Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments.

Executive summary Objective: The aims of this study were to identify the impact of Pandemic (H1N1) 2009 Influenza on Australian Emergency Departments (EDs) and their staff, and to inform planning, preparedness, and response management arrangements for future pandemics, as well as managing infectious patients presenting to EDs in everyday practice. Methods This study involved three elements: 1. The first element of the study was an examination of published material including published statistics. Standard literature research methods were used to identify relevant published articles. In addition, data about ED demand was obtained from Australian Government Department of Health and Ageing (DoHA) publications, with several state health departments providing more detailed data. 2. The second element of the study was a survey of Directors of Emergency Medicine identified with the assistance of the Australasian College for Emergency Medicine (ACEM). This survey retrieved data about demand for ED services and elicited qualitative comments on the impact of the pandemic on ED management. 3. The third element of the study was a survey of ED staff. A questionnaire was emailed to members of three professional colleges—the ACEM; the Australian College of Emergency Nursing (ACEN); and the College of Emergency Nursing Australasia (CENA). The overall response rate for the survey was 18.4%, with 618 usable responses from 3355 distributed questionnaires. Topics covered by the survey included ED conditions during the (H1N1) 2009 influenza pandemic; information received about Pandemic (H1N1) 2009 Influenza; pandemic plans; the impact of the pandemic on ED staff with respect to stress; illness prevention measures; support received from others in work role; staff and others’ illness during the pandemic; other factors causing ED staff to miss work during the pandemic; and vaccination against Pandemic (H1N1) 2009 Influenza. Both qualitative and quantitative data were collected and analysed. Results: The results obtained from Directors of Emergency Medicine quantifying the impact of the pandemic were too limited for interpretation. Data sourced from health departments and published sources demonstrated an increase in influenza-like illness (ILI) presentations of between one and a half and three times the normal level of presentations of ILIs. Directors of Emergency Medicine reported a reasonable level of preparation for the pandemic, with most reporting the use of pandemic plans that translated into relatively effective operational infection control responses. Directors reported a highly significant impact on EDs and their staff from the pandemic. Growth in demand and related ED congestion were highly significant factors causing distress within the departments. Most (64%) respondents established a ‘flu clinic’ either as part of Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments. the ED operations or external to it. They did not note a significantly higher rate of sick leave than usual. Responses relating to the impact on staff were proportional to the size of the colleges. Most respondents felt strongly that Pandemic (H1N1) 2009 Influenza had a significant impact on demand in their ED, with most patients having low levels of clinical urgency. Most respondents felt that the pandemic had a negative impact on the care of other patients, and 94% revealed some increase in stress due to lack of space for patients, increased demand, and filling staff deficits. Levels of concern about themselves or their family members contracting the illness were less significant than expected. Nurses displayed significantly higher levels of stress overall, particularly in relation to skill-mix requirements, lack of supplies and equipment, and patient and patients’ family aggression. More than one-third of respondents became ill with an ILI. Whilst respondents themselves reported taking low levels of sick leave, respondents cited difficulties with replacing absent staff. Ranked from highest to lowest, respondents gained useful support from ED colleagues, ED administration, their hospital occupational health department, hospital administration, professional colleges, state health department, and their unions. Respondents were generally positive about the information they received overall; however, the volume of information was considered excessive and sometimes inconsistent. The media was criticised as scaremongering and sensationalist and as being the cause of many unnecessary presentations to EDs. Of concern to the investigators was that a large proportion (43%) of respondents did not know whether a pandemic plan existed for their department or hospital. A small number of staff reported being redeployed from their usual workplace for personal risk factors or operational reasons. As at the time of survey (29 October –18 December 2009), 26% of ED staff reported being vaccinated against Pandemic (H1N1) 2009 Influenza. Of those not vaccinated, half indicated they would ‘definitely’ or ‘probably’ not get vaccinated, with the main reasons being the vaccine was ‘rushed into production’, ‘not properly tested’, ‘came out too late’, or not needed due to prior infection or exposure, or due to the mildness of the disease. Conclusion: Pandemic (H1N1) 2009 Influenza had a significant impact on Australian Emergency Departments. The pandemic exposed problems in existing plans, particularly a lack of guidelines, general information overload, and confusion due to the lack of a single authoritative information source. Of concern was the high proportion of respondents who did not know if their hospital or department had a pandemic plan. Nationally, the pandemic communication strategy needs a detailed review, with more engagement with media networks to encourage responsible and consistent reporting. Also of concern was the low level of immunisation, and the low level of intention to accept vaccination. This is a problem seen in many previous studies relating to seasonal influenza and health care workers. The design of EDs needs to be addressed to better manage infectious patients. Significant workforce issues were confronted in this pandemic, including maintaining appropriate staffing levels; staff exposure to illness; access to, and appropriate use of, personal protective equipment (PPE); and the difficulties associated with working in PPE for prolonged periods. An administrative issue of note was the reporting requirement, which created considerable additional stress for staff within EDs. Peer and local support strategies helped ensure staff felt their needs were provided for, creating resilience, dependability, and stability in the ED workforce. Policies regarding the establishment of flu clinics need to be reviewed. The ability to create surge capacity within EDs by considering staffing, equipment, physical space, and stores is of primary importance for future pandemics.

