Building the toolkit of quality monitoring clinical outcomes as a means of assessing quality in residential care

Residential aged care in Australia does not have a system of quality assessment related to clinical outcomes, creating a significant gap in quality monitoring. Clinical outcomes represent the results of all inputs into care, thus providing an indication of the success of those inputs. To fill this gap, an assessment tool based on resident outcomes (the ResCareQA) was developed and evaluated in collaboration with residential care providers. A useful output of the ResCareQA is a profile of resident clinical status, and this paper will use such outputs to present a snapshot of nine residential facilities. Such comprehensive data has not yet been available within Australia, so this will provide an important insight. ResCareQA data was collected from all residents (N=498) of nine aged care facilities from two major aged care providers. For each facility, numerator–denominator data were calculated to assess the degree of potential clinical problems. Results varied across clinical areas and across facilities, and rank-ordered facility results for selected clinical areas are reviewed and discussed. Use of the ResCareQA to generate clinical outcome data provides a concrete means of monitoring care quality within residential facilities; regular use of the ResCareQA could thus contribute to improved care outcomes within residential aged care.

An analysis of the determinants of job satisfaction when individuals' baseline satisfaction levels may differ.

A growing literature seeks to explain differences in individuals' self-reported satisfaction with their jobs. The evidence so far has mainly been based on cross-sectional data and when panel data have been used, individual unobserved heterogeneity has been modelled as an ordered probit model with random effects. This article makes use of longitudinal data for Denmark, taken from the waves 1995-1999 of the European Community Household Panel, and estimates fixed effects ordered logit models using the estimation methods proposed by Ferrer-i-Carbonel and Frijters (2004) and Das and van Soest (1999). For comparison and testing purposes a random effects ordered probit is also estimated. Estimations are carried out separately on the samples of men and women for individuals' overall satisfaction with the jobs they hold. We find that using the fixed effects approach (that clearly rejects the random effects specification), considerably reduces the number of key explanatory variables. The impact of central economic factors is the same as in previous studies, though. Moreover, the determinants of job satisfaction differ considerably between the genders, in particular once individual fixed effects are allowed for.

Violence, Spatiality and other Rurals

Occidentalism, which treats the other as the same, can be detected in both the criminological and rural sociological treatment of violence in the sociospatial sites of rural countrysides. Criminology tends to mistakenly assume that violence in the modern world is primarily an urban phenomenon (Baldwin & Bottoms, 1976, p. 1; Braithwaite, 1989, p. 47). If violence in rural settings is encountered it tends to be treated as a smaller scale version of the urban problem, or the importation of an otherwise urban problem - as the corrupting influence of the gesellschaft within the gemeinschaft. Within much rural sociology violence is rendered invisible by the assumption that rural communities conform to the idealised conception of the typical gemeinschaft society, small-scale traditional societies based on strong cohesiveness, intimacy and organic forms of solidarity. What these bonds conceal, rather than reveal - violence within the family - remains invisible to the public gaze. The visibility of violence within Aboriginal families and communities presents a major exception to the spatially ordered social relations which render so much white family violence hidden. The need to take into account the complexity and diversity of these sociospatial relations is concretely highlighted in our research which has taken us out of the urban context and confronted us not only with the phenomenon of the violence of other rurals, but also with fundamentally competing claims on, and conceptions of, space and place in the context of a racially divided Australian interior. This article represents the second installment of conceptual reflections on this research, with the first having been published in this journal in 1998.

Carbon nanotube synthesis from germanium nanoparticles on patterned substrates

Controlled synthesis of carbon nanotubes (CNTs) is highly desirable for nanoelectronic applications. To date, metallic catalyst particles have been deemed unavoidable for the nucleation and growth of any kind of CNTs. Ordered arrays of nanotubes have been obtained by controlled deposition of the metallic catalyst particles. However, the presence of metal species mixed with the CNTs represents a shortcoming for most electronic applications, as metal particles are incompatible with silicon semiconductor technology. In the present paper we report on a metal-catalyst-free synthesis of CNTs, obtained through Ge nanoparticles on a Si(001) surface patterned by nanoindentation. By using acetylene as the carbon feed gas in a low-pressure Chemical Vapor Deposition (CVD) system, multi-walled carbon nanotubes (MWNT) have been observed to arise from the smallest Ge islands. The CNTs and the Ge three-dimensional structures have been analysed by SEM, EDX and AFM in order to assess their elemental features and properties. EDX and SEM results allow confirmation of the absence of any metallic contamination on the surface, indicating that the origin of the CNT growth is due to the Ge nanocrystals.

