Emergency Health Services (EHS) : demand and service delivery models. [Monograph 2 : Queensland EHS users’ profile]

Emergency health is a critical component of Australia’s health system and one which is increasingly congested from growing demand and blocked access to inpatient beds. The Emergency Health Services Queensland (EHSQ) study aims to identify the factors driving increased demand for emergency health and to evaluate strategies which may safely reduce the future demand growth. This monograph addresses the characteristics of users of emergency health services with an aim to identify those that appear to contribute to demand growth. This study utilises data on patients treated by Emergency Departments (ED) and Queensland Ambulance Service (QAS) across Queensland. ED data was derived from the Emergency Department Information System (EDIS) for the period 2001-02 through to 2010-11. Ambulance data was extracted from the QAS’ Ambulance Information Management System (AIMS) and electronic Ambulance Report Form (eARF) for the period 2001-02 through to 2009-10. Due to discrepancies and comparability issues for ED data, this monograph compares data from the 2003-04 time period with 2010-11 data for 21 of the reporting EDs. Also a snapshot of users for the 2010-11 financial year for 31 reporting EDs is used to describe the characteristics of users and to compare those characteristics with population demographics. For QAS data, the 2002-03 and 2009-10 time periods were selected for detailed analyses to identify trends. • Demand for emergency health care services is increasing, representing both increased population and increased relative utilisation. Per capita demand for ED attention has increased by 2% per annum over the last decade and for ambulance attention by 3.7% per annum. • The growth in ED demand is prominent in more urgent triage categories with actual decline in less urgent patients. An estimated 55% of patients attend hospital EDs outside of normal working hours. There is no evidence that patients presenting out of hours are significantly different to those presenting within working hours; they have similar triage assessments and outcomes. • Patients suffering from injuries and poisoning comprise 28% of the ED workload (an increase of 65% in the study period), whilst declines of 32% in cardiovascular and circulatory conditions, and musculoskeletal problems have been observed. • 25.6% of patients attending EDs are admitted to hospital. 19% of admitted patients and 7% of patients who die in the ED are triage category 4 or 5 on arrival. • The average age of ED patients is 35.6 years. Demand has grown in all age groups and amongst both men and women. Men have higher utilisation rates for ED in all age groups. The only group where the growth rate in women has exceeded men is in the 20-29 age group; this growth is particularly in the injury and poisoning categories. • Considerable attention has been paid publicly to ED performance criteria. It is worth noting that 50% of all patients were treated within 33 minutes of arrival. • Patients from lower socioeconomic areas appear to have higher utilisation rates and the utilisation rate for indigenous people appears to exceed those of European and other backgrounds. The utilisation rates for immigrant people is generally less than that of Australian born however it has not been possible to eliminate the confounding impact of different age and socioeconomic profiles. • Demand for ambulance service is also increasing at a rate that exceeds population growth. Utilisation rates have increased by an average of 5% per annum in Queensland compared to 3.6% nationally, and the utilisation rate in Queensland is 27% higher than the national average. • The growth in ambulance utilisation has also been amongst the more urgent categories of dispatch and utilisation rates are higher in rural and regional areas than in the metropolitan area. The demand for ambulance increases with age but the growth in demand for ambulance service has been more prominent in younger age groups. These findings contribute significantly to an understanding of the growth in demand for emergency health. It shows that the growth is amongst patients in genuine need of emergency healthcare and public rhetoric that the congestion of emergency health services is due to inappropriate attendees is unable to be substantiated. The consistency of the growth in demand over the last decade reflects not only the changing demographics of the Australian population but also the changes in health status, standards of acute health care and other social factors. The growth is also amongst patients with acute injury and poisoning which is inconsistent with rates of chronic disease as a fundamental driver. We have also interviewed patients in regard to their decision making choices for acute health care and the factors that influence these decisions and this will be the subject of a third Monograph and publications.

