Impact of opening a new emergency department on healthcare service and patient outcomes : analyses based on linking ambulance, emergency and hospital databases

Background Emergency department (ED) crowding caused by access block is an increasing public health issue and has been associated with impaired healthcare delivery, negative patient outcomes and increased staff workload. Aim To investigate the impact of opening a new ED on patient and healthcare service outcomes. Methods A 24-month time series analysis was employed using deterministically linked data from the ambulance service and three ED and hospital admission databases in Queensland, Australia. Results Total volume of ED presentations increased 18%, while local population growth increased by 3%. Healthcare service and patient outcomes at the two pre-existing hospitals did not improve. These outcomes included ambulance offload time: (Hospital A PRE: 10 min, POST: 10 min, P < 0.001; Hospital B PRE: 10 min, POST: 15 min, P < 0.001); ED length of stay: (Hospital A PRE: 242 min, POST: 246 min, P < 0.001; Hospital B PRE: 182 min, POST: 210 min, P < 0.001); and access block: (Hospital A PRE: 41%, POST: 46%, P < 0.001; Hospital B PRE: 23%, POST: 40%, P < 0.001). Time series modelling indicated that the effect was worst at the hospital furthest away from the new ED. Conclusions An additional ED within the region saw an increase in the total volume of presentations at a rate far greater than local population growth, suggesting it either provided an unmet need or a shifting of activity from one sector to another. Future studies should examine patient decision making regarding reasons for presenting to a new or pre-existing ED. There is an inherent need to take a ‘whole of health service area’ approach to solve crowding issues.

Origins of Australian Football: Victoria's Early History. Volume 1 Amateur Heroes and the Rise of the Clubs, 1858 to 1876

This is volume 1 in a series of four volumes about the origins of Australian football as it evolved in Victoria between 1858 and 1896. This volume addresses its very beginnings as an amateur sport and the rise of the first clubs. Invented by a group of Melbourne cricketers and sports enthusiasts, Australian Rules football was developed through games played on Melbourne's park lands and was originally known as "Melbourne Football Club Rules". This formative period of the game saw the birth of the first 'amateur heroes' of the game. Players such as T.W. Wills, H.C.A. Harrison, Jack Conway, George O'Mullane and Robert Murray Smith emerged as warriors engaged in individual rugby-type scrimmages. The introduction of Challenge Cups was an important spur for this burgeoning sport. Intense competition and growing rivalries between clubs such as Melbourne, South Yarra, Royal Park, and Geelong began to flourish and the game developed as a result. By the 1870s the game "Victorian Rules" had become the most popular outdoor winter sport across the state. In subsequent decades, rapid growth in club football occurred and the game attracted increasing media attention.

Introduction : creative industries and cities

The 2000s were marked by a resurgence of interest in creativity and cities. If the rapid global proliferation of the Internet and digital media technologies in the 1990s had set off enthusiasm for a post-industrial ‘new economy’, where the significance of location would be in decline, the 2000s saw an energetic search by artists, entrepreneurs, investors, policy-makers, journalists and many others to uncover the well-springs of creativity and its relationship to place (Flew 2012a). This chapter begins with a discussion of the discourses or ‘scripts’ that have emerged to try and conceptualise the relationship between creativity and cities, notably theories of creative clusters, creative cities and creative class theories. Such work can be seen as representing a growth in the field of cultural economic geography although – as is noted in the chapter – it possesses some significant gaps. Among the issues that are drawn out in this book, and discussed in this chapter, are: the need to move beyond ‘imagined geographies’ of creative inner cities and come to terms with empirical evidence that suggests significant concentrations of the creative workforce in suburbs and regional cities; the relevance of urban cultural policy as a variable in the rise of cities as creative hubs or, in a different model, media capitals; and the challenges of bringing together cultural research with economic discourses in ways that get beyond caricatured representations of the ‘other’, as found, for instance, in some of the most influential framings of the concept of neo-liberalism.

