Non-Therapeutic Medication Omissions: Incidence and Predictors at an Australian Hospital

Background: The inconsistent definition of non-therapeutic medication omissions, under-reporting, and a poor understanding of their associated factors hamper efforts to improve medication administration practices. Aim: To examine the incidence of non-therapeutic medication omissions among acutely ill medical and surgical adult patients; and to identify the patient-, drug- and system-related predictors of these omissions. Method: A medication chart audit of 288 acutely ill adult medical and surgical patients admitted to 4 target wards (2 surgical and 2 medical) at an Australian hospital. Patients admitted to these wards from December 2008 to November 2009, with at least one regularly prescribed medication, were eligible. The sample was stratified according to gender, season and ward. A medication chart audit identified medication omissions, and data were collected on gender, age, length of stay, comorbidities, medication history and clinical pharmacy review. Results: Of the 288 medication charts audited, 220 (75%) had one or more medication omissions. Of the 15 020 medication administration episodes, there were 1687 omissions, resulting in an omission rate per medication administration episode of 11%. Analgesics and aperients were the most frequently omitted medications, with failure to sign the medication record and patient refusal, the main reasons for omission. Female gender (p < 0.001) and the number of medication administration episodes (p < 0.001) were statistically significant predictors of non-therapeutic medication omissions. Conclusion: The high incidence of medication omissions suggests there is need for an agreed definition of medication omission and its inclusion as a reportable incident. Increasing medication reconciliation via implementation of the Medication Management Plan may also reduce the opportunity for error. J Pharm Pract Res 2011; 41: 188-91.

Case study: Dragline swing to dump automation

Dragline Swing to Dump Automation By Peter Corke, CSIRO Manufacturing Technology/CRC for Mining Technology and Equipment (CMTE) Peter Corke presented a case study of a project to automate the dragline swing to dump operation. The project is funded by ACARP, BHP Coal, Pacific Coal and the CMTE and is being carried out on a dragline at Pacific Coal's Meandu mine near Brisbane. Corke began by highlighting that the minerals industry makes extensive use of large, mechanised machines. However, unlike other industries, mining has not adopted automation and most machines are controlled by human operators on board the machine itself. Choosing an automation target The dragline automation was chosen because: ò draglines are one of the biggest capital assets in a mine; ò performance between operators vary significantly, so improved capital utilisation is possible; ò the dragline is often the bottleneck in production; ò a large part of the operation cycle is spent swinging from dig to dump; and ò it is technically feasible. There has been a history of drag line automation projects, none with great success.

Dietary intake in Australian children aged 4–24 months: Consumption of meat and meat alternatives

Meat/meat alternatives (M/MA) are key sources of Fe, Zn and protein, but intake tends to be low in young children. Australian recommendations state that Fe-rich foods, including M/MA, should be the first complementary foods offered to infants. The present paper reports M/MA consumption of Australian infants and toddlers, compares intake with guidelines, and suggests strategies to enhance adherence to those guidelines. Mother–infant dyads recruited as part of the NOURISH and South Australian Infants Dietary Intake studies provided 3 d of intake data at three time points: Time 1 (T1) (n 482, mean age 5·5 (SD 1·1) months), Time 2 (T2) (n 600, mean age 14·0 (SD 1·2) months) and Time 3 (T3) (n 533, mean age 24 (SD 0·7) months). Of 170 infants consuming solids and aged greater than 6 months at T1, 50 (29 %) consumed beef, lamb, veal (BLV) or pork on at least one of 3 d. Commercial infant foods containing BLV or poultry were the most common form of M/MA consumed at T1, whilst by T2 BLV mixed dishes (including pasta bolognaise) became more popular and remained so at T3. The processed M/MA increased in popularity over time, led by pork (including ham). The present study shows that M/MA are not being eaten by Australian infants or toddlers regularly enough; or in adequate quantities to meet recommendations; and that the form in which these foods are eaten can lead to smaller M/MA serve sizes and greater Na intake. Parents should be encouraged to offer M/MA in a recognisable form, as one of the first complementary foods, in order to increase acceptance at a later age.

