730 resultados para ED Patient Experiences


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Purpose: Graduated driver licensing (GDL) has been introduced in numerous jurisdictions in Australia and internationally in an attempt to ameliorate the significantly greater risk of death and injury for young novice drivers arising from road crashes. The GDL program in Queensland, Australia, was extensively modified in July 2007. This paper reports the driving and licensing experiences of Learner drivers progressing through the current-GDL program, and compares them to the experiences of Learners who progressed through the former-GDL program. ----- ----- Method: Young drivers (n = 1032, 609 females, 423 males) aged 17 to 19 years (M = 17.43, SD = 0.67) were recruited as they progressed from a Learner to a Provisional driver’s licence. They completed a survey exploring their sociodemographic characteristics, driving and licensing experiences as a Learner. Key measures for a subsample (n = 183) of the current-GDL drivers were compared with the former-GDL drivers (n = 149) via t-tests and chi-square analyses. ----- ----- Results: As expected, Learner drivers progressing through the current-GDL program gained significantly more driving practice than those in the former program, which was more likely to be provided by mothers than in the past. Female learners in the current-GDL program reported less difficulty obtaining supervision than those in the former program. The number of attempts needed to pass the practical driving assessment did not change, nor did the amount of professional supervision. The current-GDL Learners held their licence for a significantly longer duration than those in the former program, with the majority reporting that their Logbook entries were accurate on the whole. Compared to those in the former program, a significantly smaller proportion of male current-GDL Learners reported being detected for a driving offence while the females reported significantly lower crash involvement. Most current-GDL drivers reported undertaking their supervised practice at the end of the Learner period. ----- ----- Conclusions: The enhancements to the GDL program in Queensland appear to have achieved many of their intended results. The current-GDL learners participating in the study reported obtaining a significantly greater amount of supervised driving experience compared to former-GDL learners. Encouragingly, the current-GDL Learners did not report any greater difficulty in obtaining supervised driving practice, and there was a decline in the proportion of current-GDL Learners engaging in unsupervised driving. In addition, the majority of Learners do not appear to be attempting to subvert logbook recording requirements, as evidenced by high rates of self-reported logbook accuracy. The results have implications for the development and the evaluation of GDL programs in Australia and around the world.

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Despite having a band of greenness around the edge, Australia is fundamentally a dry country. Australian vegetation has developed a high range of mechanisms to cope with the dryness, but after 200 years of white settlement, Australians still have not really come to terms with the real dryness of their country, and still exploit European paradigms that attempted to transplant European aesthetic conditions, greenness, to the brown land of Australia. Australia is going through serious water shortages that are still and will continue with the Greenhouse effect, to become a major factor in the location and extent of urbanisation, and also Australia's carrying capacity. While such aesthetic concerns might seem ornamental, until the population changes its attitude to the real condition of the country, it will keep using water and operating unsustainably. The design of the public landscape, however, offers the opportunity to contribute to changing people's aesthetic perception of the country, which might in turn help to redirect their water use practices. This essay develops a language for discussion dryness based around the experiences of water. After having developed this sensibility it then discusses a range of different approaches that landscape design in Australia has used to try to develop geographically appropriate design languages, including the Bush Garden and the Mediterranean Garden. It then discusses four design projects, one from the 1970's, the other three from the last five years that demonstrate what such an aesthetic might look like.

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In 2006, the Faculty of Built Environment and Engineering introduced the first faculty wide unit dedicated to sustainability at any Australian University. BEB200 Introducing Sustainability has semester enrolments of up to 1500 students. Instruments such as lectures, readings, field visits, group projects and structured tutorial activities are used and have evolved over the last five years in response to student and staff feedback and attempts to better engage students. More than seventy staff have taught in the unit, which is in its final offering in this form in 2010. This paper reflects on the experiences of five academics who have played key roles in the development and teaching of this unit over the last five years. They argue that sustainability is a paradigm that allows students to explore other ways of knowing as they engage with issues in a complex world, not an end in itself. From the students’ perspective, grappling with such issues enables them to move towards a context in which they can understand their own discipline and its role in the contradictory and rapidly changing professional world. Insights are offered into how sustainability units may be developed in the future.