A review of the pharmacobiotic regulation of gastrointestinal inflammation by probiotics, commensal bacteria and prebiotics.

The idea that microbes induce disease has steered medical research toward the discovery of antibacterial products for the prevention and treatment of microbial infections. The twentieth century saw increasing dependency on antimicrobials as mainline therapy accentuating the notion that bacterial interactions with humans were to be avoided or desirably controlled. The last two decades, though, have seen a refocusing of thinking and research effort directed towards elucidating the critical inter-relationships between the gut microbiome and its host that control health/wellness or disease. This research has redefined the interactions between gut microbes and vertebrates, now recognizing that the microbial active cohort and its mammalian host have shared co-evolutionary metabolic interactions that span millennia. Microbial interactions in the gastrointestinal tract provide the necessary cues for the development of regulated pro- and anti-inflammatory signals that promotes immunological tolerance, metabolic regulation and other factors which may then control local and extra-intestinal inflammation. Pharmacobiotics, using nutritional and functional food additives to regulate the gut microbiome, will be an exciting growth area of therapeutics, developing alongside an increased scientific understanding of gut-microbiome symbiosis in health and disease.

Teaching about trafficking : opportunities and challenges for critical engagement

When I was first invited to teach a women's studies course called Sex Trafficking in 2002, most of my students had never heard of the issue. Internet and literature searches for "trafficking" mostly turned up references to trafficking in drugs and weapons, not people. When I revised the course for a topical capstone in Criminology, Justice, and Policy Studies in 2006, all of my students had heard about human trafficking, and a handful had already studied it in other classes. The availability of books, films, scholarly articles, and advocacy pieces had all increased exponentially since I first became engaged in the field. This bounty provided a wealth of resources for teaching but also presented a greater challenge when it came to deciding which texts to include. It also added to the inevitable pedagogical angst over what to leave out. I came to know about trafficking by accident, when I was hired as a research assistant at The Protection Project (TPP) in 1999. In my time at TPP I authored a literature review on human trafficking. At that time, my comprehensive database of sources contained fewer than one hundred books and articles, a few UN documents, a handful of films, and some websites from nongovernmental organizations. My review of the literature inevitably reflected the ideological chasm between those who saw trafficking as primarily a labor, migration, and rights issue and those who saw it as primarily a sexual exploitation issue. On the policy end, these ideological orientations created bizarre bedfellows of individuals and organizations that otherwise would have been at odds. The ideological divide has not diminished in the intervening years, and it is important to be aware of and to negotiate this in designing a course on trafficking. As a feminist teacher, I was very aware of the divisions among feminists on the subject of trafficking, and was interested in communicating these differences to students who were not well versed in the varieties of feminist thought. I was also mindful of the difficulties my American students had in engaging with some of the course texts and issues the first time around. For some students, moral judgments about prostitutes were as far as they were able to go in engaging with the course. These students could not find a way in to think about the many issues involved in trafficking. How could I reach them? In this article, I share some of my texts and tactics with others who might find themselves in a position to teach about human trafficking. I include my case for why feminist teachers should teach trafficking, an overview of the debate that divides the field, my rationale for organizing the course the way that I did, issues to consider when designing a course on trafficking, and some suggested readings, films, and web resources.

Media education, collaboration and industry : a case study of what a group of year 10 and 11 students value in a community of practice

This case study incorporated an analysis of a group of young people as media producers and placed young people’s perspectives of their media education learning at the core of the analysis. Communities of practice social learning theory provided an effective conceptual framework for investigating the nature of the participants’ involvement in a secondary school and creative industry partnership. The analysis of the data in this study indicated that the participants valued their learning by imagining, actively participating and belonging to a media education community of practice. By enabling young people to work directly with creative industries this school and industry partnership provided students with what they saw as valuable first-hand experience of professional expertise, that contributed to students’ understanding of their own and others’ identities.

