New estimates for CRNA vacancies

A national survey to estimate vacancy rates of Certified Registered Nurse Anesthetists (CRNAs) in hospitals and ambulatory surgical centers was conducted in 2007. Poisson regression methods were used to improve the precision of the estimates. A significant increase in the estimated vacancy rate was reported for hospitals relative to an earlier study from 2002, although it is important to note that there were some methodological differences between the 2 surveys explaining part of the increase. Results from this study found the vacancy rate was higher in rural hospitals than in nonrural hospitals, and it was lower in ambulatory surgical centers. A number of simulations were run to predict the effects of relevant changes in the market for surgeries and number of CRNAs, which were compared to the predictions from the previous survey. The remarkable factor since the last survey was the unusually large rate of new CRNAs entering the market, yet the vacancy rates remain relatively high.

Nano-scale morphology and electron spectrum of defect states in low-k SiOCH films

Results of experimental investigations on the relationship between nanoscale morphology of carbon doped hydrogenated silicon-oxide (SiOCH) low-k films and their electron spectrum of defect states are presented. The SiOCH films have been deposited using trimethylsilane (3MS) - oxygen mixture in a 13.56 MHz plasma enhanced chemical vapor deposition (PECVD) system at variable RF power densities (from 1.3 to 2.6 W/cm2) and gas pressures of 3, 4, and 5 Torr. The atomic structure of the SiOCH films is a mixture of amorphous-nanocrystalline SiO2-like and SiC-like phases. Results of the FTIR spectroscopy and atomic force microscopy suggest that the volume fraction of the SiC-like phase increases from ∼0.2 to 0.4 with RF power. The average size of the nanoscale surface morphology elements of the SiO2-like matrix can be controlled by the RF power density and source gas flow rates. Electron density of the defect states N(E) of the SiOCH films has been investigated with the DLTS technique in the energy range up to 0.6 eV from the bottom of the conduction band. Distinct N(E) peaks at 0.25 - 0.35 eV and 0.42 - 0.52 eV below the conduction band bottom have been observed. The first N(E) peak is identified as originated from E1-like centers in the SiC-like phase. The volume density of the defects can vary from 1011 - 1017 cm-3 depending on specific conditions of the PECVD process.

Art spaces, public space, and the link to community development

Recent literature credits community art spaces with both enhancing social interaction and engagement and generating economic revitalization. This article argues that the ability of art spaces to realize these outcomes is linked to their role as public spaces and that their community development potential can be expanded with greater attention to this role. An analysis of the public space characteristics is useful because it encourages consideration of sometimes overlooked issues, particularly the effect of the physical environment on outcomes related to community development. I examine the relationship between public space and community development at various types of art spaces including artist cooperatives, ethnic-specific art spaces, and city-sponsored art centers in central city and suburban locations. This study shows that through their programming and other activities, art spaces serve various public space roles related to community development. However, the ability of many to perform as public spaces is hindered by facility design issues and poor physical connections in their surrounding area. This article concludes with proposals for enhancing the community development role of the art spaces through their function as public spaces.

Cultural development strategies and urban revitalization

Municipal governments around the globe increasingly turn to museums, performing arts centers, arts districts, and other cultural activities to promote and revitalize their cities. While a significant body of literature examines revitalization strategies that focus primarily around entertainment and commerce, the empirical body of research that specifically investigates the role of cultural strategies in urban redevelopment is still growing. This paper first discusses the development of municipal cultural strategies in the United States, and draws from the literature to outline the characteristics of three different models of such strategies. Second, the paper presents findings from a national survey distributed to municipal agencies involved in the promotion and development of cultural activities and facilities in large and medium‐sized US cities. The survey data indicate that although most agencies are guided by a varied set of goals, entrepreneurial objectives continue to guide the development and support of cultural activities in most cities.

