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.

Communication and control : case studies in Australian telecommuting

This paper discusses the results of in-depth semi-structured interviews with 39 telecommuters from 12 Australian organisations. The paper serves two broad aims: firstly, it identifies current trends in telecommuting and offers a perspective on Australian developments. Secondly, it provides a focus on significant communication aspects of the Australian telecommuting experience. Findings are that the majority of interviewees reported overall satisfaction with telecommuting as an important contributor to their improved work and lifestyle outcomes. Overall, telecommuters appear to cope with communication aspects of their work environments. They also were not overreliant on advanced communications media when telecommuting. Difficulties as reported by telecommuter interviewees included: perceived discomfort over lack of management support for their telecommuting; reduced levels of interpersonal communication suggesting the likely need to adopt a ‘media mix’ approach to servicing their communication needs; problems of information access; and telecommuters’ reported levels of difficulty with their uses of some computer and communication technologies. Problems relating to telecommuters’ perceived professional and social isolation, were also identified. Finally, the paper underscores where organisational communication theorists and practitioners need to more energetically embrace the concepts of virtual work and telecommuting

Household food expenditure and its contribution to socioeconomic inequalities in purchasing foods consistent with Australian dietary guideline recommendations

Aim: To examine the amount of money spent on food by household income, and to ascertain whether food expenditure mediates the relationship between household income and the purchase of staple foods consistent with Australian dietary guideline recommendations. ----- ----- Methods: In face-to-face interviews (n = 1003, 66.4% response rate), households in Brisbane, Australia were asked about their purchasing choices for a range of staple foods, including grocery items, fruits and vegetables. For each participant, information was obtained about their total weekly household food expenditure, along with their sociodemographic and household characteristics. ----- ----- Results: Household income was significantly associated with food expenditure; participants residing in higher-income households spent more money on food per household member than those from lower-income households. Lower income households were less likely to make food purchasing choices of dietary staples that were consistent with recommendations. However, food expenditure did not attenuate the relationship between household income and the purchase of staple foods consistent with dietary guideline recommendations. ----- ----- Conclusions: The findings suggest that food expenditure may not contribute to income inequalities in purchasing staple foods consistent with dietary guideline recommendations: instead, other material or psychosocial factors not considered in the current study may be more important determinants of these inequalities. Further research should examine whether expenditure on non-staple items and takeaway foods is a larger contributor to socioeconomic inequalities in dietary behavior.

Reconnecting the interrupted landscape : a cultural landscape approach to Australian open-cut coal mining landscapes

In the late 20th century, a value-shift began to influence political thinking, recognising the need for environmentally, socially and culturally sustainable resource development. This shift entailed moves away from thinking of nature and culture as separate entities - The former existing merely to serve the latter. Cultural landscape theory recognises 'nature' as at once both 'natural', and as a 'cultural' construct. As such it may offer a framework through which to progress in the quest for 'sustainable development'. This 2005 Masters thesis makes a contribution to that quest by asking whether contemporary developments in cultural landscape theory can contribute to rehabilitation strategies for Australian open-cut coal mining landscapes, an examplar resource development landscape. A thematic historial overview of landscape values and resource development in Australis post-1788, and a review of cultural landscape theory literature contribute to the formation of the theoretical framework: "reconnecting the interrupted landscape". The author then explores a possible application of this framework within the Australian open-cut coal mining landscape.

Towards a relational contracting framework in the Australian construction industry : an initial framework

The Australian construction industry is characterized as being a competitive and risky business environment due to lack of cooperation, insufficient trust, ineffective communication and adversarial relationships which are likely lead to poor project performance. Relational contracting (RC) is advocated by literature as an innovative approach to improve the procurement process in the construction industry. Various studies have collectively added to the current knowledge of known RC norms, but there seem to be little effort on investigating the determinants of RC and its impact on project outcomes. In such circumstances, there is lack of evidence and explanation on the manner on how these issues lead to different performance. Simultaneously, the New Engineering Contract (NEC) that embraced the concept of RC is seen as a modern way of contracting and also considered as one of the best approaches to the perennial problem of improving adversarial relationships within the industry. The reality of practice of RC in Australia is investigated through the lens of the NEC. A synthesis of literature views on the concept, processes and tools of RC is first conducted to develop the framework of RC. A case study approach is proposed for an in-depth analysis to explore the critical issues addressed by RC in relation to project performance. Understanding the realities of RC will assist stakeholders in the construction industry with their investment in RC.

