The effects of ambulance ramping on Emergency Department length of stay and mortality

Background: Ambulance ramping within the Emergency Department (ED) is a common problem both internationally and in Australia. Previous research has focused on various issues associated with ambulance ramping such as access block, ED overcrowding and ambulance bypass. However, limited research has been conducted on ambulance ramping and its effects on patient outcomes. ----- ----- Methods: A case-control design was used to describe, compare and predict patient outcomes of 619 ramped (cases) vs. 1238 non-ramped (control) patients arriving to one ED via ambulance from 1 June 2007 to 31 August 2007. Cases and controls were matched (on a 1:2 basis) on age, gender and presenting problem. Outcome measures included ED length of stay and in-hospital mortality. ----- ----- Results: The median ramp time for all 1857 patients was 11 (IQR 6—21) min. Compared to nonramped patients, ramped patients had significantly longer wait time to be triaged (10 min vs. 4 min). Ramped patients also comprised significantly higher proportions of those access blocked (43% vs. 34%). No significant difference in the proportion of in-hospital deaths was identified (2%vs. 3%). Multivariate analysis revealed that the likelihood of having an ED length of stay greater than eight hours was 34% higher among patients who were ramped (OR 1.34, 95% CI 1.06—1.70, p = 0.014). In relation to in-hospital mortality age was the only significant independent predictor of mortality (p < 0.0001). ----- ----- Conclusion: Ambulance ramping is one factor that contributes to prolonged ED length of stay and adds additional strain on ED service provision. The potential for adverse patient outcomes that may occur as a result of ramping warrants close attention by health care service providers.

Understanding engagement with tangible user interfaces

This paper examines the issues surrounding the successful design and development of tangible technology for optimal engagement in playful activities. At present there is very little data on how, and in what contexts, tangible interactions with technology promote lasting engagement and immersion. The framework at the core of this paper has been designed to guide the effective design of tangible technology for immersive interaction. The paper investigates the relationship between tangible user interfaces (TUI) characteristics of representation and control, and immersive flow experiences produced through balancing skill and challenge in user interaction.

Management [4th Asia Pacific Edition]

The fourth edition of this popular text has been throughly updated, continuing its strong emphasis on the importance of the Asian region to contemporary Australian and New Zealand organizations. Many Asian case examples are featured to illustrate key management concepts. ----- ----- ----- Joining the author team for this edition and enhancing this edition's critical analysis of management theory and applications are the best-selling authors from another of Wiley's undergraduate introductory management texts - Management: Core Concepts and Applications, 2nd Australasian edition (Davidson et al.).----- ----- ----- This new edition also discusses the impact of recent events such as the global financial crisis on the management of organisations, both during the crisis and in its aftermath.----- ----- ----- Of course, Management, 4th Asia- Pacific edition also retains the features that made it so popular with students and lecturers in the earlier editions: a balanced coverage of small to medium-sized enterprises and larger multinational corporations an emphasis on the need for business activities to be sustainable in terms of preserving the welfare of future generations the Career Readiness Workbook at the end of the book, which includes a range of individual and group activities to encourage the practical applications of management theory. With its clear insights into dynamics of management in the workplace of today and the future, Management, 4th Asia-Pacific edition provides a sound basis for the contemporary undergraduate study of introductory management.

Workplace sexual harassment 30 years on : a review of the literature

Despite its proscription in legal jurisdictions around the world, workplace sexual harassment (SH) continues to be experienced by many women and some men in a variety of organizational settings. The aims of this review article are threefold: first, with a focus on workplace SH as it pertains to management and organizations, to synthesize the accumulated state of knowledge in the field; second, to evaluate this evidence, highlighting competing perspectives; and third, to canvass areas in need of further investigation. Variously ascribed through individual (psychological or legal consciousness) frameworks, sociocultural explanations and organizational perspectives, research consistently demonstrates that, like other forms of sexual violence, individuals who experience workplace SH suffer significant psychological, health- and job-related consequences. Yet they often do not make formal complaints through internal organizational procedures or to outside bodies. Laws, structural reforms and policy initiatives have had some success in raising awareness of the problem and have shaped rules and norms in the employment context. However, there is an imperative to target further workplace actions to effectively prevent and respond to SH.

Strategic technology management : case study development in innovative building products

National and international competition demands that Australian organisations become more competent at making the strategic technological decisions that impact their future in the international business economy. A new subject unit, Management of Technology is now offered in the popular Master of Project Management and Master of Business Administration programs at the Queensland University of Technology. This cross-disciplinary subject provides students with a theoretical foundation and practical tools to improve the efficiency and competitiveness of technically-oriented organisations. Applied case studies—shown to be the most appropriate mode of learning for mature-age students—form an integral component of the teaching program. In the first offerings of this subject during 1995 and 1996, American case studies were used. QUT has now supported the development of Australian case study packages for technology management through its Teaching and Learning Grants Scheme. The first case developed—Inland Oil Refiners’ Microstill Project—was completed in early 1996. A newly developed case—Automated Door Opening System for Wheelchair Access—is currently being completed. This case (comprising case study documentation and video presentation) tracks a cross-disciplinary product development driven by legislative and community pressures. It also reinforces the importance of personal relationships in the technology and business development that has taken this young Brisbane-based company from its embryonic beginnings on the Queensland Cultural Centre in 1994 to a national and export-focussed organisation in 1997. This paper reviews the need to develop Australian case material in Management of Technology, discusses the case study documentation and supporting video developed, and application of the case study approach in this teaching initiative in QUT’s Master of Project Management and Master of Business Administration programs.