The Habitual Rhythms of Becoming-Involved: Insights into Participation Experiences in Urban Spaces by Children with Diverse Mobility

This chapter reports on a study that reveals the essence of participation in urban spaces by ten children who live with various physical conditions: Muscular Dystrophy, Cerebral Palsy, and Autoimmune Rheumatic Diseases. These conditions affect muscle and movement differently resulting in diverse ways in which children move through space (personal mobility). The children at the time of the research were 9-12 years of age residing in South-east Queensland, Australia. The approach and methods selected for this study, interpretive phenomenological inquiry and grounded theory, were chosen for their capacity to capture the complexity and multiple interactions of the child’s urban living. The confronting and poignant accounts by children and their families of their experiences produced a new way of understanding the concept of participation, as a ‘journey of becoming involved.’ Their accounts of performing everyday routines (e.g. leaving home, getting in and out of the car, and entering places) in urban spaces (neighbourhood streets, schools, open spaces, shopping centres, and hospitals) revealed differences in the way settings were experienced. These differences were associated with the interplay between the body, space and context. Where interplays were problematic, explicit decisions about children’s involvement were made. These decisions were described in terms of ‘avoid going’, ‘pick and choose’, ‘discontinue’, ‘accept’, or ‘contest.’ What these decisions mean is some spaces are avoided, some journeys are discontinued, and some barriers encountered in journeys are normalised as everyday experiences, i.e. ‘tolerable discrimination’. These actions resulted in experiences of non-participation or partial–tokenistic participation. The key substantive contribution of the research lies in the identification of points in children’s journeys that shape participation experience. These points identify where future interventions in policy, programming and design can be made to make real and sustaining changes to lives of children and their families in geographies crucial to urban living.

In Response: "Oral versus IV treatment for catheter-related bloodstream infections - by Burke A. Cunha"

In his letter Cunha suggests that oral antibiotic therapy is safer and less expensive than intravenous therapy via central venous catheters (CVCs) (1). The implication is that costs will fall and increased health benefits will be enjoyed resulting in a gain in efficiency within the healthcare system. CVCs are often used in critically ill patients to deliver antimicrobial therapy, but expose patients to a risk of catheter-related bloodstream infection (CRBSI). Our current knowledge about the efficiency (i.e. costeffectiveness) of allocating resources toward interventions that prevent CRBSI in patients requiring a CVC has already been reviewed (2). If for some patient groups antimicrobial therapy can be delivered orally, instead of through a CVC, then the costs and benefits of this alternate strategy should be evaluated...

The effectiveness of workshops as managerial learning opportunities

Purpose The purpose of this paper is to examine the effectiveness of workshops as a learning tool for small business owner‐managers (SBO‐Ms). It aims to concentrate on workshops delivered over 18 months from January 2007 to July 2008 as part of several publicly‐funded small business development programmes in two Australian local government areas (LGAs). Design/methodology/approach Effectiveness is measured in terms of meeting the overarching learning needs and expectations of participants in the context of the programme goals. The paper analyses data gathered from workshop participants either post‐workshop, in later focus groups or through a questionnaire as well as additional feedback from participants and the organisers' reflections. The thematic analysis is organised through an analogy of “going shopping”, where the SBO‐M shopper is buying “learning” when they attend a workshop. Findings Understanding motivation to participate or the “what's in it for me” is important as SBO‐Ms tend to be reluctant, resist or fail to engage with externally sponsored business support initiatives. Workshops were valued for the “space” they create to reflect on practice. For many SBO‐Ms, content “comes alive” with discussion while networking helps reduce the isolation SBO‐Ms can feel. Practical implications The shopping analogy suggests workshops must cater for purposeful shoppers as well as browsers, while interaction with others in the workshop is critical to realising the value of workshops. Originality/value Knowing whether, and how, workshops deliver learning can help to better target and refine these types of support initiatives to ensure they provide positive outcomes for individuals, organisations and economies.