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Scoliosis is a spinal deformity that requires surgical correction in progressive cases. In order to optimize surgical outcomes, patient-specific finite element models are being developed by our group. In this paper, a single rod anterior correction procedure is simulated for a group of six scoliosis patients. For each patient, personalised model geometry was derived from low-dose CT scans, and clinically measured intra-operative corrective forces were applied. However, tissue material properties were not patient-specific, being derived from existing literature. Clinically, the patient group had a mean initial Cobb angle of 47.3 degrees, which was corrected to 17.5 degrees after surgery. The mean simulated post-operative Cobb angle for the group was 18.1 degrees. Although this represents good agreement between clinical and simulated corrections, the discrepancy between clinical and simulated Cobb angle for individual patients varied between -10.3 and +8.6 degrees, with only three of the six patients matching the clinical result to within accepted Cobb measurement error of +-5 degrees. The results of this study suggest that spinal tissue material properties play an important role in governing the correction obtained during surgery, and that patient-specific modelling approaches must address the question of how to prescribe patient-specific soft tissue properties for spine surgery simulation.

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Reviews into teacher education emphasise the need for preservice teachers to have more school-based experiences. In this study, a school-based experience was organised within a nine-week science curriculum university unit that allowed preservice teachers’ repeated experiences in teaching primary science. This research uses a survey, questionnaire with extended written responses, and researcher observations to investigate preservice teachers’ (n=38) learning experiences in two school settings. Survey results indicated that the majority of these preservice teachers either agreed or strongly agreed that school-based experiences developed their: personal-professional skill development (100%); system requirements (range: 81-100%); teaching practices (81-100%); student behaviour management (range: 94-100%); providing student feedback (89-94%); and reflection on practice (92-100%). Qualitative data provided insights into their development particularly for science content knowledge and receiving positive reinforcement on effective teaching behaviours. According to these preservice teachers, the school-based experiences facilitated “teachable moments – having the knowledge or skills to run with students’ questions or ideas” and allowed preservice teachers to “critically reflect between groups to make the task flow better”. Embedding school-based experiences needs to be part of each and every preservice teacher education unit so preservice teachers can develop confidence, knowledge and skills within authentic school contexts.