Who wants to work in childcare? Pre-service early childhood teachers' consideration of work in the child care sector

Australia is currently witnessing considerable change in conceptualisation of the role of child care. This is a response to the strong evidence from developmental science that demonstrates the lifelong impact of early experiences. The recent commitment made by the Council of Australian Governments (COAG) (Communiqué, December 2009a) to improved qualifications and quality of those working in child care is a manifestation of this shift and highlights the importance of the childcare workforce. This study focused on the considerations of a third year cohort of B.Ed (EC) pre-service teachers (n = 55), about entering the childcare workforce. It examines their willingness to work in child care and identifies barriers and incentives for so doing. Our results indicate that, although attitudes to maternal work and child care were largely positive, few would prefer to work in child care under the current conditions. Key barriers were the pay and work conditions, particularly as they compare to other forms of potential employment. Incentives were the opportunity for leadership, creativity and a commitment to advocate for the rights of children. Those more willing to consider work in child care were distinguished from those less willing by altruism—foregoing personal gain to advocate for improved quality as a child’s right.

The Canadian ‘Model Forest’ approach : a way forward for Tasmania?

Forest policy and forestry management in Tasmania have undergone a number of changes in the last thirty years, many explicitly aimed at improving industry sustainability, job security, and forest biodiversity conservation. Yet forestry remains a contentious issue in Tasmania, due to a number of interacting factors, most significant of which is the prevalence of a ‘command and control’ governance approach by policymakers and managers. New approaches such as multiple-stakeholder decision-making, adaptive management, and direct public participation in policymaking are needed. Such an approach has been attempted in Canada in the last decade, through the Canadian Model Forest Program, and may be suitable for Tasmania. This paper seeks to describe what the Canadian Model Forest approach is, how it may be implemented in Tasmania, and what role it may play in the shift to a new forestry paradigm. Until such a paradigm shift occurs contentions and confrontations are likely to continue.

Acknowledging social justice and equity through good practice for monitoring student learning engagement in FYE

As higher education institutions respond to government targets to widen participation, their student populations will become increasingly diverse, and the issues around student success and retention will be more closely scrutinised. The concept of student engagement is a key factor in student achievement and retention and Australasian institutions have a range of initiatives aimed at monitoring and intervening with students who are at risk of disengaging. Within the widening participation agenda, it is absolutely critical that these initiatives are designed to enable success for all students, particularly those for whom social and cultural disadvantage have been a barrier. Consequently, for the sector, initiatives of this type must be consistent with the concept of social justice and a set of principles would provide this foundation. This session will provide an opportunity for participants to examine a draft set of principles and to discuss their potential value for the participants’ institutional contexts.

Understanding speeding in school zones in Malaysia and Australia using an extended Theory of Planned Behaviour : the potential role of mindfulness

Speeding in school zones is a problem in both Malaysia and Australia. While there are differences between the countries in terms of school zone treatments and more generally, these differences do not explain why people choose to speed in school zones. Because speeding is usually an intentional behaviour, the Theory of Planned Behaviour (TPB) has been used to understand speeding and develop interventions, however it has limitations which can be addressed by extending the model to incorporate other constructs. One promising construct is mindfulness, which can improve the explanatory value of the TPB by taking into account unintentional speeding attributable to a lack of focus on important elements of the driving environment. We explain what mindfulness is (and is not), how it can assist in providing a better understanding of speeding in school zones, and how it can contribute to the development of interventions. We then outline a program of research which has been commenced, investigating the contribution of mindfulness to an understanding of speed choice in school zones in two different settings (Australia and Malaysia) using the TPB.

Report on capacity-building workshops for road safety in Indonesia

In addition to the established problem of road safety in developing countries such as Indonesia, the agencies responsible for road safety often lack personnel with professional training in road safety. In Indonesia this is compounded by a need for more effective collaboration between agencies. In 2009, CARRS-Q was commissioned under the Indonesia Transport Safety Assistance Package to provide professional training in road safety for middle level officers in Jakarta, the province of Jawa Barat, and the cities of Bandung, Bogor and Sukabumi, aimed at developing action plans and fostering collaboration between agencies. This was achieved through a workshop, which followed up by a second workshop with the same participants. The course was very well received, action plans were successfully prepared during the first workshop, and most had progressed well by the time of the second workshop. Good cooperation between agencies was also evident. There would be considerable benefits in extending modified workshops more widely in Indonesia.