Shifting from asset dominant to service centric delivery systems: engaging users and communities

Research and practice has observed a shift toward service-oriented approaches that depend on input from users and community as co-producers of services. Yet, in delivering public infrastructure the focus is still on assets rather than services. The contribution of external stakeholders in the co-production of public services is still limited. Using the Policy Delphi with a panel of experts, we found that although practitioners understand the need for asset management to follow the service approach, guidelines and policies still lack that service-centric perspective. Findings revealed a range of obstacles to effective service delivery, related to the sub-optimal involvement of stakeholders’, asymmetric levels of power, the lack of accountability, transparency and availability of government, and the lack of genuine consultations between government and stakeholder groups. The paper concludes by offering directions and strategies for asset managers and policymakers to support and reconnect disengaged government-citizen relations for optimal service delivery outcomes in asset management.

Protocol engineering for protection against denial-of-service attacks

Denial-of-service attacks (DoS) and distributed denial-of-service attacks (DDoS) attempt to temporarily disrupt users or computer resources to cause service un- availability to legitimate users in the internetworking system. The most common type of DoS attack occurs when adversaries °ood a large amount of bogus data to interfere or disrupt the service on the server. The attack can be either a single-source attack, which originates at only one host, or a multi-source attack, in which multiple hosts coordinate to °ood a large number of packets to the server. Cryptographic mechanisms in authentication schemes are an example ap- proach to help the server to validate malicious tra±c. Since authentication in key establishment protocols requires the veri¯er to spend some resources before successfully detecting the bogus messages, adversaries might be able to exploit this °aw to mount an attack to overwhelm the server resources. The attacker is able to perform this kind of attack because many key establishment protocols incorporate strong authentication at the beginning phase before they can iden- tify the attacks. This is an example of DoS threats in most key establishment protocols because they have been implemented to support con¯dentiality and data integrity, but do not carefully consider other security objectives, such as availability. The main objective of this research is to design denial-of-service resistant mechanisms in key establishment protocols. In particular, we focus on the design of cryptographic protocols related to key establishment protocols that implement client puzzles to protect the server against resource exhaustion attacks. Another objective is to extend formal analysis techniques to include DoS- resistance. Basically, the formal analysis approach is used not only to analyse and verify the security of a cryptographic scheme carefully but also to help in the design stage of new protocols with a high level of security guarantee. In this research, we focus on an analysis technique of Meadows' cost-based framework, and we implement DoS-resistant model using Coloured Petri Nets. Meadows' cost-based framework is directly proposed to assess denial-of-service vulnerabil- ities in the cryptographic protocols using mathematical proof, while Coloured Petri Nets is used to model and verify the communication protocols using inter- active simulations. In addition, Coloured Petri Nets are able to help the protocol designer to clarify and reduce some inconsistency of the protocol speci¯cation. Therefore, the second objective of this research is to explore vulnerabilities in existing DoS-resistant protocols, as well as extend a formal analysis approach to our new framework for improving DoS-resistance and evaluating the performance of the new proposed mechanism. In summary, the speci¯c outcomes of this research include following results; 1. A taxonomy of denial-of-service resistant strategies and techniques used in key establishment protocols; 2. A critical analysis of existing DoS-resistant key exchange and key estab- lishment protocols; 3. An implementation of Meadows's cost-based framework using Coloured Petri Nets for modelling and evaluating DoS-resistant protocols; and 4. A development of new e±cient and practical DoS-resistant mechanisms to improve the resistance to denial-of-service attacks in key establishment protocols.

Effective web service discovery using a combination of a semantic model and a data mining technique