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Cell based therapies as they apply to tissue engineering and regenerative medicine, require cells capable of self renewal and differentiation, and a prerequisite is to be able to prepare an effective dose of ex vivo expanded cells for autologous transplants. The in vivo identification of a source of physiologically relevant cell types suitable for cell therapies therefore figures as an integral part of tissue engineering. Stem cells serve as a reserve for biological repair, having the potential to differentiate into a number of specialised cell types within the body; they therefore represent the most useful candidates for cell based therapies. The primary goal of stem cell research is to produce cells that are both patient specific, as well as having properties suitable for the specific conditions for which they are intended to remedy. From a purely scientific perspective, stem cells allow scientists to gain a deeper understanding of developmental biology and regenerative therapies. Stem cells have acquired a number of uses for applications in regenerative medicine, immunotherapy, gene therapy, but it is in the area of tissue engineering that they generate most excitement, primarily as a result of their capacity for self-renewal and pluripotency. A unique feature of stem cells is their ability to maintain an uncommitted quiescent state in vivo and then, once triggered by conditions such as disease, injury or natural wear or tear, serve as a reservoir and natural support system to replenish lost cells. Although these cells retain the plasticity to differentiate into various tissues, being able to control this differentiation process is still one of the biggest challenges facing stem cell research. In an effort to harness the potential of these cells a number of studies have been conducted using both embryonic/foetal and adult stem cells. The use of embryonic stem cells (ESC) have been hampered by strong ethical and political concerns, this despite their perceived versatility due to their pluripotency. Ethical issues aside, other concerns raised with ESCs relates to the possibility of tumorigenesis, immune rejection and complications with immunosuppressive therapies, all of which adds layers of complications to the application ESC in research and which has led to the search for alternative sources for stem cells. The adult tissues in higher organisms harbours cells, termed adult stem cells, and these cells are reminiscent of unprogrammed stem cells. A number of sources of adult stem cells have been described. Bone marrow is by far the most accessible source of two potent populations of adult stem cells, namely haematopoietic stem cells (HSCs) and bone marrow mesenchymal stem cells (BMSCs). Autologously harvested adult stem cells can, in contrast to embryonic stem cells, readily be used in autografts, since immune rejection is not an issue; and their use in scientific research has not attracted the ethical concerns which have been the case with embryonic stem cells. The major limitation to their use, however, is the fact that adult stem cells are exceedingly rare in most tissues. This fact makes identifying and isolating these cells problematic; bone marrow being perhaps the only notable exception. Unlike the case of HSCs, there are as yet no rigorous criteria for characterizing MSCs. Changing acuity about the pluripotency of MSCs in recent studies has expanded their potential application; however, the underlying molecular pathways which impart the features distinctive to MSCs remain elusive. Furthermore, the sparse in vivo distribution of these cells imposes a clear limitation to their study in vitro. Also, when MSCs are cultured in vitro, there is a loss of the in vivo microenvironment, resulting in a progressive decline in proliferation potential and multipotentiality. This is further exacerbated with increased passage numbers in culture, characterized by the onset of senescence related changes. As a consequence, it is necessary to establish protocols for generating large numbers of MSCs but without affecting their differentiation potential. MSCs are capable of differentiating into mesenchymal tissue lineages, including bone, cartilage, fat, tendon, muscle, and marrow stroma. Recent findings indicate that adult bone marrow may also contain cells that can differentiate into the mature, nonhematopoietic cells of a number of tissues, including cells of the liver, kidney, lung, skin, gastrointestinal tract, and myocytes of heart and skeletal muscle. MSCs can readily be expanded in vitro and can be genetically modified by viral vectors and be induced to differentiate into specific cell lineages by changing the microenvironment–properties which makes these cells ideal vehicles for cellular gene therapy. MSCs can also exert profound immunosuppressive effects via modulation of both cellular and innate immune pathways, and this property allows them to overcome the issue of immune rejection. Despite the many attractive features associated with MSCs, there are still many hurdles to overcome before these cells are readily available for use in clinical applications. The main concern relates to in vivo characterization and identification of MSCs. The lack of a universal biomarker, sparse in vivo distribution, and a steady age related decline in their numbers, makes it an obvious need to decipher the reprogramming pathways and critical molecular players which govern the characteristics unique to MSCs. This book presents a comprehensive insight into the biology of adult stem cells and their utility in current regeneration therapies. The adult stem cell populations reviewed in this book include bone marrow derived MSCs, adipose derived stem cells (ASCs), umbilical cord blood stem cells, and placental stem cells. The features such as MSC circulation and trafficking, neuroprotective properties, and the nurturing roles and differentiation potential of multiple lineages have been discussed in details. In terms of therapeutic applications, the strengths of MSCs have been presented and their roles in disease treatments such as osteoarthritis, Huntington’s disease, periodontal regeneration, and pancreatic islet transplantation have been discussed. An analysis comparing osteoblast differentiation of umbilical cord blood stem cells and MSCs has been reviewed, as has a comparison of human placental stem cells and ASCs, in terms of isolation, identification and therapeutic applications of ASC in bone, cartilage regeneration, as well as myocardial regeneration. It is my sincere hope that this book will update the reader as to the research progress of MSC biology and potential use of these cells in clinical applications. It will be the best reward to all contributors of this book, if their efforts herein may in some way help the readers in any part of their study, research, and career development.