Polybrominated diphenyl ether (PBDE) concentrations decrease with age : analysis of pooled human blood serum in the Australian population

Introduction Polybrominated diphenyl ethers (PBDEs) are considered to be a cost effective and efficient way to reduce the possibility of product ignition and inhibit the spread of fire, thereby limiting harm caused by fires. PBDEs are incorporated into a wide variety of manufactured products and are now considered an ubiquitous contaminant found worldwide in biological and environmental samples1 . In comparison to “traditional” persistent organic pollutants (POPs), the exposure modes of PBDEs in humans are less well defined, although dietary sources, inhalation (air/particulate matter) and dust ingestion have been reported 2-4. Limited investigations of population specific factors such as age or gender and PBDE concentrations report: no conclusive correlation by age in adults; higher concentrations in children ; similar concentrations in maternal and cord blood; and no gender differences. After preliminary findings of higher PBDE concentrations in children than in adults in Australia11 we sought to investigate at what age the PBDE concentrations peaked in an effort to focus exposure studies. This investigation involved the collection of blood samples from young age groups and the development of a simple model to predict PBDE concentrations by age in Australia.

Low frequency of CHEK2 1100delC allele in Australian multiple-case breast cancer families : functional analysis in heterozygous individuals

A protein-truncating variant of CHEK2, 1100delC, is associated with a moderate increase in breast cancer risk. We have determined the prevalence of this allele in index cases from 300 Australian multiple-case breast cancer families, 95% of which had been found to be negative for mutations in BRCA1 and BRCA2. Only two (0.6%) index cases heterozygous for the CHEK2 mutation were identified. All available relatives in these two families were genotyped, but there was no evidence of co-segregation between the CHEK2 variant and breast cancer. Lymphoblastoid cell lines established from a heterozygous carrier contained approximately 20% of the CHEK2 1100delC mRNA relative to wild-type CHEK2 transcript. However, no truncated CHK2 protein was detectable. Analyses of expression and phosphorylation of wild-type CHK2 suggest that the variant is likely to act by haploinsufficiency. Analysis of CDC25A degradation, a downstream target of CHK2, suggests that some compensation occurs to allow normal degradation of CDC25A. Such compensation of the 1100delC defect in CHEK2 might explain the rather low breast cancer risk associated with the CHEK2 variant, compared to that associated with truncating mutations in BRCA1 or BRCA2.

Mental health of newly arrived Burmese refugees in Australia : contributions of pre-migration and post-migration experience

Objective: This study documents the mental health status of people from Burmese refugee backgrounds, recently arrived in Australia; then examines the contributions of gender, premigration and postmigration factors in predicting mental health. Method: Structured interviews, including a demographic questionnaire, the Harvard Trauma Questionnaire, Postmigration Living Difficulties Checklist and Hopkins Symptom Checklist assessed premigration trauma, postmigration living difficulties, depression, anxiety, somatisation and traumatisation symptoms in a sample of 70 adults across five Burmese ethnic groups. Results: Substantial proportions of participants reported psychological distress in symptomatic ranges including: posttraumatic stress disorder (9%); anxiety (20%), and; depression (36%), as well as significant symptoms of somatisation (37%). Participants reported multiple and severe premigration traumas. Postmigration living difficulties of greatest concern included communication problems and worry about family not in Australia. Gender did not predict mental health. Level of exposure to traumatic events and postmigration living difficulties each made unique and relatively equal contributions to traumatisation symptoms. Postmigration living difficulties made unique contributions to depression, anxiety and somatisation symptoms. Conclusions: While exposure to traumatic events impacted on participants’ mental wellbeing, postmigration living difficulties had greater salience in predicting mental health outcomes of people from Burmese refugee backgrounds. Reported rates of posttraumatic stress disorder symptoms were consistent with a large review of adults across seven western countries. High levels of somatisation pointed to a nuanced expression of distress. Findings have implications for service provision in terms of implementing appropriate interventions to effectively meet the needs of this newly arrived group in Australia.

Cultivating Innovation through Social Relationships: A Qualitative Study of Outstanding Australian Innovators in Science, Technology and the Creative Industries

In this chapter, we describe and explore social relationship patterns associated with outstanding innovation. In doing so, we draw upon the findings of 16 in-depth interviews with award-winning Australian innovators from science & technology and the creative industries. The interviews covered topics relating to various influences on individual innovation capacity and career development. We found that for all of the participants, innovation was a highly social process. Although each had been recognised individually for their innovative success, none worked in isolation. The ability to generate innovative outcomes was grounded in certain types of interaction and collaboration. We outline the distinctive features of the social relationships which seem to be important to innovation, and ask which ‘social network capabilities’ might underlie the ability to create an optimal pattern of interpersonal relationships. We discuss the implications of these findings for universities, which we argue play a key role in the development of nascent innovators.

