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.

The genesis of 'the new geography and the new imperialism : 1870-1918', or 'how I came to Jamaica and joined the UWI Geography Department

In this article, Brian Hudson relates how he came to write the paper published in the journal Antipode, for which he gained recognition as a radical geographer in the late 1970's. It is a tale of a journey in which the loves of his life, geography, history, travel and his wife of over 40 years, came together through living in a number of different places: the United Kingdom, Ghana, Hong Kong, and Jamaica. After leaving UWI, Brian and his family settled in Brisbane, Australia where he taught at Queensland University of Technology until his retirement.

New Commonwealth and Queensland workplace relations legislation : an overview

I seem to have heard a lot about thresholds lately. In fact, I sometimes feel as though I am standing at the edge of an abyss. Certainly the industrial relations systems we have come to know and love are in the process of metamorphosis but that process began a decade ago. So what is all the fuss about...

Observation of new particle formation in subtropical urban environment

The aim of this study was to characterise the new particle formation events in a subtropical urban environment in the southern hemisphere. The study measured the number concentration of particles and its size distribution in Brisbane, Australia during 2009. The variation of particle number concentration and nucleation burst events were characterised as well as the particle growth rate which was first reported in urban environment of Australia. The annual average NUFP, NAitken and NNuc were 9.3 x 103, 3.7 x 103 and 5.6 x 103 cm-3, respectively. Weak seasonal variation in number concentration was observed. Local traffic exhaust emissions were a major contributor of the pollution (NUFP) observed in morning which was dominated by the Aitken mode particles, while particles formed by secondary formation processes contributed to the particle number concentration during afternoon. Overall, 65 nucleation burst events were identified during the study period. Nucleation burst events were classified into two groups, with and without particles growth after the burst of nucleation mode particles observed. The average particle growth rate of the nucleation events was 4.6 nm hr-1 (ranged from 1.79 – 7.78 nm hr-1). Case studies of the nucleation burst events were characterised including i) the nucleation burst with particle growth which is associated with the particle precursor emitted from local traffic exhaust emission, ii) the nucleation burst without particle growth which is due to the transport of industrial emissions from the coast to Brisbane city or other possible sources with unfavourable conditions which suppressed particle growth and iii) interplay between the above two cases which demonstrated the impact of the vehicle and industrial emissions on the variation of particle number concentration and its size distribution during the same day.

Creating new possibilities : using design processes to overcome constraints

This paper describes how a team from a large company, when faced with a challenge to develop new customers in fast growing international markets, carried out the exploration of the needs of new clients in the largely unexplored market space of a developing country. This team used design methods and processes to identify the latent needs of new customers in situations of major economic, geographical, cultural and financial constraints. This encapsulation of the life experiences of potential customers is used extensively in some new product development, but is largely novel to business practices and in processes of developing new services. This research links with the sub-theme of discovering creativity in necessity and highlights the potential benefits of design methodologies to create new possibilities for better accessibility of the company’s products to new clients, with future implications for organizational strategy. The overall theme of Design for the Colloquium encourages exploration of the ways and means of developing new ideas for new business with better outcomes, using design concepts and design technologies.

Journalists and Twitter : how Australian news organisations adapt to a new medium

Twitter has developed an increasingly visible presence in Australian journalism, and in the discussion of news. Many journalists have begun to explore manageable approaches to incorporating Twitter into their work practices, and for some – like the ABC’s ‘star recruits’ Annabel Crabb and Latika Bourke – it has already become a career driver. This article examines the positioning of journalists as ‘personal brands’ on Twitter, by documenting the visibility of leading personal and institutional accounts during two major political events in Australia: the Rudd/Gillard leadership spill on 23 June 2010, and the day of the subsequent federal election on 21 August 2010. It highlights the fact that in third-party networks such as Twitter, journalists and news organisations no longer operate solely on their own terms, as they do on their own Websites, but gain and maintain prominence in the network and reach for their messages only in concert with other users. It places these observations in a wider context of journalist/audience relations, a decade after the emergence of the first citizen journalism Websites.

A new approach for trip generation estimation for use in traffic impact assessments

Findings from an online survey conducted by Queensland University of Technology (QUT) shows that Australia is suffering from a lack of data reflecting trip generation for use in Traffic Impact Assessments (TIAs). Current independent variables for trip generation estimation are not able to create robust outcomes as well. It is also challenging to account for the impact of the new development on public and active transport as well as the effect of trip chaining behaviour in Australian TIA studies. With this background in mind, research is being implemented by QUT to find a new approach developing a combined model of trip generation and mode choice with consideration of trip chaining effects. It is expected that the model will provide transferable outcomes as it is developed based on socio-demographic parameters. Child Care Centres within the Brisbane area have been nominated for model development. At the time, the project is in the data collection phase. Findings from the pilot survey associated with capturing trip chaining and mode choice information reveal that applying questionnaire is able to capture required information in an acceptable level. The result also reveals that several centres within an area should be surveyed in order to provide sufficient data for trip chaining and modal split analysis.