With the advent of Service Oriented Architecture, Web Services have gained tremendous popularity. Due to the availability of a large number of Web services, finding an appropriate Web service according to the requirement of the user is a challenge. This warrants the need to establish an effective and reliable process of Web service discovery. A considerable body of research has emerged to develop methods to improve the accuracy of Web service discovery to match the best service. The process of Web service discovery results in suggesting many individual services that partially fulfil the user’s interest. By considering the semantic relationships of words used in describing the services as well as the use of input and output parameters can lead to accurate Web service discovery. Appropriate linking of individual matched services should fully satisfy the requirements which the user is looking for. This research proposes to integrate a semantic model and a data mining technique to enhance the accuracy of Web service discovery. A novel three-phase Web service discovery methodology has been proposed. The first phase performs match-making to find semantically similar Web services for a user query. In order to perform semantic analysis on the content present in the Web service description language document, the support-based latent semantic kernel is constructed using an innovative concept of binning and merging on the large quantity of text documents covering diverse areas of domain of knowledge. The use of a generic latent semantic kernel constructed with a large number of terms helps to find the hidden meaning of the query terms which otherwise could not be found. Sometimes a single Web service is unable to fully satisfy the requirement of the user. In such cases, a composition of multiple inter-related Web services is presented to the user. The task of checking the possibility of linking multiple Web services is done in the second phase. Once the feasibility of linking Web services is checked, the objective is to provide the user with the best composition of Web services. In the link analysis phase, the Web services are modelled as nodes of a graph and an allpair shortest-path algorithm is applied to find the optimum path at the minimum cost for traversal. The third phase which is the system integration, integrates the results from the preceding two phases by using an original fusion algorithm in the fusion engine. Finally, the recommendation engine which is an integral part of the system integration phase makes the final recommendations including individual and composite Web services to the user. In order to evaluate the performance of the proposed method, extensive experimentation has been performed. Results of the proposed support-based semantic kernel method of Web service discovery are compared with the results of the standard keyword-based information-retrieval method and a clustering-based machine-learning method of Web service discovery. The proposed method outperforms both information-retrieval and machine-learning based methods. Experimental results and statistical analysis also show that the best Web services compositions are obtained by considering 10 to 15 Web services that are found in phase-I for linking. Empirical results also ascertain that the fusion engine boosts the accuracy of Web service discovery by combining the inputs from both the semantic analysis (phase-I) and the link analysis (phase-II) in a systematic fashion. Overall, the accuracy of Web service discovery with the proposed method shows a significant improvement over traditional discovery methods.

What value do users derive from social network applications?

Research on social networking sites like Facebook is emerging but sparse. This exploratory study investigates the value users derive from self-described ‘cool’ Facebook applications, and explores the features that either encourage or discourage users to recommend applications to their friends. The concepts of value and cool are explored in a social networking context. Our qualitative data reveals consumers derive a combination of functional value along with either social or emotional value from the applications. Female Facebook users indicate self-expression as important motivators, while males tend to use Facebook applications to socially compete. Three broad categories emerged for application features; symmetrical features can both encourage or discourage recommendation, polar features where different levels of the same feature encourage or discourage, and uni-directional features only encourage or discourage but not both. Recommending or not recommending an application tends to be the result of a combination of features and context, rather than one feature in isolation.

Views of general practitioners and benzodiazepine users on benzodiazepines : a qualitative analysis

Effectively assisting benzodiazepine users to cease use requires a greater understanding of general practitioners’ (GPs)and benzodiazepine users’ views on using and ceasing benzodiazepines. This paper reports the findings from a qualitative study that examined the views of 28 GPs and 23 benzodiazepine users (BUs) in Cairns, Australia. A semistructured interview was conducted with all participants and the information gained was analysed using the Consensual Qualitative Research Approach, which allowed comparisons to be made between the views of the two groups of interviewees. There was commonality between GPs and BUs on reasons for commencing benzodiazepines, the role of dependence in continued use, and the importance of lifestyle change in its cessation. However, several differences emerged regarding commencement of use and processes of cessation. In particular, users felt there was greater need for GPs to routinely advise patients about non-pharmacological management of their problems and potential adverse consequences of long-term use before commencing benzodiazepines. Cessation could be discussed with all patients who use benzodiazepines for longer than 3 months, strategies offered to assist in management of withdrawal and anxiety, and referral to other health service providers for additional support. Lifestyle change could receive greater focus at all stages of treatment.

Augmenting web service discovery by cognitive semantics and abduction

We argue that web service discovery technology should help the user navigate a complex problem space by providing suggestions for services which they may not be able to formulate themselves as (s)he lacks the epistemic resources to do so. Free text documents in service environments provide an untapped source of information for augmenting the epistemic state of the user and hence their ability to search effectively for services. A quantitative approach to semantic knowledge representation is adopted in the form of semantic space models computed from these free text documents. Knowledge of the user’s agenda is promoted by associational inferences computed from the semantic space. The inferences are suggestive and aim to promote human abductive reasoning to guide the user from fuzzy search goals into a better understanding of the problem space surrounding the given agenda. Experimental results are discussed based on a complex and realistic planning activity.

