelling (BIM): Malaysian Quantity Surveyors perspectives

Cost estimating is a key task within Quantity Surveyors’ (QS) offices. Provision of an accurate estimate is vital to ensure that the objectives of the client are met by staying within the client’s budget. Building Information Modelling (BIM) is an evolving technology that has gained attention in the construction industries all over the world. Benefits from the use of BIM include cost and time savings if the processes used by the procurement team are adapted to maximise the benefits of BIM. BIM can be used by QSs to automate aspects of quantity take-off and the preparation of estimates, decreasing turnaround time and assist in controlling errors and inaccuracies. The Malaysian government has decided to require the use of BIM for its projects beginning from 2016. However, slow uptake is reported in the use of BIM both within companies and to support collaboration within the Malaysian industry. It has been recommended that QSs to start evaluating the impact of BIM on their practices. This paper reviews the perspectives of QSs in Malaysia towards the use of BIM to achieve more dependable results in their cost estimating practice. The objectives of this paper include identifying strategies in improving practice and potential adoption drivers that lead QSs to BIM usage in their construction projects. From the expert interviews, it was found out that, despite still using traditional methods and not practising BIM, the interviewees still acquire limited knowledge related to BIM. There are some drivers that potentially motivate them to employ BIM in their practices. These include client demands, innovation in traditional methods, speed in estimating costs, reduced time and costs, improvement in practices and self-awareness, efficiency in projects, and competition from other companies. The findings of this paper identify the potential drivers in encouraging Malaysian Quantity Surveyors to exploit BIM in their construction projects.

Is Aldi’s move to woo cashed-up shoppers a risk?

While Aldi’s launch of their new “trial” stores may seem to be an attempt to capture middle income shoppers, it may end in disaster. Aldi’s four new trial stores located in Queensland, NSW, ACT and Victoria, will offer improved lighting, larger layouts and an expanded offering of fresh food including extending produce ranges, in-house bakeries and premium brands. Employing Nielsen’s 2014 Homescan Report, Aldi have determined that only 30% of their customers were now considered “low-income shoppers”. Some 34.4% were from middle-income households and the remaining 35.6% now had household incomes greater than AUD$90,000 a year - a segment which has grown by 6.7% since 2011. So this probably the reason for Aldi’s foray into new stores and ranges. However, such a move is considered risky.

Deeply superficial digital media engagement? The case of Twitter and Movember 2013

Using activity generated with Twitter during Movember 2013, we interrogate the natures of superficiality running through what can be defined as a highly successful public health engagement intervention. Indeed, Movember arguably has not just been successful in one year in terms of raising funds for the causes it is concerned with, it has done this year-on-year since 2004. We tracked the keyword 'movember' (without the hash symbol) using an in-house installation of YourTwapperkeeper hosted on a NECTAR server. Data collection ran from 01 October - 04 December 2013, covering the ramp-up and wind-down periods of the event. We collected a total of 1,313,426 tweets from 759,345 unique users.

Platelet endothelial cell adhesion molecule 1 (PECAM-1) and its interactions with glycosaminoglycans: 1. Molecular modeling studies

Platelet endothelial cell adhesion molecule 1 (PECAM-1) has many functions, including its roles in leukocyte extravasation as part of the inflammatory response and in the maintenance of vascular integrity through its contribution to endothelial cell−cell adhesion. PECAM-1 has been shown to mediate cell−cell adhesion through homophilic binding events that involve interactions between domain 1 of PECAM-1 molecules on adjacent cells. However, various heterophilic ligands of PECAM-1 have also been proposed. The possible interaction of PECAM-1 with glycosaminoglycans (GAGs) is the focus of this study. The three-dimensional structure of the extracellular immunoglobulin (Ig) domains of PECAM-1 were constructed using homology modeling and threading methods. Potential heparin/heparan sulfate-binding sites were predicted on the basis of their amino acid consensus sequences and a comparison with known structures of sulfate-binding proteins. Heparin and other GAG fragments have been docked to investigate the structural determinants of their protein-binding specificity and selectivity. The modeling has predicted two regions in PECAM-1 that appear to bind heparin oligosaccharides. A high-affinity binding site was located in Ig domains 2 and 3, and evidence for a low-affinity site in Ig domains 5 and 6 was obtained. These GAG-binding regions were distinct from regions involved in PECAM-1 homophilic interactions.