Corporate-cooperative management of fisheries: A potential alternative governance structure for low value small fisheries?

While the economic and environmental benefits of fisheries management are well accepted, the costs of effective management in low value fisheries, including the research necessary to underpin such management, may be considerable relative to the total economic benefits they may generate. Co-management is often seen as a panacea in low value fisheries. Increasing fisher participation increases legitimacy of management decision in the absence of detailed scientific input. However, where only a small number of operators exist, the potential benefits of co-management are negated by the high transaction cost to the individual fishers engaging in the management process. From an economic perspective, sole ownership has been identified as the management structure which can best achieve biological and economic sustainability. Moving low value fisheries with a small number of participants to a corporate-cooperative management model may come close to achieving these sole ownership benefits, with lower transaction costs. In this paper we look at the applicability of different management models with industry involvement to low value fisheries with a small number of participants. We provide an illustration as to how a fishery could be transitioned to a corporate-cooperative management model that captures the key benefits of sole management at a low cost and is consistent with societal objectives.

Fractional models in space for diffusive processes in heterogeneous media with applications in cell motility and electrical signal propagation

This work addresses fundamental issues in the mathematical modelling of the diffusive motion of particles in biological and physiological settings. New mathematical results are proved and implemented in computer models for the colonisation of the embryonic gut by neural cells and the propagation of electrical waves in the heart, offering new insights into the relationships between structure and function. In particular, the thesis focuses on the use of non-local differential operators of non-integer order to capture the main features of diffusion processes occurring in complex spatial structures characterised by high levels of heterogeneity.

A review on prognostic techniques for non-stationary and non-linear rotating systems

The field of prognostics has attracted significant interest from the research community in recent times. Prognostics enables the prediction of failures in machines resulting in benefits to plant operators such as shorter downtimes, higher operation reliability, reduced operations and maintenance cost, and more effective maintenance and logistics planning. Prognostic systems have been successfully deployed for the monitoring of relatively simple rotating machines. However, machines and associated systems today are increasingly complex. As such, there is an urgent need to develop prognostic techniques for such complex systems operating in the real world. This review paper focuses on prognostic techniques that can be applied to rotating machinery operating under non-linear and non-stationary conditions. The general concept of these techniques, the pros and cons of applying these methods, as well as their applications in the research field are discussed. Finally, the opportunities and challenges in implementing prognostic systems and developing effective techniques for monitoring machines operating under non-stationary and non-linear conditions are also discussed.

Fast unscented transformation-based transient stability margin estimation incorporating uncertainty of wind generation

Intermittent generation from wind farms leads to fluctuating power system operating conditions pushing the stability margin to its limits. The traditional way of determining the worst case generation dispatch for a system with several semi-scheduled wind generators yields a conservative solution. This paper proposes a fast estimation of the transient stability margin (TSM) incorporating the uncertainty of wind generation. First, the Kalman filter (KF) is used to provide linear estimation of system angle and then unscented transformation (UT) is used to estimate the distribution of the TSM. The proposed method is compared with the traditional Monte Carlo (MC) method and the effectiveness of the proposed approach is verified using Single Machine Infinite Bus (SMIB) and IEEE 14 generator Australian dynamic system. This method will aid grid operators to perform fast online calculations to estimate TSM distribution of a power system with high levels of intermittent wind generation.

ACE research briefing paper 008 : How to Design and Manage Successful Joint Ventures in the Exploration Space

Joint ventures are formed and dissolved regularly in the mining industry. What impact do such changes have on the viability of mineral exploration projects? The Australian Centre for Entrepreneurship Research (ACE) has taken 9 years' worth of data (2002-2011) on 1,025 joint ventures in the Australasian mining industry and studied trends in fomentation, dissolution, and reconfiguration and how they impact project outcomes. This research is generously sponsored by the Queensland Exploration Council (QEC) and the Australian Research Council (ARC).