Evaluating the effect of a patient education brochure on patients’ expectations and satisfaction with emergency department service

Introduction: The purpose of this study was to assess the capacity of a written intervention, in this case a patient information brochure, to improve patient satisfaction during an Emergency Department (ED) visit. For the purpose of measuring the effect of the intervention the ED journey was conceptualised as a series of distinct areas of service comprising waiting time, service by the triage nurse, care from doctors and nurses and information giving Background of study: Research into patient satisfaction has become a widespread activity endorsed by both governments and hospital administrations. The literature on ED patient satisfaction has consistently indicated three primary areas of patient dissatisfaction: waiting time, nursing care and communication. Recent developments in the literature on patient satisfaction studies however have highlighted the relationship between patients. expectations of a service encounter and their consequent assessment of the experience as dissatisfying or satisfying. Disconfirmation theory posits that the degree to which expectations are confirmed will affect subsequent levels of satisfaction. The conceptual framework utilised in this study is Coye.s (2004) model of disconfirmation. Coye while reiterating satisfaction is a consequence of the degree expectations are either confirmed or disconfirmed also posits that expectations can be modified by interventions. Coye.s work conceptualises these interventions as intra encounter experiences (cues) which function to adjust expectations. Coye suggests some cues are unintended and may have a negative impact which also reinforces the value of planned cues intended to meet or exceed consumer expectations. Consequently the brochure can be characterized as a potentially positive cue, encouraging the patient to understand processes and to orient them in what can be a confronting environment. Only a limited number of studies have examined the effect of written interventions within an ED. No studies could be located which have tested the effect of ED interventions using a conceptual framework which relates the effect of the degree to which expectations are confirmed or disconfirmed in terms of satisfaction with services. Method: Two studies were conducted. Study One used qualitative methods to explore patients. expectations of the ED from the perspective of both patients and health care professionals. Study One was used in part to direct the development of the intervention (brochure) in Study Two. The brochure was an intervention designed to modify patients. expectations thus increasing their satisfaction with the provision of ED service. As there was no existing tools to measure ED patients. expectations and satisfaction a new tool was also developed based on the findings and the literature of Study One. Study Two used a non-randomised, quasi-experimental approach using a non-equivalent post-test only comparison group design used to investigate the effect of the patient education brochure (Stommel and Wills, 2004). The brochure was disseminated to one of two study groups (the intervention group). The effect of the brochure was assessed by comparing the data obtained from both the intervention and control group. These two groups consisted of 150 participants each. It was expected that any differences in the relevant domains selected for examination would indicate the effect of the brochure both on expectation and potentially satisfaction. Results: Study One revealed several areas of common ground between patients and nurses in terms of relevant content for the written intervention, including the need for information on the triage system and waiting times. Areas of difference were also found with patients emphasizing communication issues, whereas focus group members expressed concern that patients were often unable to assimilate verbal information. The findings suggested the potential utility of written material to reinforce verbal communication particularly in terms of the triage process and other ED protocols. This material was synthesized within the final version of the written intervention. Overall the results of Study Two indicated no significant differences between the two groups. The intervention group did indicate a significant number of participants who viewed the brochure of having changed their expectations. The effect of the brochure may have been obscured by a lack of parity between the two groups as the control group presented with statistically significantly higher levels of acuity and experienced significantly shorter waiting times. In terms of disconfirmation theory this would suggest expectations that had been met or exceeded. The results confirmed the correlation of expectations with satisfaction. Several domains also indicated age as a significant predictor with older patients tending to score higher satisfaction results. Other significant predictors of satisfaction established were waiting time and care from nurses, reinforcing the combination of efficient service and positive interpersonal experiences as being valued by patients. Conclusions: Information presented in written form appears to benefit a significant number of ED users in terms of orientation and explaining systems and procedures. The degree to which these effects may interact with other dimensions of satisfaction however is likely to be limited. Waiting time and interpersonal behaviours from staff also provide influential cues in determining satisfaction. Written material is likely to be one element in a series of coordinated strategies to improve patient satisfaction during periods of peak demand.