Fatalism and road safety in developing countries, with a focus on Pakistan

Road crashes are a significant problem in developing countries such as Pakistan. Attitudes are among the human factors which influence risky road use and receptiveness to interventions. Fatalism is a set of attitudes known to be important in Pakistan and other developing countries; however it is rarely addressed in the road safety literature. Two broad types of fatalism are “theological fatalism” and “empirical fatalism”, both of which are found in developed countries as well as in developing countries. Where research has been conducted into the issue, fatalism is considered to interfere with messages aimed at improving road safety. Pakistan has a serious road crash problem, and there is sufficient information to suggest that fatalism is an important contributing factor to the problem, but a better understanding of how fatalism operates in Pakistan is needed if effective prevention strategies are to be developed. A proposed study using an anthropological approach is described which will be exploratory in nature and which is aimed at investigating fatalism and related concepts among Pakistani road users and those who develop and implement road safety policy.

Social influences on drivers in China

China is one of Asia’s many rapidly-motorising nations and recent increases in private-vehicle ownership have been coupled with an escalation in novice drivers. Several pieces of road safety legislation have been introduced in recent decades in China. While managing the legal aspects of road use is important, social influences on driver behaviour may offer alternative avenues to alter behaviour, particularly in a culture where such factors carry high importance. This paper reports qualitative research with Beijing drivers to investigate social influence factors that have, to date, received little attention in the literature. Findings indicated that family members, friends, and driving instructors appear influential on driver behaviour and that some newly licensed drivers seek additional assistance to facilitate the transition from learning to drive in a controlled environment to driving on the road in complex conditions. Strategies to avoid detection and penalties for inappropriate road use were described, many of which involved the use of a third person. These findings indicate potential barriers to implementing effective traffic enforcement and highlight the importance of understanding culturally-specific social factors relating to driver behaviour.

iRAP Malaysia training course : decade of action for road safety

The International Road Assessment Program (iRAP) is a not-for-profit organisation that works in partnership with governments and non-government organisations in all parts of the world to make roads safe. The iRAP Malaysia pilot study on 3700km of road identified the potential to prevent 31,800 deaths and serious injuries over the next 20 years from proven engineering improvements. To help ensure the iRAP data and results are available to planners and engineers, iRAP, together with staff from the Centre for Accident Research and Road Safety – Queensland (CARRS-Q) and the Malaysian Institute of Road Safety Research (MIROS), developed a five-day iRAP training course that covers the background, theory and practical application of iRAP protocols, with a special focus on Malaysian case studies. Funding was provided by a competitive grant from the Australia-Malaysia Institute.

Out of time: The moral temporality of sex, crime and taboo

This paper discusses the relationship between law and morality. Morality does not necessarily coincide with the law, but it contributes to it. An act may be legal but nevertheless considered to be immoral in a particular society. For example, the use of pornography may be considered by many to be immoral. Nevertheless, the sale and distribution of non-violent, non-child related, sexually explicit material is legal (or regulated) in many jurisdictions. Many laws are informed by, and even created by, morality. This paper examines the historical influence of morality on the law and on society in general. It aims to develop a theoretical framework for examining legal moralism and the social construction of morality and crime as well as the relationship between sex, desire and taboo. Here, we refer to the moral temporality of sex and taboo, which examines the way in which moral judgments about sex and what is considered taboo change over time, and the kinds of justifications that are employed in support of changing moralities. It unpacks the way in which abstract and highly tenuous concepts such as ‘‘desire’’, ‘‘art’’ and ‘‘entertainment’’ may be ‘‘out of time’’ with morality, and how morality shapes laws over time, fabricating justifications from within socially constructed communities of practice. This theoretical framework maps the way in which these concepts have become temporally dominated by heteronormative structures such as the family, marriage, reproduction, and longevity. It is argued that the logic of these structures is inexorably tied to the heterosexual life-path, charting individual lives and relationships through explicit phases of childhood, adolescence and adulthood that, in the twenty-first century, delimit the boundaries of taboo surrounding sex more than any other time in history.

Designing the future

While there have been improvements in Australian engineering education since the 1990s, there are still strong concerns that more progress needs to be made, particularly in the areas of developing graduate competencies and in outcomes-based curricula. This paper comments on the findings from a two-day Australian Learning and Teaching Council funded forum that sought to establish a shared understanding with the thee stakeholders (students, academics and industry) about how to achieve a design-based engineering curriculum. This paper reports on the findings from the first day’s activities, and reveals that there is a shared desire for design and project-based curricula that would encourage the development of the “three-dimensional” graduate: one who has technical, personal, and professional and systems-thinking/design-based competence. In addition, the data also reveal industry willingness to engage in the engineering curriculum to enhance authentic learning experiences.