Systems-based approach to investigate unsafe pedestrian behaviour at level crossings

Crashes at level crossings are a major issue worldwide. In Australia, as well as in other countries, the number of crashes with vehicles has declined in the past years, while the number of crashes involving pedestrians seems to have remained unchanged. A systematic review of research related to pedestrian behaviour highlighted a number of important scientific gaps in current knowledge. The complexity of such intersections imposes particular constraints to the understanding of pedestrians’ crossing behaviour. A new systems-based framework, called Pedestrian Unsafe Level Crossing framework (PULC) was developed. The PULC organises contributing factors to crossing behaviour on different system levels as per the hierarchical classification of Jens Rasmussen’s Framework for Risk Management. In addition, the framework adapts James Reason’s classification to distinguish between different types of unsafe behaviour. The framework was developed as a tool for collection of generalizable data that could be used to predict current or future system failures or to identify aspects of the system that require further safety improvement. To give it an initial support, the PULC was applied to the analysis of qualitative data from focus groups discussions. A total number of 12 pedestrians who regularly crossed the same level crossing were asked about their daily experience and their observations of others’ behaviour which allowed the extraction and classification of factors associated with errors and violations. Two case studies using Rasmussen’s AcciMap technique are presented as an example of potential application of the framework. A discussion on the identified multiple risk contributing factors and their interactions is provided, in light of the benefits of applying a systems approach to the understanding of the origins of individual’s behaviour. Potential actions towards safety improvement are discussed.

Understanding the effects of complex seasonality on suburban daily transit ridership

Fluctuations in transit ridership pattern over the year have always concerned transport planners, operators and researchers. Predominantly, metrological elements have been specified to explain variability in ridership volume. However, the outcome of this research points to new direction to explain ridership fluctuation in Brisbane. It explored the relationship between daily bus ridership, seasonality and weather variables for a one-year period, 2012. Rather than segregating the entire year’s ridership into the four calendar seasons (summer, autumn, spring, and winter), this analysis distributed the yearly ridership into nine complex seasonality blocks. These represent calendar season, school/university (academic) period and their corresponding holidays, as well as other observant holidays such as Christmas. The dominance of complex seasonality over typical calendar season was established through analysis and using Multiple Linear Regression (MLR). This research identified a very strong association between complex seasonality and bus ridership. Furthermore, an expectation that Brisbane’s subtropical summer is unfavourable to transit usage was not supported by the findings of this study. A nil association of precipitation and temperature was observed in this region. Finally, this research developed a ridership estimation model, capable of predicting daily ridership within very limited error range. Following the application of this developed model, the estimated annual time series data of each suburb was analysed using Fourier Transformation to appreciate whether any cyclical effects remained, compared with the original data.

Design of a tablet sized human-computer interface and its effect on situation awareness

Emergency Response Teams increasingly use interactive technology to help manage information and communications. The challenge is to maintain a high situation awareness for different interactive devices sizes. This research specifically compared a handheld interactive device in the form of an iPad with a large interactive multi-touch tabletop. A search and rescue inspired simulator was designed to test operator situation awareness for the two sized devices. The results show that operators had better situation awareness on the tabletop device when the operation related to detecting of moving targets, searching target locations, distinguishing target types, and comprehending displayed information.

DoGood : A gamified mobile app to promote civic engagement

The rise of the mobile Internet enables the creation of applications that provide new and easier ways for people to organise themselves, raise issues, take action and interact with their city. However, a lack of motivation or knowledge often prevents many citizens from regularly contributing to the common good. Therefore, this thesis presents DoGood, a smartphone app, that aims at motivating citizens to carry out civic activities. The thesis asks what kinds of activities citizens consider to be civic and to what extent gamification can motivate users in this context. The DoGood app uses gamified elements to encourage citizens to submit and promote their civic activities as well as to join the activities of others. Gamification is sometimes criticized for simply adding a limited number of game elements, such as leaderboards, on top of an existing experience. However, in the case of the DoGood app, the process of game design was an integral part of the development, and the gamified elements target the user’s intrinsic motivations instead of providing them with an external reward. DoGood was implemented as hybrid mobile app and deployed to citizens of Brisbane in a five weeks long user study. The app successfully motivated most of its users to do more civic activities and its gamified elements were well received. Based on the results of the user study, civic activities can be defined as activities that give citizens the opportunity to become involved and improve life in their local community.