Ethical fashion : the human stories driving a fashion movement

This paper examines and compares two stories, the novel Helen Fleetwood (Elizabeth, 1841) and the film China Blue (Teddy Bear Films, 2005), in relation to the Ethical Fashion movement. In 2005, more than 50 designers from around the world took part in The Ethical Fashion Show in Paris. This movement dictates that designers ensure that their garments are produced in an ethical manner, rather than support the ‘sweatshop’ environments of some industrialists determined to make a profit at the expense of workers rights. The momentum of the Ethical Fashion movement suggests that it is possible for fashion to be ethical, desirable and profitable in the 21st century. In 1841, after extensive research, Charlotte Elizabeth Tonna (using the pseudonym Charlotte Elizabeth) began to write about the atrocities of the factory system in industrialised England. Her novel, Helen Fleetwood, is one of the earliest examples of this kind of work, providing the reader with an extensive insight into the life of English factory workers in the mid-19th century. The story is about the Widow Green and her orphan dependents who are led, through circumstance, to leave their rural home and take up employment in the cotton mills of Manchester, with the hope of having an independent existence. Instead they discover the realities of factory life – extremely long hours, unsafe conditions, poor wages and a steady decline into extreme poverty. In his film China Blue (Teddy Bear Films, 2005), director Micha X. Peled tells an alarmingly similar tale set in 21st century China. This ‘docu-drama’ (a recreation from actual interviews and diary entries) tells the story of ‘Little Jasmine’ who leaves her family’s farm to pursue an independent life in Southern China’s manufacturing district. It is not long before the realities of modern factory life are revealed to the teenage ‘heroine’ – crowded dormitories, long working hours, arbitrary fines and wages that do not compare with those of workers in the Western world. While much of the human story remains unchanged, there have been significant improvements in technology and safety in the last 165 years that result in the reality that not all clothing manufacture is performed in ‘sweatshop’ conditions. After a recent visit to a manufacturing plant in China, consultation with peers in the industry and having worked in the Australian fashion industry for many years, the author compares these stories with her own experiences.

That's a rap : the making of an Australian hip hop integrated musical film

To date, the majority of films that utilise or feature hip hop music and culture, have either been in the realms of documentary, or in ‘show musicals’ (where the film musical’s device of characters’ bursting into song, is justified by the narrative of a pursuit of a career in the entertainment industry). Thus, most films that feature hip hop expression have in some way been tied to the subject of hip hop. A research interest and enthusiasm was developed for utilising hip hop expression in film in a new way, which would extend the narrative possibilities of hip hop film to wider topics and themes. The creation of the thesis film Out of My Cloud, and the writing of this accompanying exegesis, investigates a research concern of the potential for the use of hip hop expression in an ‘integrated musical’ film (where characters’ break into song without conceit or explanation). Context and rationale for Out of My Cloud (an Australian hip hop ‘integrated musical’ film) is provided in this writing. It is argued that hip hop is particularly suitable for use in a modern narrative film, and particularly in an ‘integrated musical’ film, due to its: current vibrancy and popularity, rap (vocal element of hip hop) music’s focus on lyrical message and meaning, and rap’s use as an everyday, non-performative method of communication. It is also argued that Australian hip hop deserves greater representation in film and literature due to: its current popularity, and its nature as a unique and distinct form of hip hop. To date, representation of Australian hip hop in film and television has almost solely been restricted to the documentary form. Out of My Cloud borrows from elements of social realist cinema such as: contrasts with mainstream cinema, an exploration/recognition of the relationship between environment and development of character, use of non-actors, location-shooting, a political intent of the filmmaker, displaying sympathy for an underclass, representation of underrepresented character types and topics, and a loose narrative structure that does not offer solid resolution. A case is made that it may be appropriate to marry elements of social realist film with hip hop expression due to common characteristics, such as: representation of marginalised or underrepresented groups and issues in society, political objectives of the artist/s, and sympathy for an underclass. In developing and producing Out of My Cloud, a specific method of working with, and filming actor improvisation was developed. This method was informed by improvisation and associated camera techniques of filmmakers such as Charlie Chaplin, Mike Leigh, Khoa Do, Dogme 95 filmmakers, and Lars von Trier (post-Dogme 95). A review of techniques used by these filmmakers is provided in this writing, as well as the impact it has made on my approach. The method utilised in Out of My Cloud was most influenced by Khoa Do’s technique of guiding actors to improvise fairly loosely, but with a predetermined endpoint in mind. A variation of this technique was developed for use in Out of My Cloud, which involved filming with two cameras to allow edits from multiple angles. Specific processes for creating Out of My Cloud are described and explained in this writing. Particular attention is given to the approaches regarding the story elements and the music elements. Various significant aspects of the process are referred to including the filming and recording of live musical performances, the recording of ‘freestyle’ performances (lyrics composed and performed spontaneously) and the creation of a scored musical scene involving a vocal performance without regular timing or rhythm. The documentation of processes in this writing serve to make the successful elements of this film transferable and replicable to other practitioners in the field, whilst flagging missteps to allow fellow practitioners to avoid similar missteps in future projects. While Out of My Cloud is not without its shortcomings as a short film work (for example in the areas of story and camerawork) it provides a significant contribution to the field as a working example of how hip hop may be utilised in an ‘integrated musical’ film, as well as being a rare example of a narrative film that features Australian hip hop. This film and the accompanying exegesis provide insights that contribute to an understanding of techniques, theories and knowledge in the field of filmmaking practice.