On the effectiveness of a license scheme for E-waste recycling : the challenge of China and India

It is well known that China and India have been recycling centers of WEEE, especially printed circuit boards, and that serious environmental pollution in these countries has been generated by improper recycling methods. After the governments of China and India banned improper recycling by the informal sector, improper recycling activities spread to other places. Then, these governments changed their policies to one of promoting proper recycling by introducing a scheme, under which E-waste recycling requires a license issued by the government. In this paper, the effectiveness of that license scheme is examined by means of an economic model. It can be shown that the license scheme can work effectively only if disposers of E-waste have a responsibility to sell E-waste to license holders. Our results run counter to the idea that international E-waste trade should be banned and provide an alternative solution to the problem.

Gender and entrepreneurial performance : testing a holistic framework

The aim of this study was to test a holistic framework for assessing new venture performance outcomes that incorporates the impact of gender on internal resource availability (human, financial and social capital) and how, in turn, this impacts: the entrepreneurs’ goals; the investment (both money and time) they make in their new ventures; and the performance outcomes of those ventures. Our results indicate that a majority of the paths examined (using structural equation modeling) are significant and in the expected direction. For example: an entrepreneur’s human capital (comprising management work experience, start-up experience and industry experience) is significantly related to her/his growth goal (in terms of employee numbers); the entrepreneur’s growth goal is positively related to the time invested in the new venture; and the time invested in the new venture is positively related to new venture outcomes.

Preventing infections following caesarean section

Surgical site infections following caesarean section are a serious and costly adverse event for Australian hospitals. In the United Kingdom, 9% of women are diagnosed with a surgical site infection following caesarean section either in hospital or post-discharge (Wloch et al 2012, Ward et al 2008). Additional staff time, pharmaceuticals and health supplies, and increased length of stay or readmission to hospital are often required (Henman et al 2012). Part of my PhD investigated the economics of preventing post-caesarean infection. This paper summarises a review of relevant infection prevention strategies. Administering antibiotic prophylaxis 15 to 60 minutes pre-incision, rather than post cordclamping, is probably the most important infection prevention strategy for caesarean section (Smaill and Gyte2010, Liu et al 2013, Dahlke et al 2013). However the timing of antibiotic administration is reportedly inconsistent in Australian hospitals. Clinicians may be taking advice from the influential, but out-dated RANZCOG and United States Centers for Disease Control and Prevention guidelines (Royal Australian and New Zealand College of Obstetricians and Gynaecologists 2011, Mangram et al 1999). A number of other important international clinical guidelines, including Australia's NHMRC guidelines, recommend universal prophylactic antibiotics pre-incision for caesarean section (National Health and Medical Research Council 2010, National Collaborating Centre for Women's and Children's Health 2008, Anderson et al 2008, National Collaborating Centre for Women's and Children's Health 2011, Bratzler et al 2013, American College of Obstetricians and Gynecologists 2011a, Antibiotic Expert Group 2010). We need to ensure women receive preincision antibiotic prophylaxis, particularly as nurses and midwives play a significant role in managing an infection that may result from sub-optimal practice. It is acknowledged more explicitly now that nurses and midwives can influence prescribing and administration of antibiotics through informal approaches (Edwards et al 2011). Methods such as surgical safety checklists are a more formal way for nurses and midwives to ensure that antibiotics are administered pre-incision (American College of Obstetricians and Gynecologists 2011 b). Nurses and midwives can also be directly responsible for other infection prevention strategies such as instructing women to not remove pubic hair in the month before the expected date of delivery and wound management education (Ng et al 2013). Potentially more costly but effective strategies include using a Chlorhexidine-gluconate (CHG) sponge preoperatively (in addition to the usual operating room skin preparation) and vaginal cleansing with a povidone-iodine solution (Riley et al 2012, Rauk 2010, Haas, Morgan, and Contreras 2013).

