Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments.

Executive summary Objective: The aims of this study were to identify the impact of Pandemic (H1N1) 2009 Influenza on Australian Emergency Departments (EDs) and their staff, and to inform planning, preparedness, and response management arrangements for future pandemics, as well as managing infectious patients presenting to EDs in everyday practice. Methods This study involved three elements: 1. The first element of the study was an examination of published material including published statistics. Standard literature research methods were used to identify relevant published articles. In addition, data about ED demand was obtained from Australian Government Department of Health and Ageing (DoHA) publications, with several state health departments providing more detailed data. 2. The second element of the study was a survey of Directors of Emergency Medicine identified with the assistance of the Australasian College for Emergency Medicine (ACEM). This survey retrieved data about demand for ED services and elicited qualitative comments on the impact of the pandemic on ED management. 3. The third element of the study was a survey of ED staff. A questionnaire was emailed to members of three professional colleges—the ACEM; the Australian College of Emergency Nursing (ACEN); and the College of Emergency Nursing Australasia (CENA). The overall response rate for the survey was 18.4%, with 618 usable responses from 3355 distributed questionnaires. Topics covered by the survey included ED conditions during the (H1N1) 2009 influenza pandemic; information received about Pandemic (H1N1) 2009 Influenza; pandemic plans; the impact of the pandemic on ED staff with respect to stress; illness prevention measures; support received from others in work role; staff and others’ illness during the pandemic; other factors causing ED staff to miss work during the pandemic; and vaccination against Pandemic (H1N1) 2009 Influenza. Both qualitative and quantitative data were collected and analysed. Results: The results obtained from Directors of Emergency Medicine quantifying the impact of the pandemic were too limited for interpretation. Data sourced from health departments and published sources demonstrated an increase in influenza-like illness (ILI) presentations of between one and a half and three times the normal level of presentations of ILIs. Directors of Emergency Medicine reported a reasonable level of preparation for the pandemic, with most reporting the use of pandemic plans that translated into relatively effective operational infection control responses. Directors reported a highly significant impact on EDs and their staff from the pandemic. Growth in demand and related ED congestion were highly significant factors causing distress within the departments. Most (64%) respondents established a ‘flu clinic’ either as part of Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments. the ED operations or external to it. They did not note a significantly higher rate of sick leave than usual. Responses relating to the impact on staff were proportional to the size of the colleges. Most respondents felt strongly that Pandemic (H1N1) 2009 Influenza had a significant impact on demand in their ED, with most patients having low levels of clinical urgency. Most respondents felt that the pandemic had a negative impact on the care of other patients, and 94% revealed some increase in stress due to lack of space for patients, increased demand, and filling staff deficits. Levels of concern about themselves or their family members contracting the illness were less significant than expected. Nurses displayed significantly higher levels of stress overall, particularly in relation to skill-mix requirements, lack of supplies and equipment, and patient and patients’ family aggression. More than one-third of respondents became ill with an ILI. Whilst respondents themselves reported taking low levels of sick leave, respondents cited difficulties with replacing absent staff. Ranked from highest to lowest, respondents gained useful support from ED colleagues, ED administration, their hospital occupational health department, hospital administration, professional colleges, state health department, and their unions. Respondents were generally positive about the information they received overall; however, the volume of information was considered excessive and sometimes inconsistent. The media was criticised as scaremongering and sensationalist and as being the cause of many unnecessary presentations to EDs. Of concern to the investigators was that a large proportion (43%) of respondents did not know whether a pandemic plan existed for their department or hospital. A small number of staff reported being redeployed from their usual workplace for personal risk factors or operational reasons. As at the time of survey (29 October –18 December 2009), 26% of ED staff reported being vaccinated against Pandemic (H1N1) 2009 Influenza. Of those not vaccinated, half indicated they would ‘definitely’ or ‘probably’ not get vaccinated, with the main reasons being the vaccine was ‘rushed into production’, ‘not properly tested’, ‘came out too late’, or not needed due to prior infection or exposure, or due to the mildness of the disease. Conclusion: Pandemic (H1N1) 2009 Influenza had a significant impact on Australian Emergency Departments. The pandemic exposed problems in existing plans, particularly a lack of guidelines, general information overload, and confusion due to the lack of a single authoritative information source. Of concern was the high proportion of respondents who did not know if their hospital or department had a pandemic plan. Nationally, the pandemic communication strategy needs a detailed review, with more engagement with media networks to encourage responsible and consistent reporting. Also of concern was the low level of immunisation, and the low level of intention to accept vaccination. This is a problem seen in many previous studies relating to seasonal influenza and health care workers. The design of EDs needs to be addressed to better manage infectious patients. Significant workforce issues were confronted in this pandemic, including maintaining appropriate staffing levels; staff exposure to illness; access to, and appropriate use of, personal protective equipment (PPE); and the difficulties associated with working in PPE for prolonged periods. An administrative issue of note was the reporting requirement, which created considerable additional stress for staff within EDs. Peer and local support strategies helped ensure staff felt their needs were provided for, creating resilience, dependability, and stability in the ED workforce. Policies regarding the establishment of flu clinics need to be reviewed. The ability to create surge capacity within EDs by considering staffing, equipment, physical space, and stores is of primary importance for future pandemics.