Transition to school of diverse learners

This thesis examines the approaches taken by early years teachers in supporting the inclusive school transition of diverse learners. A Thesis by Publication format has been employed, where instead of traditional thesis chapters, scholarly journal articles are presented in an ordered sequence in two sections. The first set of journal articles establishes a synthesis of approaches to diversity and inclusion and to transition to school, in order to set a clear theoretical position arising from the literature. The second set of journal articles reports empirical evidence from three school sites on diversity, inclusion and transition to school, discussed in relation to both the first set of papers and to additional literature. The relationship between these articles, and the methodology used for the theoretical papers, is outlined in linking summaries of the challenges the papers seek to address.

Eucharistic rituals in Catholic primary schools in the Archdiocese of Brisbane : a study of administrators' conceptions

The focus of this study is the celebration of Eucharist in Catholic primary schools within the Archdiocese of Brisbane. The context of the contemporary Australian Catholic primary school embodies certain 'problematical realities' in relation to the time-honoured way in which school Eucharistic rituals have been celebrated. These contemporary realities raise a number of issues that impact on school celebrations of Eucharist. The purpose of this study is to explore administrators' differing conceptions of school Eucharistic rituals in an attempt to investigate some of these issues and assist members of individual school communities as they strive to make celebrations of Eucharist appropriate and meaningful for the group gathered. The phenomenographic research approach was adopted, as it is well suited to the purpose of this study and the nature of the research question. Phenomenography is essentially a study of variation. It attempts to map the 'whole' phenomenon under investigation by describing on equal terms all conceptions of the phenomenon and establishing an ordered relationship among them. The purpose of this study and the nature of the research question necessitate an approach that allows the identification and description of the different ways in which administrators' experience school Eucharistic rituals. Accordingly, phenomenography was selected. Members of the Administration Team, namely the principal, the APRE (Assistant to the Principal Religious Education) and, in larger primary schools, the AP A (Assistant to the Principal Administration) share responsibility for leading change in Catholic primary schools in the Archdiocese of Brisbane. In practice, however, principals delegate the role of leading the development of the school's religion program and providing leadership in the religious life of the school community to the APRE (Brisbane Catholic Education, 1997). Informants in this study are nineteen APREs from a variety of Catholic primary schools in the Archdiocese of Brisbane. These APREs come from schools across the archdiocese, rather than from within one particular region. Several significant findings resulted from this study. Firstly, the data show that there are significant differences in how APREs' experience school Eucharistic rituals, although the number of these qualitatively different conceptions is quite limited. The study identifies and describes six distinct yet related conceptions of school Eucharistic rituals. The logical relationship among these conceptions (the outcome space) is presented in the form of a diagram with accompanying explication. The variation among the conceptions is best understood and described in terms of three dimensions of the role of Eucharist in the Catholic primary school and is represented on the model of the outcome space. Individual transcripts suggest that individual APREs tend to emphasise some conceptions more than others. It is the contention of the present study that change in the practice of school Eucharistic rituals is unlikely to occur until all of a school community's conceptions are brought out into the open and articulated. As leaders of change, APREs need to be alerted to their own biases and become aware of alternative ways of conceiving school Eucharistic ritual. It is proposed that the different categories of description and dimensions, represented by the model of the outcome space, can be used to help in the process of articulating a school community's conceptions of Eucharist, with the APRE as facilitator of this process. As a result, the school community develops a better understanding of why their particular school does what it does in relation to school Eucharistic rituals.

Statistical and Econometric Methods for Transportation Data Analysis, 2nd edition

Now in its second edition, this book describes tools that are commonly used in transportation data analysis. The first part of the text provides statistical fundamentals while the second part presents continuous dependent variable models. With a focus on count and discrete dependent variable models, the third part features new chapters on mixed logit models, logistic regression, and ordered probability models. The last section provides additional coverage of Bayesian statistical modeling, including Bayesian inference and Markov chain Monte Carlo methods. Data sets are available online to use with the modeling techniques discussed.

The effects of cognitive ageing on the use of complex interfaces

This paper discusses an experiment investigating the effects of cognitive ageing and prior-experience with technology on using complex interfaces intuitively. Overall 37 participants, between the ages of 18 to 83, participated in this study. All participants were assessed for their cognitive abilities and prior-experience with technology. It was anticipated that the Central Executive function (a component of Working Memory) would emerge as one of the important cognitive functions in using complex interfaces. This was found to be the case with the strongest negative correlation occurring between sustained attention (one of the functions of the Central Executive), the time to complete the task and number of errors made by the participants.

Older adults, interface experience and cognitive decline

This paper describes an experiment undertaken to investigate intuitive interaction, particularly in older adults. Previous work has shown that intuitive interaction relies on past experience, and has also suggested that older people demonstrate less intuitive uses and slower times when completing set tasks with various devices. Similarly, this experiment showed that past experience with relevant products allowed people to use the interfaces of two different microwaves more quickly and intuitively. It also revealed that certain aspects of cognitive decline related to aging, such as central executive function, have more impact on time, correct uses and intuitive uses than chronological age. Implications of these results are discussed.

