Improving national hospice/palliative care service symptom outcomes systematically through point-of-care data collection, structured feedback and benchmarking

PURPOSE Every health care sector including hospice/palliative care needs to systematically improve services using patient-defined outcomes. Data from the national Australian Palliative Care Outcomes Collaboration aims to define whether hospice/palliative care patients' outcomes and the consistency of these outcomes have improved in the last 3 years. METHODS Data were analysed by clinical phase (stable, unstable, deteriorating, terminal). Patient-level data included the Symptom Assessment Scale and the Palliative Care Problem Severity Score. Nationally collected point-of-care data were anchored for the period July-December 2008 and subsequently compared to this baseline in six 6-month reporting cycles for all services that submitted data in every time period (n = 30) using individual longitudinal multi-level random coefficient models. RESULTS Data were analysed for 19,747 patients (46 % female; 85 % cancer; 27,928 episodes of care; 65,463 phases). There were significant improvements across all domains (symptom control, family care, psychological and spiritual care) except pain. Simultaneously, the interquartile ranges decreased, jointly indicating that better and more consistent patient outcomes were being achieved. CONCLUSION These are the first national hospice/palliative care symptom control performance data to demonstrate improvements in clinical outcomes at a service level as a result of routine data collection and systematic feedback.

Exploring Australian intensive care physicians clinical judgement during donation after cardiac death : an exploratory qualitative study

BACKGROUND: Donation after Cardiac Death (DCD) is one possible solution to the world wide organ shortage. Intensive care physicians are central to DCD becoming successful since they are responsible for making the clinical judgements and decisions associated with DCD. Yet international evidence shows health care professionals have not embraced DCD and are often reluctant to consider it as an option for patients. PURPOSE: To explore intensive care physicians' clinical judgements when selecting a suitable DCD candidate. METHODS: Using interpretative exploratory methods six intensive care physicians were interviewed from three hospital sites in Australia. Following verbatim transcription, data was subjected to thematic analysis. FINDINGS: Three distinct themes emerged. Reducing harm and increasing benefit was a major focus of intensive care physicians during determination of DCD. There was an acceptance of DCD if there was clear evidence that donation was what the patient and family wanted. Characteristics of a defensible decision reflected the characteristics of sequencing, separation and isolation, timing, consensus and collaboration, trust and communication to ensure that judgements were robust and defensible. The final theme revealed the importance of minimising uncertainty and discomfort when predicting length of survival following withdrawal of life-sustaining treatment. CONCLUSION: DCD decisions are made within an environment of uncertainty due to the imprecision associated with predicting time of death. Lack of certainty contributed to the cautious and collaborative strategies used by intensive care physicians when dealing with patients, family members and colleagues around end-of-life decisions, initiation of withdrawal of life-sustaining treatment and the discussion about DCD. This study recommends that nationally consistent policies are urgently needed to increase the degree of certainty for intensive care staff concerning the DCD processes.

Tales of science and defiance : the case for co-learning and collaboration in bridging the science/emotion divide in water recycling debates

Although science is generally assumed to be well integrated into rational decision-making models, it can be used to destabilise consultative processes, particularly when emotions are involved. Water policies are often seen as debates over technical and engineering issues, but can be highly controversial. Recycled water proposals, in particular, can create highly emotive conflicts. Through a case study regarding the rejection of recycled water proposals in the south-east Queensland, Australia, we explore the influence of science and emotions in contemporary water planning. We highlight the dangers inherent in promoting technical water planning issues at the expense of appropriate consideration of citizen concerns. Combining the science–policy interface and stakeholder engagement literatures, we advocate for collaborative decision-making processes that accommodate emotions and value judgements. A more collaborative stakeholder engagement model, founded on the principles of co-learning, has the potential to broaden the decision-making base and to promote better and more inclusive decision-making.

Emotion and architectural environments : a case for Functional Near Infrared Spectroscopy (fNIRS) in assessing emotional responses to spatial environments

Collaboration between neuroscience and architecture is emerging as a key field of research as demonstrated in recent times by development of the Academy of Neuroscience for Architecture (ANFA) and other societies. Neurological enquiry of affect and spatial experience from a design perspective remains in many instances unchartered. Research using portable near infrared spectroscopy (fNIRs) - an emerging non-invasive neuro-imaging device, is proving convincing in its ability to detect emotional responses to visual, spatio-auditory and task based stimuli. This innovation provides a firm basis to potentially track cortical activity in the appraisal of architectural environments. Additionally, recent neurological studies have sought to explore the manifold sensory abilities of the visually impaired to better understand spatial perception in general. Key studies reveal that early blind participants perform as well as sighted due to higher auditory and somato-sensory spatial acuity. Studies also report pleasant and unpleasant emotional responses within certain interior environments revealing a deeper perceptual sensitivity than would be expected. Comparative fNIRS studies between the sighted and blind concerning spatial experience has the potential to provide greater understanding of emotional responses to architectural environments. Supported by contemporary theories of architectural aesthetics, this paper presents a case for the use of portable fNIRS imaging in the assessment of emotional responses to spatial environments experienced by both blind and sighted. The aim of the paper is to outline the implications of fNIRS upon spatial research and practice within the field of architecture and points to a potential taxonomy of particular formations of space and affect.