Aggression in Sexually Abused Trafficked Girls and Efficacy of Intervention

The broad objective of this study was to understand the incidence and severity of aggression among sexually abused girls who were trafficked and who were then further used for commercial sexual exploitation (referred to subsequently as sexually abused trafficked girls). In addition, the impact of counseling for minimizing aggression in these girls was investigated. A group of 120 sexually abused trafficked Indian girls and a group of 120 nonsexually abused Indian girls, aged 13 to 18, participated in the study. The sexually abused trafficked girls were purposively selected from four shelters located in and around Kolkata, India. The nonsexually abused girls were selected randomly from four schools situated near the shelters, and these girls were matched by age with the sexually abused trafficked girls. Data were collected using a Background Information Schedule and a standardized psychological test, that is, The Aggression Scale. Results revealed that 16.7% of the girls were first sexually abused between 6 and 9 years of age, 37.5% between 10 and 13 years of age, and 45.8% between 14 and 17 years of age. Findings further revealed that 4.2% of the sexually abused trafficked girls demonstrated saturated aggression, and 26.7% were highly aggressive, that is, extremely frustrated and rebellious. Across age groups, the sexually abused trafficked girls suffered from more aggression (p < .05), compared with the nonvictimized girls. Psychological interventions, such as individual and group counseling, were found to have a positive impact on the sexually abused trafficked girls. These findings should motivate counselors to deal with sexually abused children. It is also hoped that authorities in welfare homes will understand the importance of counseling for sexually abused trafficked children, and will appoint more counselors for this purpose.

Beyond discovery : a case study of teacher interaction, young children and computer tasks

The integration of computer technologies into everyday classroom life continues to provide pedagogical challenges for school systems, teachers and administrators. Data from an exploratory case study of one teacher and a multiage class of children in the first years of schooling in Australia show that when young children are using computers for set tasks in small groups, they require ongoing support from teachers, and to engage in peer interactions that are meaningful and productive. Classroom organization and the nature of teacher-child talk are key factors in engaging children in set tasks and producing desirable learning and teaching outcomes.

Should cooking be a dietetic competency?

Aim:  There are issues surrounding the apparent decline and devaluing of cooking skills in the population, potential health impacts and the role of dietitians. The present paper aims to outline several arguments and raise questions on the relationship between cooking and dietetics.---------- Methods:  Evidence from dietetics and nutrition journals and other sources is used to develop positions for dietetics and its relationship to cooking and cooking skills. ---------- Results:  The historical relationship between dietetics and home economics has seen dietetics professionally distance itself by its scientific education on food and nutrition, rather than actual involvement with cooking. In pursuing this rational scientific approach there are concerns that dietitians have inadvertently supported the growth of the functional and convenience food market, particularly given the demise of home economics as a skill-based curricula in schools in several states. There is a need to consider what role cooking skills could have in dietetics training as a professional competency for practice, particularly for public health interventions. This is in the light of Commonwealth government funding that is legitimising cooking skill interventions as a policy response to obesity. There may be a role for dietitians to develop partnerships and train a new professional category or paraprofessionals and/or peer educators to deliver cooking skill interventions. ---------- Conclusion:  There is a need for research on dietitian's views and use of cooking skill interventions. This would help answer whether we should consider cooking and cooking skills as part of our professional practice and whether cooking should be a dietetic competency.