Clinical outcomes in residential care : setting benchmarks for quality

Aim Australian residential aged care does not have a system of quality assessment related to clinical outcomes, or comprehensive quality benchmarking. The Residential Care Quality Assessment was developed to fill this gap; and this paper discusses the process by which preliminary benchmarks representing high and low quality were developed for it. Methods Data were collected from all residents (n = 498) of nine facilities. Numerator–denominator analysis of clinical outcomes occurred at a facility-level, with rank-ordered results circulated to an expert panel. The panel identified threshold scores to indicate excellent and questionable care quality, and refined these through Delphi process. Results Clinical outcomes varied both within and between facilities; agreed thresholds for excellent and poor outcomes were finalised after three Delphi rounds. Conclusion Use of the Residential Care Quality Assessment provides a concrete means of monitoring care quality and allows benchmarking across facilities; its regular use could contribute to improved care outcomes within residential aged care in Australia.

Order and disorder in the structures of two crystal polymorphs of the adduct bis(quinolinium-2-carboxylate) DL-malic acid

The structures of two polymorphs of the anhydrous cocrystal adduct of bis(quinolinium-2-carboxylate) DL-malic acid, one triclinic the other monoclinic and disordered, have been determined at 200 K. Crystals of the triclinic polymorph 1 have space group P-1, with Z = 1 in a cell with dimensions a = 4.4854(4), b = 9.8914(7), c = 12.4670(8)Å, α = 79.671(5), β = 83.094(6), γ = 88.745(6)deg. Crystals of the monoclinic polymorph 2 have space group P21/c, with Z = 2 in a cell with dimensions a = 13.3640(4), b = 4.4237(12), c = 18.4182(5)Å, β = 100.782(3)deg. Both structures comprise centrosymmetric cyclic hydrogen-bonded quinolinic acid zwitterion dimers [graph set R2/2(10)] and 50% disordered malic acid molecules which lie across crystallographic inversion centres. However, the oxygen atoms of the malic acid carboxylic groups in 2 are 50% rotationally disordered whereas in 1 these are ordered. There are similar primary malic acid carboxyl O-H...quinaldic acid hydrogen-bonding chain interactions in each polymorph, extended into two-dimensional structures but in l this involves centrosymmetric cyclic head-to-head malic acid hydroxyl-carboxyl O-H...O interactions [graph set R2/2(10)] whereas in 2 the links are through single hydroxy-carboxyl hydrogen bonds.

Crossing boundaries to explore sustainable architecture by open system design

This paper argues a model of open system design for sustainable architecture, based on a thermodynamics framework of entropy as an evolutionary paradigm. The framework can be simplified to stating that an open system evolves in a non-linear pattern from a far-from-equilibrium state towards a non-equilibrium state of entropy balance, which is a highly ordered organization of the system when order comes out of chaos. This paper is work in progress on a PhD research project which aims to propose building information modelling for optimization and adaptation of buildings environmental performance as an alternative sustainable design program in architecture. It will be used for efficient distribution and consumption of energy and material resource in life-cycle buildings, with the active involvement of the end-users and the physical constraints of the natural environment.

Clinical indicators of quality for Australian residential aged care facilities : establishing reliability, validity, and quality thresholds