Peripheral, central and coercive routes for promoting Enterprise Social Networks

Organisations employ Enterprise Social Networks (ESNs) (such as Yammer) expecting better intra-organisational communication and collaboration. However, ESNs are struggling to gain momentum and wide adoption among users. Promoting user participation is a challenge, particularly in relation to lurkers – the silent ESN members who do not contribute any content. Building on behaviour change research, we propose a three-route model consisting of the central, peripheral and coercive routes of influence that depict users’ cognitive strategies, and we examine how management interventions (e.g. sending promotional emails) impact users’ beliefs and (consequent) posting and lurking behaviours in ESNs. Furthermore, we identify users’ salient motivations to lurk or post. We employ a multi-method research design to conceptualise, operationalise and validate the research model. This study has implications for academics and practitioners regarding the nature, patterns and outcomes of management interventions in prompting ESN.

Inquiry skills in the Australian Curriculum v6 : a bird’s-eye view

This paper presents an analysis of inquiry skills in the Australian Curriculum version 6. It juxtaposes the inquiry skills strands in the scope and sequence of Science, History, Geography,Economics and Business,and Civics and Citizenship with the Critical and Creative Thinking and Information and Communication Technology general capabilities. In doing so, it reveals the extent of inquiry skills embedded in the Australian Curriculum and identifies some misalignments and omissions.

Statistics critical in securing our food supply

“World food security … is at its lowest in half a century,” wrote Julian Cribb FTSE, a wellknown consultant in science communication and founding editor of www.sciencealert. com.au in the lead article in the 2008 ATSE Focus magazine issue entitled “Food for the world: the nation’s challenge”. Food security continues to be a key national and international concern and it is pleasing to see this issue of Focus again exploring aspects of the topic with the aim of continuing to raise awareness of issues and influencing relevant policy decisions. Statistics (or statistical science, more broadly) has been critical to the information and decision-making value chain needed to optimise agriculture and the food supply chain. The key steps are most often addressed by multidisciplinary research groups including statisticians in collaboration with life and physical scientists, agri-industry personnel and other relevant stakeholders.

Foundations for the future : A long-term plan for Australian ecosystem science

Abstract: Australia’s ecosystems are the basis of our current and future prosperity, and our national well-being.A strong and sustainable Australian ecosystem science enterprise is vital for understanding and securing these ecosystems in the face of current and future challenges. This Plan defines the vision and key directions for a national ecosystem science capability that will enable Australia to understand and effectively manage its ecosystems for decades to come.The Plan’s underlying theme is that excellent science supports a range of activities, including public engagement, that enable us to understand and maintain healthy ecosystems.Those healthy ecosystems are the cornerstone of our social and economic well-being.The vision guiding the development of this Plan is that in 20 years’ time the status of Australian ecosystems and how they change will be widely reported and understood, and the prosperity and well-being they provide will be secure. To enable this, Australia’s national ecosystem science capability will be coordinated, collaborative and connected.The Plan is based on an extensive set of collaboratively generated proposals from national town hall meetings that also formthe basis for its implementation. Some directions within the Plan are for the Australian ecosystem science community itself to implement, others will involve the users of ecosystem science and the groups that fund ecosystem science.We identify six equal priority areas for action to achieve our vision: (i) delivering maximum impact for Australia: enhancing relationships between scientists and end-users; (ii) supporting long-termresearch; (iii) enabling ecosystem surveillance; (iv) making the most of data resources; (v) inspiring a generation: empowering the public with knowledge and opportunities; (vi) facilitating coordination, collaboration and leadership. This shared vision will enable us to consolidate our current successes, overcome remaining barriers and establish the foundations to ensure Australian ecosystem science delivers for the future needs of Australia..

Do good things and talk about them : a theory of academics usage of enterprise social networks for impression management tactics

Enterprise social networks provide benefits especially for knowledge-intensive work as they enable communication, collaboration and knowledge exchange. These platforms should therefore lead to increased adoption and use by knowledge-intensive workers such as consultants or indeed researchers. Our interest is in ascertaining whether scientific researchers use enterprise social networks as part of their work practices. This focus is motivated by an apparent schism between a need for researchers to exchange knowledge and profile themselves, and the aversion to sharing breakthrough ideas and joining in an ever-increasing publishing and marketing game. We draw on research on academic work practices and impression management to develop a model of academics’ ESN usage for impression management tactics. We describe important constructs of our model, offer strategies for their operationalization and give an outlook to our ongoing empirical study of the use of an ESN platform by 20 schools across six faculties at an Australian university.