Gamifying collective intelligence for the common good

The rise of the mobile internet enables the creation of applications that provide new and easier ways for people to organise themselves, raise issues, take action and interact with their city. At the same time, society faces new problems that can only be solved when citizens work together. Nevertheless, a lack of motivation or knowledge often prevents many citizens from regularly contributing to the common good. In this position paper, we present DoGood – a mobile app – as a socio-technological system that aims at supporting the collective intelligence of citizens in their pursuit of civic engagement and civic collaboratories. Our study asks to what extent gamification can motivate users to “do good” deeds. The DoGood app uses gamified elements to encourage citizens to submit and promote their civic activities as well as to join the activities of others. Gamification is sometimes criticised for simply adding a limited number of game elements, such as leaderboards, on top of an existing experience with the hope of increasing motivation. However, in the case of the DoGood app, the process of game design was an integral part of the development, and the gamified elements target the user’s intrinsic motivations instead of providing them with an external reward. In this paper, we present design elements of the app and discuss their potential to support collective intelligence for the common good.

Regulating ride-sharing in the peer economy

The rise of the peer economy poses complex new regulatory challenges for policy-makers. The peer economy, typified by services like Uber and AirBnB, promises substantial productivity gains through the more efficient use of existing resources and a marked reduction in regulatory overheads. These services are rapidly disrupting existing established markets, but the regulatory trade-offs they present are difficult to evaluate. In this paper, we examine the peer economy through the context of ride-sharing and the ongoing struggle over regulatory legitimacy between the taxi industry and new entrants Uber and Lyft. We first sketch the outlines of ride-sharing as a complex regulatory problem, showing how questions of efficiency are necessarily bound up in questions about levels of service, controls over pricing, and different approaches to setting, upholding, and enforcing standards. We outline the need for data-driven policy to understand the way that algorithmic systems work and what effects these might have in the medium to long term on measures of service quality, safety, labour relations, and equality. Finally, we discuss how the competition for legitimacy is not primarily being fought on utilitarian grounds, but is instead carried out within the context of a heated ideological battle between different conceptions of the role of the state and private firms as regulators. We ultimately argue that the key to understanding these regulatory challenges is to develop better conceptual models of the governance of complex systems by private actors and the available methods the state has of influencing their actions. These struggles are not, as is often thought, struggles between regulated and unregulated systems. The key to understanding these regulatory challenges is to better understand the important regulatory work carried out by powerful, centralised private firms – both the incumbents of existing markets and the disruptive network operators in the peer-economy.

Regulating ride-sharing in the peer economy

The rise of the peer economy poses complex new regulatory challenges for policy-makers. The peer economy, typified by services like Uber and AirBnB, promises substantial productivity gains through the more efficient use of existing resources and a marked reduction in regulatory overheads. These services are rapidly disrupting existing established markets, but the regulatory trade-offs they present are difficult to evaluate. In this paper, we examine the peer economy through the context of ride-sharing and the ongoing struggle over regulatory legitimacy between the taxi industry and new entrants Uber and Lyft. We first sketch the outlines of ride-sharing as a complex regulatory problem, showing how questions of efficiency are necessarily bound up in questions about levels of service, controls over pricing, and different approaches to setting, upholding, and enforcing standards. We outline the need for data-driven policy to understand the way that algorithmic systems work and what effects these might have in the medium to long term on measures of service quality, safety, labour relations, and equality. Finally, we discuss how the competition for legitimacy is not primarily being fought on utilitarian grounds, but is instead carried out within the context of a heated ideological battle between different conceptions of the role of the state and private firms as regulators. We ultimately argue that the key to understanding these regulatory challenges is to develop better conceptual models of the governance of complex systems by private actors and the available methods the state has of influencing their actions. These struggles are not, as is often thought, struggles between regulated and unregulated systems. The key to understanding these regulatory challenges is to better understand the important regulatory work carried out by powerful, centralised private firms – both the incumbents of existing markets and the disruptive network operators in the peer-economy.