What's cooking for dietetics? A review of the literature

Aim: There has been no systematic research on the role of cooking skills for improving dietary intakes in Australia. Cooking skills are proposed to be declining and/or being devalued. If cooking skills have been devalued and declining, then what evidence is there for this decline and what impact might this have on dietary intakes? The aim of the present paper is to explore these assumptions with particular reference to Australia. The objectives of the present paper are to define the terms cooking and cooking skills, discuss evidence on levels of cooking skills in Australia and describe the evidence linking cooking skills to dietary intakes.---------- Methods: A review of the peer-reviewed literature using multiple databases from 1990 to September 2009.---------- Results: Cooking skills are complex and require a range of processes for people to develop efficiency or confidence in food preparation. There is little evidence on the level of cooking skills in the Australian population and how this relates to dietary intakes. The Australian Bureau of Statistic’s latest Time Use Survey and Household Expenditure Survey suggest that cooking is still a gendered activity and that the time devoted to cooking has changed little in the past 15 years, but there is an increasing use of foods prepared outside the home.---------- Conclusion: Further research is required to examine the prevalence of different types and levels of cooking skills in Australia as well as their potential effects on dietary intakes. Dietitians need evidence about the level of cooking skills people require for healthy dietary intakes.

Deliberative assessment of surrogate consent in dementia research

Background Research involving incapacitated persons with dementia entails complex scientific, legal, and ethical issues, making traditional surveys of layperson views on the ethics of such research challenging. We therefore assessed the impact of democratic deliberation (DD), involving balanced, detailed education and peer deliberation, on the views of those responsible for persons with dementia. Methods One hundred and seventy-eight community-recruited caregivers or primary decision-makers for persons with dementia were randomly assigned to either an all-day DD session group or a control group. Educational materials used for the DD session were vetted for balance and accuracy by an interdisciplinary advisory panel. We assessed the acceptability of family-surrogate consent for dementia research (“surrogate-based research”) from a societal policy perspective as well as from the more personal perspectives of deciding for a loved one or for oneself (surrogate and self-perspectives), assessed at baseline, immediately post-DD session, and 1 month after DD date, for four research scenarios of varying risk-benefit profiles. Results At baseline, a majority in both the DD and control groups supported a policy of family consent for dementia research in all research scenarios. The support for a policy of family consent for surrogate-based research increased in the DD group, but not in the control group. The change in the DD group was maintained 1 month later. In the DD group, there were transient changes in attitudes from surrogate or self-perspectives. In the control group, there were no changes from baseline in attitude toward surrogate consent from any perspective. Conclusions Intensive, balanced, and accurate education, along with peer deliberation provided by democratic deliberation, led to a sustained increase in support for a societal policy of family consent in dementia research among those responsible for dementia patients.

Loneliness and classroom participation in adolescents with learning disabilities : a social cognitive view