A collaborative rapid persona-building workshop : creating design personas with health researchers

In the HealthMap project for People With HIV, (PWHIV) designers employed a collaborative rapid ‘persona-building' workshop with health researchers to develop patient personas that embodied patient-centred design goals and contextual awareness from a variety of qualitative and quantitative data. On reflection, this collaborative rapid workshop was a process for drawing together the divergent user research insights and expertise of stakeholders into focus for a chronic disease self-management design. This paper discusses, (i) an analysis of the transcript of the workshop and, (ii) interviews with five practising senior designers, in order to reflect on how the persona-building process was enacted and its role in the HealthMap design evolution. The collaborative rapid persona-building methodology supported: embedding user research insights, eliciting domain expertise, introducing design thinking, facilitating stakeholder collaboration and defining early design requirements. The contribution of this paper is to model the process of collaborative rapid persona-building and to introduce the collaborative rapid persona-building framework as a method to generate design priorities from domain expertise and user research data.

Report on INEX 2013

INEX investigates focused retrieval from structured documents by providing large test collections of structured documents, uniform evaluation measures, and a forum for organizations to compare their results. This paper reports on the INEX 2013 evaluation campaign, which consisted of four activities addressing three themes: searching professional and user generated data (Social Book Search track); searching structured or semantic data (Linked Data track); and focused retrieval (Snippet Retrieval and Tweet Contextualization tracks). INEX 2013 was an exciting year for INEX in which we consolidated the collaboration with (other activities in) CLEF and for the second time ran our workshop as part of the CLEF labs in order to facilitate knowledge transfer between the evaluation forums. This paper gives an overview of all the INEX 2013 tracks, their aims and task, the built test-collections, and gives an initial analysis of the results.

Orthopaedics and Trauma Queensland Annual Report 2013

Orthopaedics and Trauma Queensland, the Centre for Research and Education in Musculoskeletal Disorders, is an internationally recognised research group that continues to develop its reputation as an international leader in research and education. It provides a stimulus for research, education and clinical application within the international orthopaedic and trauma communities. Orthopaedics and Trauma Queensland develops and promotes the innovative use of engineering and technology, in collaboration with surgeons, to provide new techniques, materials, procedures and medical devices. Its integration with clinical practice and strong links with hospitals ensure that the research will be translated into practical outcomes for patients.

Echology: Making sense of data - reflections on resilient ecologies of partnership [Abstract]

The Echology: Making Sense of Data initiative seeks to break new ground in arts practice by asking artists to innovate with respect to a) the possible forms of data representation in public art and b) the artist's role in engaging publics on environmental sustainability in new urban developments. Initiated by ANAT and Carbon Arts in 2011, Echology has seen three artists selected by National competition in 2012 for Lend Lease sites across Australia. In 2013 commissioning of one of these works, the Mussel Choir by Natalie Jeremijenko, began in Melbourne's Victoria Harbour development. This emerging practice of data - driven and environmentally engaged public artwork presents multiple challenges to established systems of public arts production and management, at the same time as offering up new avenues for artists to forge new modes of collaboration. The experience of Echology and in particular, the Mussel Choir is examined here to reveal opportunities for expansion of this practice through identification of the factors that lead to a resilient 'ecology of part nership' between stakeholders that include science and technology researchers, education providers, city administrators, and urban developers.

The potential for new understandings of normal and abnormal cognition by integration of neuroimaging and behavioral data : Not an exercise in carrying coals to Newcastle

Discovering the means to prevent and cure schizophrenia is a vision that motivates many scientists. But in order to achieve this goal, we need to understand its neurobiological basis. The emergent metadiscipline of cognitive neuroscience fields an impressive array of tools that can be marshaled towards achieving this goal, including powerful new methods of imaging the brain (both structural and functional) as well as assessments of perceptual and cognitive capacities based on psychophysical procedures, experimental tasks and models developed by cognitive science. We believe that the integration of data from this array of tools offers the greatest possibilities and potential for advancing understanding of the neural basis of not only normal cognition but also the cognitive impairments that are fundamental to schizophrenia. Since sufficient expertise in the application of these tools and methods rarely reside in a single individual, or even a single laboratory, collaboration is a key element in this endeavor. Here, we review some of the products of our integrative efforts in collaboration with our colleagues on the East Coast of Australia and Pacific Rim. This research focuses on the neural basis of executive function deficits and impairments in early auditory processing in patients using various combinations of performance indices (from perceptual and cognitive paradigms), ERPs, fMRI and sMRI. In each case, integration of two or more sources of information provides more information than any one source alone by revealing new insights into structure-function relationships. Furthermore, the addition of other imaging methodologies (such as DTI) and approaches (such as computational models of cognition) offers new horizons in human brain imaging research and in understanding human behavior.