Engaging children and young people in creating resilient and healthy urban spaces

Urban public space in Australia and internationally, can be critically examined from a number of multidisciplinary standpoints, including human geography, urban design, planning, sociology, and public health. Viewing urban public space from a range of perspectives encourages different vantage points to emerge and questions around health, wellbeing and public space are increasingly topical and important in the broadest of terms, with public space being a key arena for physical activity, mental health, commercial, cultural and community life and the possibility of social inclusion. However, in the name of urban regeneration, programs of securitisation, ‘gentrification’ ‘creative’ and ‘smart’ city initiatives refashion public space as sites of selective inclusion and exclusion (Watson 2005; Gabrys 2014). In this context of monitoring and control procedures, in particular, children and young people’s use of space in parks, neighbourhoods, shopping malls and streets, is often viewed as a threat to social order, requiring various forms of remedial action, such as being ‘designed out’ of public space (Johnson 2014). Rarely are children and young people actively and respectfully brought into planning and governance processes and consequently many urban public spaces are essentially adult places, where control and ongoing surveillance are the key concerns (Freeman 2011, Dee 2013). There is also a political economy of public space discernable in cities like Brisbane, where ‘flagship’ infrastructure such as road tunnels take pride of place, while more humbly appointed pedestrian footpaths are often narrow, in a poor state of repair and a potential barrier to good health (Atkinson and Easthope 2009). The recent development of bikeways in Brisbane is a case in point, presenting both challenges and opportunities in being a valuable new form of public space heavily used by ‘commuter cyclists’ by day, but poorly lit and conceived, for a range of users at other times (Wyeth 2014). This paper concentrates on questions of social citizenship rights and discourses of health and wellbeing and suggests that cities, places and spaces and those who seek to use them, can be resilient in maintaining and extending democratic freedoms, calling surveillance, planning and governance systems to account (Smith 2014). The active inclusion of children and young people better informs the implementation of public policy around the design, build and governance of public space and also understandings of urban citizenship, leading to healthier, more inclusive, public space for all (Jacobs 1965).

Young people and the struggle for public space in Australia

Public Space is important to the overall health and wellbeing of children and young people in allowing them to explore their local and wider community, meet up with friends, get some exercise and feel included in the society in which they live. A problem exists in the capacity of modern, urban public space to genuinely accommodate children and young people’s need to experience excitement and fun in what has been termed “unprogrammed space” (Lynch 1977:71), or simply to ‘hang out’ in unstructured social space, with control by civic authorities a key concern. For many children and young people, their experiences of attempting to use public space are sometimes marred by the denial of everyday rights and courtesies, in youth ‘unfriendly’ spaces and this is often the case in shopping centres in Australia as expolored in this paper.

Public space and the marginalisation of children and young people

Throughout Australia (and elsewhere in the world) public spaces are under attack by developers and also attempts by civic authorities to regulate, restrict and reframe them. A consequence of the increasingly security driven, privatised and surveilled nature of public space is the exclusion and displacement of those considered flawed and unwelcome in the “spectacular” consumption spaces of major urban centres. In this context of monitoring and control procedures, children and young people’s use of public space in parks, neighbourhoods, shopping malls and streets is often viewed as a threat to social order, requiring various forms of punitive and/or remedial action. This paper discusses developments in the surveillance, governance and control of public space used by children and young people in particular and the capacity for their displacement and marginality, diminishing their sense of belonging, wellbeing and right to public space as an expression of social, political and civil citizenship.

Temporal Characterization of Ossification of the Crania in Australian Subadults: New standards for Age Estimation using Computed Tomography