Students with learning disabilities (LD) often experience significant feelings of loneliness. There is some evidence to suggest that these feelings of loneliness may be related to social difficulties that are linked to their learning disability. Adolescents experience more loneliness than any other age group, primarily because this is a time of identity formation and self-evaluation. Therefore, adolescents with learning disabilities are highly likely to experience the negative feelings of loneliness. Many areas of educational research have highlighted the impact of negative feelings on learning. This begs the question, =are adolescents with learning disabilities doubly disadvantaged in regard to their learning?‘ That is, if their learning experience is already problematic, does loneliness exacerbate these learning difficulties? This thesis reveals the findings of a doctoral project which examined this complicated relationship between loneliness and classroom participation using a social cognitive framework. In this multiple case-study design, narratives were constructed using classroom observations and interviews which were conducted with 4 adolescent students (2 girls and 2 boys, from years 9-12) who were identified as likely to be experiencing learning disabilities. Discussion is provided on the method used to identify students with learning disabilities and the related controversy of using disability labels. A key aspect of the design was that it allowed the students to relate their school experiences and have their stories told. The design included an ethnographic element in its focus on the interactions of the students within the school as a culture and elements of narrative inquiry were used, particularly in reporting the results. The narratives revealed all participants experienced problematic social networks. Further, an alarmingly high level of bullying was discovered. Participants reported that when they were feeling rejected or were missing a valued other they had little cognitive energy for learning and did not want to be in school. Absenteeism amongst the group was high, but this was also true for the rest of the school population. A number of relationships emerged from the narratives using social cognitive theory. These relationships highlighted the impact of cognitive, behavioural and environmental factors in the school experience of lonely students with learning disabilities. This approach reflects the social model of disability that frames the research.

Multi-criteria ranking and receptor modelling of airborne fine particles at three sites in the Pearl River Delta region of China

The multi-criteria decision making methods, Preference METHods for Enrichment Evaluation (PROMETHEE) and Graphical Analysis for Interactive Assistance (GAIA), and the two-way Positive Matrix Factorization (PMF) receptor model were applied to airborne fine particle compositional data collected at three sites in Hong Kong during two monitoring campaigns held from November 2000 to October 2001 and November 2004 to October 2005. PROMETHEE/GAIA indicated that the three sites were worse during the later monitoring campaign, and that the order of the air quality at the sites during each campaign was: rural site > urban site > roadside site. The PMF analysis on the other hand, identified 6 common sources at all of the sites (diesel vehicle, fresh sea salt, secondary sulphate, soil, aged sea salt and oil combustion) which accounted for approximately 68.8 ± 8.7% of the fine particle mass at the sites. In addition, road dust, gasoline vehicle, biomass burning, secondary nitrate, and metal processing were identified at some of the sites. Secondary sulphate was found to be the highest contributor to the fine particle mass at the rural and urban sites with vehicle emission as a high contributor to the roadside site. The PMF results are broadly similar to those obtained in a previous analysis by PCA/APCS. However, the PMF analysis resolved more factors at each site than the PCA/APCS. In addition, the study demonstrated that combined results from multi-criteria decision making analysis and receptor modelling can provide more detailed information that can be used to formulate the scientific basis for mitigating air pollution in the region.

Changing perceptions of preservice teachers : innovations in middle schooling teacher education

For the past twenty years, the disengagement of early adolescents has been the focus of much of the literature related to middle schooling. In response, some universities in Australia have introduced teacher education programs that focus upon graduating specialised middle schooling teachers. The aim of this study was to explore and describe the 38 first-year preservice teachers’ perceptions of their first middle schooling elective unit and ascertain whether the combination of university classes and school-based experiences assisted their development of middle schooling concepts and approaches. Data were gathered using pre-test and post-test questionnaires combined with guided written reflections to record their views before, after and during the unit delivery. Results indicated that initially the preservice teachers had little understanding of middle schooling concepts and pedagogical practices, however, 11 participants recognised that bullying and peer pressure were issues experienced by early adolescents. The reflections, which were presented after their field experiences, focused on teaching, learning, behaviour management, and resources and infrastructure. More school-based experiences linked to theoretical underpinnings can help to facilitate understandings about students in the middle phase.