News media representations of homelessness : do economic news production pressures prevent journalists from adequately reporting complex social issues

This study used both content and frame analyses to test news-media representations of homelessness in The Courier-Mail newspaper for evidence of restricted journalism practice. Specifically, it sought signs of either direct manipulation of issue representation based on ideological grounds, and also evidence of news organisations prioritising low-cost news production over Public Sphere journalistic news values. The study found that news stories from the earlier parts of the longitudinal study showed stereotypical misrepresentations of homelessness for public deliberation which might be attributed to either, or both of the nominated restricting factors. However news stories from the latter part of the study saw a distinct change in the way the issue was represented, indicating a journalistic capacity to thoughtfully and sensitively represent a complex social issue to the public. Further study is recommended to ascertain how and why this change occurred, so that journalistic practice might be further improved.

‘I always look under the bed for a man’. Needs and barriers to the expression of sexuality in residential aged care: the views of residents with and without dementia

Objectives: This qualitative study canvassed residents' perceptions of the needs and barriers to the expression of sexuality in long-term care. Methods: Sixteen residents, including five with dementia, from six aged care facilities in two Australian states were interviewed. Data were analysed using a constant comparative method. Results: Four categories describe residents' views about sexuality, their needs and barriers to its expression: ‘It still matters’; ‘Reminiscence and resignation’, ‘It's personal’, and ‘It's an unconducive environment’. Discussion: Residents, including those with dementia, saw themselves as sexual beings and with a continuing need and desire to express their sexuality. The manner in which it was expressed varied. Many barriers to sexual expression were noted, including negative attitudes of staff, lack of privacy and limited opportunities for the establishment of new relationships or the continuation of old ones. Interviewees agreed that how a resident expressed their sexuality was their business and no one else's.

At times of crisis, Twitter shines brightest

By any measure, 2011 was a year marked by disasters. In Australia, it began with major flooding which saw vast portions of the state of Queensland, including Brisbane and surrounding areas, under water. A significant earthquake caused massive destruction and serious loss of life in Christchurch, New Zealand. And a 9.0 quake off the Sendai coast caused an unprecedented tsunami in Japan and led to the Fukushima meltdown. All this before the end of March; later months would see a range of human-made crises from the Arab Spring to the London riots.

Importance of a resilient air services network to Australian remote, rural, and regional communities

Rural, regional, and remote settlements in Australia require resilient infrastructure to remain sustainable in a context characterized by frequent large-scale natural disasters, long distances between urban centers, and the pressures of economic change. A critical aspect of this infrastructure is the air services network, a system of airports, aircraft operators, and related industries that enables the high-speed movement of people, goods, and services to remote locations. A process of deregulation during the 1970s and 1980s resulted in many of these airports passing into local government and private ownership, and the rationalization of the industry saw the closure of a number of airlines and airports. This paper examines the impacts of deregulation on the resilience of air services and the contribution that they make to regional and rural communities. In particular, the robustness, redundancy, resourcefulness, and rapidity of the system are examined. The conclusion is that while the air services network has remained resilient in a situation of considerable change, the pressures of commercialization and the tendency to manage aspects of the system in isolation have contributed to a potential decrease in overall resilience.

Does the social inclusion discourse add value?

The election of a national Labor Government in 2007 saw ‘social inclusion’ emerge as Australia’s overarching social policy agenda. Being ‘included’ has since been defined as being able to ‘have the resources, opportunities and capabilities needed to learn, work, engage and have a voice’. Various researchers have adopted the social inclusion concept to construct a multi-dimensional framework for measuring disadvantage, beyond poverty alleviation. This research program has enabled various forms of statistical modelling based on some agreement about what it means to be ‘included’ in society. At the same time it is acknowledged that social inclusion remains open and contestable and can be used in the name of both progressive and more punitive programs and policies. This ambiguity raises questions about whether the social inclusion framework, as it is presently defined, has the potential to be a progressive and transformative discourse. In this paper we examine whether the Australian social inclusion agenda has the capacity to address social inequality in a meaningful way, concluding with a discussion about the need to understand social inequality and social disadvantage in relational terms.