Background: In response to the need for more comprehensive quality assessment within Australian residential aged care facilities, the Clinical Care Indicator (CCI) Tool was developed to collect outcome data as a means of making inferences about quality. A national trial of its effectiveness and a Brisbane-based trial of its use within the quality improvement context determined the CCI Tool represented a potentially valuable addition to the Australian aged care system. This document describes the next phase in the CCI Tool.s development; the aims of which were to establish validity and reliability of the CCI Tool, and to develop quality indicator thresholds (benchmarks) for use in Australia. The CCI Tool is now known as the ResCareQA (Residential Care Quality Assessment). Methods: The study aims were achieved through a combination of quantitative data analysis, and expert panel consultations using modified Delphi process. The expert panel consisted of experienced aged care clinicians, managers, and academics; they were initially consulted to determine face and content validity of the ResCareQA, and later to develop thresholds of quality. To analyse its psychometric properties, ResCareQA forms were completed for all residents (N=498) of nine aged care facilities throughout Queensland. Kappa statistics were used to assess inter-rater and test-retest reliability, and Cronbach.s alpha coefficient calculated to determine internal consistency. For concurrent validity, equivalent items on the ResCareQA and the Resident Classification Scales (RCS) were compared using Spearman.s rank order correlations, while discriminative validity was assessed using known-groups technique, comparing ResCareQA results between groups with differing care needs, as well as between male and female residents. Rank-ordered facility results for each clinical care indicator (CCI) were circulated to the panel; upper and lower thresholds for each CCI were nominated by panel members and refined through a Delphi process. These thresholds indicate excellent care at one extreme and questionable care at the other. Results: Minor modifications were made to the assessment, and it was renamed the ResCareQA. Agreement on its content was reached after two Delphi rounds; the final version contains 24 questions across four domains, enabling generation of 36 CCIs. Both test-retest and inter-rater reliability were sound with median kappa values of 0.74 (test-retest) and 0.91 (inter-rater); internal consistency was not as strong, with a Chronbach.s alpha of 0.46. Because the ResCareQA does not provide a single combined score, comparisons for concurrent validity were made with the RCS on an item by item basis, with most resultant correlations being quite low. Discriminative validity analyses, however, revealed highly significant differences in total number of CCIs between high care and low care groups (t199=10.77, p=0.000), while the differences between male and female residents were not significant (t414=0.56, p=0.58). Clinical outcomes varied both within and between facilities; agreed upper and lower thresholds were finalised after three Delphi rounds. Conclusions: The ResCareQA provides a comprehensive, easily administered means of monitoring quality in residential aged care facilities that can be reliably used on multiple occasions. The relatively modest internal consistency score was likely due to the multi-factorial nature of quality, and the absence of an aggregate result for the assessment. Measurement of concurrent validity proved difficult in the absence of a gold standard, but the sound discriminative validity results suggest that the ResCareQA has acceptable validity and could be confidently used as an indication of care quality within Australian residential aged care facilities. The thresholds, while preliminary due to small sample size, enable users to make judgements about quality within and between facilities. Thus it is recommended the ResCareQA be adopted for wider use.

Workshop on HCI and game interfaces : a long romance

This full day workshop invites participants to consider the nexus where the interests of game design, the expectations of play and HCI meet: the game interface. Game interfaces seem different to the interface to other software and there have been a number of observations. Shneiderman famously noticed that while most software designers are intent on following the tenets of the “invisible computer” and making access easy for the user, games inter-faces are made for players: they embed challenge. Schell discusses a “strange” relationship between the player and the game enabled by the interface and user interface designers frequently opine that much can be learned from the design of game interfaces. So where does the game interface actually sit? Even more interesting is the question as to whether the history of the relationship and sub-sequent expectations are now limiting the potential of game design as an expressive form. Recent innovations in I/O design such as Nintendo’s Wii, Sony’s Move and Microsoft's Kinect seem to usher in an age of physical player-enabled interaction, experience and embodied, engaged design. This workshop intends to cast light on this often mentioned and sporadically examined area and to establish a platform for new and innovative design in the field.

Reliability analysis and economic equipment replacement appraisal for substation and sub-transmission systems with explicit inclusion of non-repairable failures

The modern society has come to expect the electrical energy on demand, while many of the facilities in power systems are aging beyond repair and maintenance. The risk of failure is increasing with the aging equipments and can pose serious consequences for continuity of electricity supply. As the equipments used in high voltage power networks are very expensive, economically it may not be feasible to purchase and store spares in a warehouse for extended periods of time. On the other hand, there is normally a significant time before receiving equipment once it is ordered. This situation has created a considerable interest in the evaluation and application of probability methods for aging plant and provisions of spares in bulk supply networks, and can be of particular importance for substations. Quantitative adequacy assessment of substation and sub-transmission power systems is generally done using a contingency enumeration approach which includes the evaluation of contingencies, classification of the contingencies based on selected failure criteria. The problem is very complex because of the need to include detailed modelling and operation of substation and sub-transmission equipment using network flow evaluation and to consider multiple levels of component failures. In this thesis a new model associated with aging equipment is developed to combine the standard tools of random failures, as well as specific model for aging failures. This technique is applied in this thesis to include and examine the impact of aging equipments on system reliability of bulk supply loads and consumers in distribution network for defined range of planning years. The power system risk indices depend on many factors such as the actual physical network configuration and operation, aging conditions of the equipment, and the relevant constraints. The impact and importance of equipment reliability on power system risk indices in a network with aging facilities contains valuable information for utilities to better understand network performance and the weak links in the system. In this thesis, algorithms are developed to measure the contribution of individual equipment to the power system risk indices, as part of the novel risk analysis tool. A new cost worth approach was developed in this thesis that can make an early decision in planning for replacement activities concerning non-repairable aging components, in order to maintain a system reliability performance which economically is acceptable. The concepts, techniques and procedures developed in this thesis are illustrated numerically using published test systems. It is believed that the methods and approaches presented, substantially improve the accuracy of risk predictions by explicit consideration of the effect of equipment entering a period of increased risk of a non-repairable failure.