Current status and future prospects for cultured limbal tissue transplants in Australia and New Zealand

Cultured limbal tissue transplants have become widely used over the last decade as a treatment for limbal stem cell deficiency (LSCD). While the number of patients afflicted with LSCD in Australia and New Zealand is considered to be relatively low, the impact of this disease on quality of life is so severe that the potential efficacy of cultured transplants has necessitated investigation. We presently review the basic biology and experimental strategies associated with the use of cultured limbal tissue transplants in Australia and New Zealand. In doing so, we aim to encourage informed discussion on the issues required to advance the use of cultured limbal transplants in Australia and New Zealand. Moreover, we propose that a collaborative network could be established to maintain access to the technology in conjunction with a number of other existing and emerging treatments for eye diseases.

New organisational leadership capabilities : transitional engineer the new designer?

Traditionally, design has been centred within the manufacturing and production areas of companies and or as a styling afterthought. Increasingly, design is viewed as a vital and important strategic business resource (Dell’Era, Marchesi & Verganti, 2010) and consequently companies worldwide look to design to help them innovate, differentiate and compete in the global marketplace. The role of the professional designer is evolving to a point where they are needed to work beyond being a specialist in the manufacturing and aesthetics of an artefact (Wrigley & Bucolo, 2011). This paper challenges the values held by academics and industry regarding the traditional role of designers in business. It investigates the emerging transitional engineering framework and puts forward a proposal for the next generation designer in the future era of design. Questions surrounding how designers will develop these new skills and how the Authors’ new framework of design led innovation can contribute to the future of design will be presented. This research is needed to better equip future designers to have a more central role in business.

A new approach for trip generation estimation for TIA

Transport Impact Assessment (TIA) -Generally a short range transport planning activity -Assess transport impacts of new developments or expansions -Present solutions to mitigate impacts Problems with TIA Process -Private vehicles focus (i.e. Veh Trip Ends) -Proxy variables (e.g. 100sqm GFA) -Trip generation rates (e.g. VTE/proxy) -Little info/guidance on trip chaining effects -Little info/guidance on non-PV modes Requires significant professional judgment

Personality and player types in Fallout New Vegas

The aim of this study was to explore the relationship between personality and videogame player types. Study participants completed an online survey that gathered information regarding the individual's personality, via the Big Five Inventory, and player types. The study was focused on understanding this relationship in the context of the action role-playing videogame, Fallout New Vegas (FNV). A relationship between personality and player type was found, specifically with respect to the personality traits of openness to experience and conscientiousness.

Gaps in organizational leadership : linking strategic and operational activities through design-led propositions

The relationship between design process and business systems has been of interest to both practitioners and researchers exploring the numerous opportunities and challenges of this unlikely relationship. Often the relationship is presented as building design thinking capability within an organization, which can be broadly described as the union of design and strategy. Brown (2008) notes that design thinking is ‘‘a discipline that uses the designer’s sensibility and methods to match people’s needs with what is technically feasible and what business strategy can convert into customer value and market opportunities’’ (p. 1). The value that design thinking brings to an organization is a different way of framing situations and possibilities, doing things, and tackling problems: essentially a cultural transformation of the way it undertakes its business. The work of Martin (2009) has clearly shown the generalized differences between design thinking and business thinking, highlighting many instances in which these differences have been overcome, but also noting the many obstacles of trying to unify both approaches within an organization. Liedtka (2010) encourages firms to try and persist in overcoming these barriers, as she has noted that ‘‘business strategy desperately needs design ... because design is all about action and business strategy too often turns out to be only about talk ... fewer than 10 percent of new strategies are ever fully executed’’ (p. 9).

A gamified mobile application for engaging new students at university orientation

The term gamification describes the addition of game elements to non-game contexts as a means to motivate and engage users. This study investigates the design, delivery and pilot evaluation of a gamified, smartphone application built to introduce new students to the campus, services and people at university during their first few weeks. This paper describes changes to the application made after an initial field study was undertaken and provides an evaluation of the impact of the redesign. Survey responses were collected from thirteen students and usage data was captured from 105 students. Results indicate three levels of user engagement and suggest that there is value in adding game elements to the experience in this way. A number of issues are identified and discussed based on game challenges, input, and facilitating game elements in an event setting such as university orientation.

The 'new' news

This themed issue of Media International Australia brings together a collection of work that critically examines some of the rapid changes to the news media system in recent years, including an explosion of news sources, formats and increasingly popular hybrid styles and the collapse in the authority of the trusted news sources of the past. Much news is now broken by social media, and journalists compete in a cycle of news and politics that has been dramatically influenced and sped up by 24-hour news channels. The role of journalists has changed, and they increasingly are being called up on to interpret and explain events rather than simply report them.