Design and delivery of a distance education programme : educating Vietnamese nurse academics from Australia

In 2008 a move away from medical staff providing nursing education in Vietnam saw the employment of many new nurse academics. To assist in the instruction of these novice academics and provide them with sound teaching and learning practice as well as curriculum design and implementation skills, Queensland University of Technology (QUT) successfully tendered an international grant. One of QUT’s initiatives in educating the Vietnamese academics was a distance learning programme. Developed specifically for Vietnamese nurse academics, the programme was designed for Australian based delivery to academics in Vietnam. This paper will present an overview of why four separate modules were utilised for the delivery of content (modules were delivered at a rate of one per semester). It will address bilingual online discussion boards which were used in each of the modules and the process of moderating these given comments were posted in both Vietnamese and English. It will describe how content was scaffolded across four modules and how the modules themselves modelled new teaching delivery strategies. Lastly, it will discuss the considerations of programme delivery given the logistics of an Australian based delivery. Feedback from the Vietnamese nurse academics across their involvement in the programme (and at the conclusion of their fourth and final module) has been overwhelmingly positive. Feedback suggests the programme has altered teaching and assessment approaches used by some Vietnamese nurse academics. Additionally, Vietnamese nurse academics are reporting that they are engaging more with the application of their content indicating a cultural shift in the approach taken in Vietnamese nurse education.

Electoral behaviour in the 2010 Australian federal election

All elections are unique, but the Australian federal election of 2010 was unusual for many reasons. It came in the wake of the unprecedented ousting of the Prime Minister who had led the Australian Labor Party to a landslide victory, after eleven years in opposition, at the previous election in 2007. In a move that to many would have been unthinkable, Kevin Rudd’s increasing unpopularity within his own parliamentary party finally took its toll and in late June he was replaced by his deputy, Julia Gillard. Thus the second unusual feature of the election was that it was contested by Australia’s first female prime minister. The third unusual feature was that the election almost saw a first-term government, with a comfortable majority, defeated. Instead it resulted in a hung parliament, for the first time since 1940, and Labor scraped back into power as a minority government, supported by three independents and the first member of the Australian Greens ever to be elected to the House of Representatives. The Coalition Liberal and National opposition parties themselves had a leader of only eight months standing, Tony Abbott, whose ascension to the position had surprised more than a few. This was the context for an investigation of voting behaviour in the 2010 election....

Were intercalated komatiites and dacites at the Black Swan nickel sulphide mine, Yilgarn Craton, Western Australia, emplaced as extrusive lavas or intrusive bodies? The significance of breccia textures and contact relationships