After attending this presentation, attendees will gain awareness of the ontogeny of cranial maturation, specifically: (1) the fusion timings of primary ossification centers in the basicranium; and (2) the temporal pattern of closure of the anterior fontanelle, to develop new population-specific age standards for medicolegal death investigation of Australian subadults. This presentation will impact the forensic science community by demonstrating the potential of a contemporary forensic subadult Computed Tomography (CT) database of cranial scans and population data, to recalibrate existing standards for age estimation and quantify growth and development of Australian children. This research welcomes a study design applicable to all countries faced with paucity in skeletal repositories. Accurate assessment of age-at-death of skeletal remains represents a key element in forensic anthropology methodology. In Australian casework, age standards derived from American reference samples are applied in light of scarcity in documented Australian skeletal collections. Currently practitioners rely on antiquated standards, such as the Scheuer and Black1 compilation for age estimation, despite implications of secular trends and population variation. Skeletal maturation standards are population specific and should not be extrapolated from one population to another, while secular changes in skeletal dimensions and accelerated maturation underscore the importance of establishing modern standards to estimate age in modern subadults. Despite CT imaging becoming the gold standard for skeletal analysis in Australia, practitioners caution the application of forensic age standards derived from macroscopic inspection to a CT medium, suggesting a need for revised methodologies. Multi-slice CT scans of subadult crania and cervical vertebrae 1 and 2 were acquired from 350 Australian individuals (males: n=193, females: n=157) aged birth to 12 years. The CT database, projected at 920 individuals upon completion (January 2014), comprises thin-slice DICOM data (resolution: 0.5/0.3mm) of patients scanned since 2010 at major Brisbane Childrens Hospitals. DICOM datasets were subject to manual segmentation, followed by the construction of multi-planar and volume rendering cranial models, for subsequent scoring. The union of primary ossification centers of the occipital bone were scored as open, partially closed or completely closed; while the fontanelles, and vertebrae were scored in accordance with two stages. Transition analysis was applied to elucidate age at transition between union states for each center, and robust age parameters established using Bayesian statistics. In comparison to reported literature, closure of the fontanelles and contiguous sutures in Australian infants occur earlier than reported, with the anterior fontanelle transitioning from open to closed at 16.7±1.1 months. The metopic suture is closed prior to 10 weeks post-partum and completely obliterated by 6 months of age, independent of sex. Utilizing reverse engineering capabilities, an alternate method for infant age estimation based on quantification of fontanelle area and non-linear regression with variance component modeling will be presented. Closure models indicate that the greatest rate of change in anterior fontanelle area occurs prior to 5 months of age. This study complements the work of Scheuer and Black1, providing more specific age intervals for union and temporal maturity of each primary ossification center of the occipital bone. For example, dominant fusion of the sutura intra-occipitalis posterior occurs before 9 months of age, followed by persistence of a hyaline cartilage tongue posterior to the foramen magnum until 2.5 years; with obliteration at 2.9±0.1 years. Recalibrated age parameters for the atlas and axis are presented, with the anterior arch of the atlas appearing at 2.9 months in females and 6.3 months in males; while dentoneural, dentocentral and neurocentral junctions of the axis transitioned from non-union to union at 2.1±0.1 years in females and 3.7±0.1 years in males. These results are an exemplar of significant sexual dimorphism in maturation (p<0.05), with girls exhibiting union earlier than boys, justifying the need for segregated sex standards for age estimation. Studies such as this are imperative for providing updated standards for Australian forensic and pediatric practice and provide an insight into skeletal development of this population. During this presentation, the utility of novel regression models for age estimation of infants will be discussed, with emphasis on three-dimensional modeling capabilities of complex structures such as fontanelles, for the development of new age estimation methods.

Online Customer Experience : What is the Experience and how is it Difference for Frequent and Infrequent Purchasers, Age Cohorts and Gender Groups?

What do we know? • Customer Experience is increasingly becoming the new standard for differentiation in both offline and online retailing, and offers a sustainable competitive advantage. o The economic value of a company’s offering has been observed to increase when the customer has a fulfilling shopping experience (Pine & Gilmore, 1998) o Crafting engaging and customer experience is a known method of generating loyalty, advocacy and word of mouth (Tynan & McKechnie, 2009). o A good experience can entice consumers to shop for longer and spend more (Kim, 2001). • The customer’s experience is made up of diverse elements occurring before, during and after the purchase itself. (Discussed further on page 5). It is cumulative over time and can be influenced by touch points across multiple channels. What remains unclear? • How do Coles customers respond to the elements of online customer experience? • How does the online customer experience differ for frequent and infrequent purchasers? • Do differences between genders and age cohorts for online customer experience exist?