Changing perceptions of preservice teachers : innovations in middle schooling teacher education

For the past twenty years, the disengagement of early adolescents has been the focus of much of the literature related to middle schooling. In response, some universities in Australia have introduced teacher education programs that focus upon graduating specialised middle schooling teachers. Constructing such programs is at the centre of much debate and discussion, however, it is advocated that positive futures for early adolescents can be enhanced through quality middle schooling teacher education programs (Education Queensland, 2004). At a Queensland university campus, middle schooling elective units were introduced as part of the Bachelor of Education (primary) degree. The design of the units was to support preservice teachers to gain the theoretical and pedagogical knowledge to engage and promote early adolescent learning. An innovative approach to the delivery of the units was promoted by a partnership agreement between local schools and the campus. The partnership allowed preservice teachers to combine university classes with opportunities to visit exemplary classrooms to observe, participate and reflect upon middle school teaching practices. The aim of this study was to explore and describe the 38 first-year preservice teachers’ perceptions of their first middle schooling elective unit and to ascertain whether the combination of university classes and school-based experiences assisted their development of middle schooling concepts and approaches. Data were gathered using pre-test and post-test questionnaires combined with guided written reflections to record their views before, after and during the unit delivery. Results indicated that initially 34 preservice teachers had little understanding of middle schooling concepts and pedagogical practices, however, 11 participants recognised that bullying and peer pressure were issues experienced by early adolescents. The collation of the written reflections supported the combined delivery of the middle years unit further supporting the inclusion of school experiences with university delivered units.

A prospective pilot study evaluating the ‘cardiac decompensation score’ in the setting of intraaortic balloon counterpulsation

The study objective was to determine whether the ‘cardiac decompensation score’ could identify cardiac decompensation in a patient with existing cardiac compromise managed with intraaortic balloon counterpulsation (IABP). A one-group, posttest-only design was utilised to collect observations in 2003 from IABP recipients treated in the intensive care unit of a 450 bed Australian, government funded, public, cardiothoracic, tertiary referral hospital. Twenty-three consecutive IABP recipients were enrolled, four of whom died in ICU (17.4%). All non-survivors exhibited primarily rising scores over the observation period (p < 0.001) and had final scores of 25 or higher. In contrast, the maximum score obtained by a survivor at any time was 15. Regardless of survival, scores for the 23 participants were generally decreasing immediately following therapy escalation (p = 0.016). Further reflecting these changes in patient support, there was also a trend for scores to move from rising to falling at such treatment escalations (p = 0.024). This pilot study indicates the ‘cardiac decompensation score’ to accurately represent changes in heart function specific to an individual patient. Use of the score in conjunction with IABP may lead to earlier identification of changes occurring in a patient's cardiac function and thus facilitate improved IABP outcomes.

Creating Active Futures : Edited Proceedings of the 26th ACHPER International Conference

Physical inactivity has become a major cause of the global increase in non-communicable disease (World Health Organisation, 2009}. In 2008, the World Economic Forum called for employers to be proactive in the prevention of non-communicable diseases in the workforce. A significant contributor to the development of a healthy workforce is a reliable pool of employees who are receptive to and aware of healthy lifestyle practices even before becoming employed. Health and Physical Education (HPE) is often stereotyped as 'doing sport'. However, if HPE is to play a part in the development of a healthy workforce, then the HPE learning environment must be about creating meaningful learning for all, which is clearly more than the creation of elite athletes. The ultimate aim of health and physical educators must be about 1) developing lifelong and habitual physical activity; 2) developing generic physical skills; 3) inspiring holistic and positive emotional attitudes and 4) instilling a focus on evidence based knowledge as a framework for inspiring active citizenship. As a response to the worldwide move to the development of healthier people, Australia currently has a strong momentum for an expanded and more unified role for HPE within a potential National curriculum. Other countries have engaged in such a process and much can be learned from their experiences of the process. The 2009 Australian Council for Health, Physical Education and Recreation (ACHPER) conference was a landmark conference that included an International group of experts from all continents and twenty three countries. Creating Active Futures: Edited Proceedings of the 26th ACHPER International Conference is an amalgamation of research and professional perspectives presented at the conference. The papers in this volume emerged from those presented for peer review, rather than through seeking specific articles. This volume is divided into sections based on the five conference themes: 1) Issues in Health and Physical Education (HPE) Pedagogy; 2) Practical Application of Science in HPE; 3) Lifestyle Enhancement; 4) Developing Sporting Excellence; 5) Contemporary Games Teaching. The 'Issues in HPE Pedagogy' section provides a diverse set of perspectives on teaching HPE with papers from a range of topics that include first aid, philosophy, access, cultural characteristics, methods and teaching styles, curriculum, qualifications and emotional development. The second section links science to teaching HPE and provides a range of valuable information on injury prevention, information technology, personality and skill development. Section 3 is a collection of writings and research about Lifestyle Enhancement. Topics include the important role of adventure, the natural world, curriculum, migrant viewpoints, beliefs and globally focused programs in the development of active citizens. The section on sporting excellence contains papers that undertake to explain an aspect of excellence in sport. The last section of this volume highlights some contemporary views on teaching games.