Bushfire sustainability : Strategies for reconciling bushfire and biodiversity with daily life

This exhibition and catalogue provides a visual record of student work exhibited at the Australian Institute of Architects offices in Brisbane from November 15 to 29, 2010. The exhibition features the final design outcomes of the inaugural Bushfire Sustainability unit conducted at QUT in semester two, 2010. The core objective of this unit was to develop our students’ skills in collaborative practice in design, research and presentation. The theme of ‘bushfire sustainability’ was chosen because living sustainably in bushfire prone landscapes presents a number of problems, the nature of which might only be resolved via multidisciplinary collaboration among the design disciplines. The students involved represent the disciplines of Interior Design, Landscape Architecture, Industrial Design, Architecture and Sustainability – all from within the School of Design at QUT. 55 students, mostly in their third year of study, worked in teams of five (one from each discipline) to design one of a number of homes in highly bushfire prone sites in either Western Australia or SE Queensland. This year level and the interdisciplinary mix are perhaps the best placed to resolve these problems: being unrestrained from the burdens of professional practice and technical overload they retain the potential for innovative, lateral thinking across the range of spatial scales and philosophical perspectives associated with inhabitation of bushfire prone landscapes. It is envisaged that, through the ‘vehicle’ of this design research, that the students’ work will contribute to understandings of how creative design disciplines might respond to this significant national problem, which hitherto has been attended to primarily by engineering and the sciences.

Queers doing theory : Australian queer student activist print media’s representations of capitalism

Queer university student print media often represents capitalism in a framework which could be classified as Marxism. However, at the same time, queer student media extensively publishes ideas which could be classified as academic queer theory. This chapter features analysis of these representations from the 2003, 2004 and 2006 editions of national queer student publication, Querelle, and from a sample of queer student media from four Australian universities. The perspectives of Marxism and academic queer theory are often argued to be contradictory (See for example, Hennessy 1994; Morton 1996b; Kirsch 2007), and thus the students’ application of these theories in tandem could be considered problematic. McKee asks ‘Who gets to be an intellectual?’ (2004) and suggests that the intellectualising undertaken by mainstream and alternative cultural creators is just as valid as that undertaken by university academics. He also raises concerns that the concept of theory is seen to be kept separate from everyday culture (McKee 2002). This chapter argues that in the construction and representation of their politics in this manner the queer student activists are creating their own version of queer theory. This analysis of queer student media contributes to research on queer communities and queer theory, demonstrating how one specific cultural subset theorises queerness and queer politics, thereby contributing to the genealogy of queer.

Relational contracting and its efficacy of project performance in the Australian construction industry

The Australian construction industry is characterized as being a competitive and risky business environment due to lack of cooperation, insufficient trust, ineffective communication and adversarial relationships which are likely lead to poor project performance. Relational contracting (RC) is advocated by literature as an innovative approach to improve the procurement process in the construction industry. Various studies have collectively added to the current knowledge of known RC norms, but there seem to be little effort on investigating the determinants of RC and its efficacy on project outcomes. In such circumstances, there is lack of evidence and explanation on the manner on how these issues lead to different performance. Simultaneously, the New Engineering Contract (NEC) that embraced the concept of RC is seen as a modern way of contracting and also considered as one of the best approaches to the perennial problem of improving adversarial relationships within the industry. The reality of practice of RC in Australia is investigated through the lens of the NEC. A synthesis of literature views on the concept, processes and tools of RC is first conducted to develop the framework of RC. A case study approach is proposed for an in-depth analysis to explore the critical issues addressed by RC in relation to project performance. Understanding the realities of RC will assist stakeholders in the construction industry with their investment in RC.

The development of fast bowling experts in Australian cricket

In this paper, we highlight key concepts from dynamical systems theory and complexity sciences to exemplify constraints on talent development in a sample of elite cricketers. Eleven international fast bowlers who cumulatively had taken more than 2,400 test wickets in over 600 international test matches were interviewed using an in-depth, open-ended, and semi-structured approach. Qualitative data were analysed to identify key components in fast bowling expertise development. Results revealed that, contrary to traditional perspectives, the athletes progressed through unique, nonlinear trajectories of development, which appears to be a commonality in the experts' developmental pathways. During development, individual experts encountered unique constraints on the acquisition of expertise in cricket fast bowling, resulting in unique performance adaptations. Specifically, data illustrated experts' ability to continually adapt behaviours under multifaceted ecological constraints.