Intercalated Archean komatiites and dacites sit above a thick footwall dacite unit in the host rock succession at the Black Swan Nickel Mine, north of Kalgoorlie in the Yilgarn Craton, Western Australia. Both lithofacies occur in units that vary in scale from laterally extensive at the scale of the mine lease to localized, thin, irregular bodies, from > 100 m thick to only centimetres thick. Some dacites are only slightly altered and deformed, and are interpreted to post-date major deformation and alteration (late porphyries). However, the majority of the dacites display evidence of deformation, especially at contacts, and metamorphism, varying from silicification and chlorite alteration at contacts to pervasive low grade regional metamorphic alteration represented by common assemblages of chlorite, sericite and albite. Texturally, the dacites vary from entirely massive and coherent to partially brecciated to totally brecciated. Strangely, some dacites are coherent at the margins and brecciated internally. Breccia textures vary from cryptically defined, to blocky, closely packed, in situ jig-saw fit textures with secondary minerals in fractures between clasts, to more apparent matrix rich textures with round clast forms, giving apparent conglomerate textures. Some clast zones have multi-coloured clasts, giving the impression of varied provenance. Strangely however, all these textural variants have gradational relationships with each other, and no bedding or depositional structures are present. This indicates that all textures have an in situ origin. The komatiites are generally altered and pervasively carbonate veined. Preservation of original textures is patchy and local, but includes coarse adcumulate, mesocumulate, orthocumulate, crescumulate-harrisite and occasionally spinifex textures. Where original contacts between komatiites and dacites are preserved intact (i.e. not sheared or overprinted by alteration), the komatiites have chilled margins, whereas the dacites do not. The margins of the dacites are commonly silicified, and inclusions of dacite occur in komatiite, even at the top contacts of komatiite units, but komatiite clasts do not occur in the dacites. The komatiites therefore were emplaced as sills into the dacites, and the intercalated relationships are interpreted as intrusive. The brecciation and alteration in the dacites are interpreted as being largely due to hydraulic fracturing and alteration induced by contact metamorphic effects and hydrothermal alteration deriving from the intrusion of komatiites into the felsic pile. The absence of autobreccia and hyaloclastite textures in the dacites suggest that they were emplaced as an earlier intrusive (sill?) complex at a high level in the crust.

Thai family support (TFS) : working with families of young substance users in primary health care

Living with substance users negatively impacts upon family members in many ways, and distress is common. Despite these deep and wide-ranging impacts, supportive interventions for family members in their own right are rarely available. Thailand has substantial and growing problems with substance use, and there is very little support or family members of drug users, especially in community setting. The Thai Family Support (TFS) program was designed for implementation in primary health care units (PCUs) in Thailand. TFS was based on two approaches with existing empirical support in Western contexts—the 5-step method and CRAFT—with adaptations to a Thai setting that included integration with Buddhist practices. Its aims were to increase well-being of family members, reduce mental distress, improve family relationships between family members, and engage substance users in behaviour change. A small-scale randomised controlled trial on TFS with a Delayed Treatment control was conducted, with assessments at 8 weeks (Post 1) and 20-24 weeks (Post 2). Structured interviews with participants and PCU staff and an examination of five case studies augmented the quantitative results. Mixed Model Analyses were applied to quantitative outcomes, and thematic analysis was used for qualitative data. Thirty-six participants (18 in each of Immediate and Delayed Conditions) were recruited. A significant difference at Baseline between the two conditions was observed on the Thai GHQ-28 and Gender, but it was not possible to statistically control for these effects. There was a significant Time by Condition interaction on the Thai GHQ-28, WHOQOL-BREF-THAI and FAS, reflecting greater improvements in the Immediate condition by Post 1, but with the Delayed condition meeting or exceeding that effect by Post 2. On FES Cohesion and Conflict, there were falls across conditions at Post 2, but only Cohesion also showed a Time by Condition interaction, and that effect was consistent with a delayed impact of treatment. Overall, TFS by PCU staff in the Delayed Condition gave similar results to TFS conducted by the researcher, supporting the viability of its dissemination to standard health services. Qualitative data also confirmed the quantitative results. Most participants reported physiological and psychological improvements even though their substance-using relative did not change their drug use behaviour. After completing TFS, participants reported increased knowledge, group support and sharing feeling, having positive patient-professional relationship, having greater knowledge of substance abuse and social support. In particular, they changed their behaviour towards the substance user, resulting in improvements to family relationships. PCU staff gave similar responses on the efficacy of TFS, and saw it as feasible for routine use, although some implementation challenges were identified. The cultural adaptation and in particular the religious activities, were recognised by participants and PCU staff as an important component of TFS to support psychological health and well-being. Findings from this study showed the impact of substance use on family members and difficulties that they experienced when living with the substance users, resulting distresses and burden that may develop severe mental health disease. Drug use policies should be modified to support family members and response to their needs effectively for early prevention. This study also gave preliminary support for application of the TFS program in rural primary care settings and identified some policies that will be required for it to be disseminated more broadly.