QUT Digital Repository: Integrating the University’s IR with other digital collections

Queensland University of Technology’s Institutional Repository, QUT ePrints (http://eprints.qut.edu.au/), was established in 2003. With the help of an institutional mandate (endorsed in 2004) the repository now holds over 11,000 open access publications. The repository’s success is celebrated within the University and acknowledged nationally and internationally. QUT ePrints was built on GNU EPrints open source repository software (currently running v.3.1.3) and was originally configured to accommodate open access versions of the traditional range of research publications (journal articles, conference papers, books, book chapters and working papers). However, in 2009, the repository’s scope, content and systems were broadened and the ‘QUT Digital repository’ is now a service encompassing a range of digital collections, services and systems. For a work to be accepted in to the institutional repository, at least one of the authors/creators must have a current affiliation with QUT. However, the success of QUT ePrints in terms of its capacity to increase the visibility and accessibility of our researchers' scholarly works resulted in requests to accept digital collections of works which were out of scope. To address this need, a number of parallel digital collections have been developed. These collections include, OZcase, a collection of legal research materials and ‘The Sugar Industry Collection’; a digitsed collection of books and articles on sugar cane production and processing. Additionally, the Library has responded to requests from academics for a service to support the publication of new, and existing, peer reviewed open access journals. A project is currently underway to help a group of senior QUT academics publish a new international peer reviewed journal. The QUT Digital Repository website will be a portal for access to a range of resources to support copyright management. It is likely that it will provide an access point for the institution’s data repository. The data repository, provisionally named the ‘QUT Data Commons’, is currently a work-in-progress. The metadata for some QUT datasets will also be harvested by and discoverable via ‘Research Data Australia’, the dataset discovery service managed by the Australian National Data Service (ANDS). QUT Digital repository will integrate a range of technologies and services related to scholarly communication. This paper will discuss the development of the QUT Digital Repository, its strategic functions, the stakeholders involved and lessons learned.

Personalising teacher professional development : strategies enabling effective learning for educators of 21st century students

In the Knowledge Society, new demands are placed on teachers as they strive to empower young people to be global citizens, ready for the 21st century. Systemic shifts need to be made, however, to build capacity across the workforce to practise new ways of teaching and learning, including the personalisation of teacher professional development. This article argues new strategies and approaches for effective adult learning, including an individualised focus, context-based learning and an empowerment of teachers to develop their own personal learning networks. This article concludes with an analysis of the challenges facing professional development leaders in moving towards personalised teacher learning.

Strategies to engage engineering students in group project work

Project focused group work is significant in developing social and personal skills as well as extending the ability to identify, formulate and solve engineering problems. As a result of increasing undergraduate class sizes, along with the requirement for many students to work part-time, group projects, peer and collaborative learning are seen as a fundamental part of engineering education. Group formation, connection to learning objectives and fairness of assessment has been widely reported as major issues that leave students dissatisfied with group project based units. Several strategies were trialled including a study of formation of groups by different methods across two engineering disciplines over the past 2 years. Other strategies involved a more structured approach to assessment practices of civil and electrical engineering disciplines design units. A confidential online teamwork management tool was used to collect and collate student self and peer assessment ratings and used for both formative feedback as well as assessment purposes. Student satisfaction and overall academic results in these subjects have improved since the introduction of these interventions. Both student and staff feedback highlight this approach as enhancing student engagement and satisfaction, improved student understanding of group roles, reducing number of dysfunctional groups whilst requiring less commitment of academic resources.