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The pervasiveness of technology in the 21st Century has meant that adults and children live in a society where digital devices are integral to their everyday lives and participation in society. How we communicate, learn, work, entertain ourselves, and even shop is influenced by technology. Therefore, before children begin school they are potentially exposed to a range of learning opportunities mediated by digital devices. These devices include microwaves, mobile phones, computers, and console games such as Playstations® and iPods®. In Queensland preparatory classrooms and in the homes of these children, teachers and parents support and scaffold young children’s experiences, providing them with access to a range of tools that promote learning and provide entertainment. This paper examines teachers’ and parents’ perspectives and considers whether they are techno-optimists who advocate for and promote the inclusion of digital technology, or whether they are they techno-pessimists, who prefer to exclude digital devices from young children’s everyday experiences. An exploratory, single case study design was utilised to gather data from three teachers and ten parents of children in the preparatory year. Teacher data was collected through interviews and email correspondence. Parent data was collected from questionnaires and focus groups. All parents who responded to the research invitation were mothers. The results of data analysis identified a misalignment among adults’ perspectives. Teachers were identified as techno-optimists and parents were identified as techno-pessimists with further emergent themes particular to each category being established. This is concerning because both teachers and mothers influence young children’s experiences and numeracy knowledge, thus, a shared understanding and a common commitment to supporting young children’s use of technology would be beneficial. Further research must investigate fathers’ perspectives of digital devices and the beneficial and detrimental roles that a range of digital devices, tools, and entertainment gadgets play in 21st Century children’s lives.

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Objective: to assess the accuracy of data linkage across the spectrum of emergency care in the absence of a unique patient identifier, and to use the linked data to examine service delivery outcomes in an emergency department setting. Design: automated data linkage and manual data linkage were compared to determine their relative accuracy. Data were extracted from three separate health information systems: ambulance, ED and hospital inpatients, then linked to provide information about the emergency journey of each patient. The linking was done manually through physical review of records and automatically using a data linking tool (Health Data Integration) developed by the CSIRO. Match rate and quality of the linking were compared. Setting: 10, 835 patient presentations to a large, regional teaching hospital ED over a two month period (August-September 2007). Results: comparison of the manual and automated linkage outcomes for each pair of linked datasets demonstrated a sensitivity of between 95% and 99%; a specificity of between 75% and 99%; and a positive predictive value of between 88% and 95%. Conclusions: Our results indicate that automated linking provides a sound basis for health service analysis, even in the absence of a unique patient identifier. The use of an automated linking tool yields accurate data suitable for planning and service delivery purposes and enables the data to be linked regularly to examine service delivery outcomes.

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Background: Ambulance ramping within the Emergency Department (ED) is a common problem both internationally and in Australia. Previous research has focused on various issues associated with ambulance ramping such as access block, ED overcrowding and ambulance bypass. However, limited research has been conducted on ambulance ramping and its effects on patient outcomes. ----- ----- Methods: A case-control design was used to describe, compare and predict patient outcomes of 619 ramped (cases) vs. 1238 non-ramped (control) patients arriving to one ED via ambulance from 1 June 2007 to 31 August 2007. Cases and controls were matched (on a 1:2 basis) on age, gender and presenting problem. Outcome measures included ED length of stay and in-hospital mortality. ----- ----- Results: The median ramp time for all 1857 patients was 11 (IQR 6—21) min. Compared to nonramped patients, ramped patients had significantly longer wait time to be triaged (10 min vs. 4 min). Ramped patients also comprised significantly higher proportions of those access blocked (43% vs. 34%). No significant difference in the proportion of in-hospital deaths was identified (2%vs. 3%). Multivariate analysis revealed that the likelihood of having an ED length of stay greater than eight hours was 34% higher among patients who were ramped (OR 1.34, 95% CI 1.06—1.70, p = 0.014). In relation to in-hospital mortality age was the only significant independent predictor of mortality (p < 0.0001). ----- ----- Conclusion: Ambulance ramping is one factor that contributes to prolonged ED length of stay and adds additional strain on ED service provision. The potential for adverse patient outcomes that may occur as a result of ramping warrants close attention by health care service providers.

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This paper describes an ethnographic study completed within a kindergarten environment with the view of gaining insights into the development of new technology for young children. Ethnography within HCI has primarily focused on studies of work practices. This project explored the effectiveness of ethnography in supporting the design of playful technology for a constantly changing, creative, and (sometimes) messy environment. The study was effective in drawing out patterns in observations and as such provides useful suggestions for the development of technology for kindergarten settings.