Cultural influences on IS service quality perceptions

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

Rethinking public service media and citizenship: digital strategies for news and current affairs at Australia’s Special Broadcasting Service

This article considers the concept of media citizenship in relation to the digital strategies of the Special Broadcasting Service (SBS). At SBS, Australia’s multicultural public broadcaster, there is a critical appraisal of its strategies to harness user-created content (UCC) and social media to promote greater audience participation through its news and current affairs Web sites. The article looks at the opportunities and challenges that user-created content presents for public service media organizations as they consolidate multiplatform service delivery. Also analyzed are the implications of radio and television broadcasters’ moves to develop online services. It is proposed that case study methodologies enable an understanding of media citizenship to be developed that maintains a focus on the interaction between delivery technologies, organizational structures and cultures, and program content that is essential for understanding the changing focus of 21st-century public service media.

Review of Apple iPad news applications : new media service

The launch of the Apple iPad on January 2010 has seen considerable interest from the newspaper and publishing industry in developing content and business models for the tablet PC device that can address the limits of both the print and online news and information media products. It is early days in the iPad’s evolution, and we wait to see what competitor devices will emerge in the near future. It is apparent, however, that it has become a significant “niche” product, with considerable potential for mass market expansion over the next few years, possibly at the expense of netbook sales. The scope for the iPad and tablet PCs to become a “fourth screen” for users, alongside the TV, PC and mobile phone, is in early stages of evolution. The study used five criteria to assess iPad apps: • Content: timeliness; archive; personalisation; content depth; advertisements; the use of multimedia; and the extent to which the content was in sync with the provider brand. • Useability: degree of static content; ability to control multimedia; file size; page clutter; resolution; signposts; and customisation. • Interactivity: hyperlinks; ability to contribute content or provide feedback to news items; depth of multimedia; search function; ability to use plug-ins and linking; ability to highlight, rate and/or save items; functions that may facilitate a community of users. • Transactions capabilities: ecommerce functionality; purchase and download process; user privacy and transaction security. • Openness: degree of linking to outside sources; reader contribution processes; anonymity measures; and application code ownership.

A spoofing detection method for civilian L1 GPS and the E1-B Galileo Safety of Life service

This paper describes an effective method for signal-authentication and spoofing detection for civilian GNSS receivers using the GPS L1 C/A and the Galileo E1-B Safety of Life service. The paper discusses various spoofing attack profiles and how the proposed method is able to detect these attacks. This method is relatively low-cost and can be suitable for numerous mass-market applications. This paper is the subject of a pending patent.

Semantics-based web service discovery using information retrieval techniques

This paper demonstrates an experimental study that examines the accuracy of various information retrieval techniques for Web service discovery. The main goal of this research is to evaluate algorithms for semantic web service discovery. The evaluation is comprehensively benchmarked using more than 1,700 real-world WSDL documents from INEX 2010 Web Service Discovery Track dataset. For automatic search, we successfully use Latent Semantic Analysis and BM25 to perform Web service discovery. Moreover, we provide linking analysis which automatically links possible atomic Web services to meet the complex requirements of users. Our fusion engine recommends a final result to users. Our experiments show that linking analysis can improve the overall performance of Web service discovery. We also find that keyword-based search can quickly return results but it has limitation of understanding users’ goals.

Cultural impact on e-service use in Saudi Arabia : results from focus groups

This paper reports the results of focus groups obtained as part of a full study that uses a mixed method approach to answer the following question: what are the cultural values that impact on e-service use in Saudi Arabia? In order to answer this question we reviewed culture theories, dimensions, and models that have been identified in the literature. Four focus groups interviewing experts and general users (customers) of online services in Saudi Arabia have been completed aiming at the end to identify the uncovered elements of Saudi culture in the literature, which hopefully will result in developing a framework of cultural values that affect e-service use in Saudi context. This paper will firstly, introduce the importance of culture and define the aspects of Saudi culture. It will then describe the method used, and finally discussing the findings of the focus groups. Findings revealed four factors that have not been covered in the literature and need to be investigated namely: nepotism, the lack of human interaction, services oriented culture, and the career path.