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In the partnering with students and industry it is important for universities to recognize and value the nature of knowledge and learning that emanates from work integrated learning experiences is different to formal university based learning. Learning is not a by-product of work rather learning is fundamental to engaging in work practice. Work integrated learning experiences provide unique opportunities for students to integrate theory and practice through the solving of real world problems. This paper reports findings to date of a project that sought to identify key issues and practices faced by academics, industry partners and students engaged in the provision and experience of work integrated learning within an undergraduate creative industries program at a major metropolitan university. In this paper, those findings are focused on some of the particular qualities and issues related to the assessment of learning at and through the work integrated experience. The findings suggest that the assessment strategies needed to better value the knowledges and practices of the Creative Industries. The paper also makes recommendations about how industry partners might best contribute to the assessment of students’ developing capabilities and to continuous reflection on courses and the assurance of learning agenda.

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In recent years, there is a dramatic growth in number and popularity of online social networks. There are many networks available with more than 100 million registered users such as Facebook, MySpace, QZone, Windows Live Spaces etc. People may connect, discover and share by using these online social networks. The exponential growth of online communities in the area of social networks attracts the attention of the researchers about the importance of managing trust in online environment. Users of the online social networks may share their experiences and opinions within the networks about an item which may be a product or service. The user faces the problem of evaluating trust in a service or service provider before making a choice. Recommendations may be received through a chain of friends network, so the problem for the user is to be able to evaluate various types of trust opinions and recommendations. This opinion or recommendation has a great influence to choose to use or enjoy the item by the other user of the community. Collaborative filtering system is the most popular method in recommender system. The task in collaborative filtering is to predict the utility of items to a particular user based on a database of user rates from a sample or population of other users. Because of the different taste of different people, they rate differently according to their subjective taste. If two people rate a set of items similarly, they share similar tastes. In the recommender system, this information is used to recommend items that one participant likes, to other persons in the same cluster. But the collaborative filtering system performs poor when there is insufficient previous common rating available between users; commonly known as cost start problem. To overcome the cold start problem and with the dramatic growth of online social networks, trust based approach to recommendation has emerged. This approach assumes a trust network among users and makes recommendations based on the ratings of the users that are directly or indirectly trusted by the target user.

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know personally. They also communicate with other members of the network who are the friends of their friends and may be friends of their friend’s network. They share their experiences and opinions within the social network about an item which may be a product or service. The user faces the problem of evaluating trust in a service or service provider before making a choice. Opinions, reputations and ecommendations will influence users' choice and usage of online resources. Recommendations may be received through a chain of friends of friends, so the problem for the user is to be able to evaluate various types of trust recommendations and reputations. This opinion or ecommendation has a great influence to choose to use or enjoy the item by the other user of the community. Users share information on the level of trust they explicitly assign to other users. This trust can be used to determine while taking decision based on any recommendation. In case of the absence of direct connection of the recommender user, propagated trust could be useful.

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Australia is currently witnessing considerable change in conceptualisation of the role of child care. This is a response to the strong evidence from developmental science that demonstrates the lifelong impact of early experiences. The recent commitment made by the Council of Australian Governments (COAG) (Communiqué, December 2009a) to improved qualifications and quality of those working in child care is a manifestation of this shift and highlights the importance of the childcare workforce. This study focused on the considerations of a third year cohort of B.Ed (EC) pre-service teachers (n = 55), about entering the childcare workforce. It examines their willingness to work in child care and identifies barriers and incentives for so doing. Our results indicate that, although attitudes to maternal work and child care were largely positive, few would prefer to work in child care under the current conditions. Key barriers were the pay and work conditions, particularly as they compare to other forms of potential employment. Incentives were the opportunity for leadership, creativity and a commitment to advocate for the rights of children. Those more willing to consider work in child care were distinguished from those less willing by altruism—foregoing personal gain to advocate for improved quality as a child’s right.

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Since 2007 Kite Arts Education Program (KITE), based at Queensland Performing Arts Centre (QPAC), has been engaged in delivering a series of theatre-based experiences for children in low socio-economic primary schools in Queensland. The twelve-week workshop experience culminates in a performance developed by the children with the assistance of the teacher artists from KITE for their community and parents/carers in a peak community cultural institution. Using Wartella’s notion of the socially competent child this analysis interrogates the performance product Precious, child participation modes, the intersection between the professional artists, teacher artists and child artists and outcomes in terms of building capacities for the development of social competencies in children.