Transitions

Transitions represents a selection of works presented by 3rd year QUT design students undertaken as part of their coursework entitled "Environments in Transitions". The work focuses upon the migration of ideas and aesthetics from East to West, with particular consideration for the influence of Japanese woodblock prints, Wabi-Sabi themes and decorative motifs upon European design during the turn of the 19th century. The works exhibited included design artifacts of various themes, and associated print work which informed the design process. A small exhibition publication accompanied the exhibition and talk.

Aesthetic tensions : evaluating outcomes for practice-led research and industry

This paper explores principles of contemporary aesthetics to suggest a basis for determining qualitative outcomes of artistic works in two contexts: the arts industry and the academy setting of practice-led research. Commonly articulated measures of quality—creativity and innovation—are questioned as mere rhetoric if not framed in specific ways in the two discrete settings. The paper also interrogates generally held assumptions that a longer time to develop work and greater periods of self-reflexivity will produce higher calibre artistic outcomes. The unease produced by apparent differences in qualitative outcomes between art works created in an industry setting and those created through practice-led research is analysed through three interconnected framing devices: intention, contextual parameters and criteria for evaluation, in conjunction with the relationships between the art work, the artist and the audience/viewer/listener. Common and differentiated criteria in the two contexts are explored, leading to the conclusion that innovation is more likely to be revealed in the end product in an industry context whereas in practice-led research it may be in the methodological processes of creating the work. While identifying and acknowledging that the two contexts encourage and produce distinctive qualitative artistic outcomes, both of value to the arts and the academy, the paper recommends ways in which closer formal liaison between industry artists and practice-led artists and supervisors might occur in order to ensure ongoing mutual influence and relevance.

How optometrists record corneal staining

Purpose: The aim of this study was to determine current approaches adopted by optometrists to the recording of corneal staining following fluorescein instillation. Methods: An anonymous ‘record-keeping task’ was sent to all 756 practitioners who are members of the Queensland Division of Optometrists Association Australia. This task comprised a form on which appeared a colour photograph depicting contact lens solution-induced corneal staining. Next to the photograph was an empty box, in which practitioners were asked to record their observations. Practitioners were also asked to indicate the level of severity of the condition at which treatment would be instigated. Results: Completed task forms were returned by 228 optometrists, representing a 30 per cent response rate. Ninety-two per cent of respondents offered a diagnosis. The most commonly used descriptive terms were ‘superficial punctate keratitis’ (36 per cent of respondents) and ‘punctate staining’ (29 per cent). The level of severity and location of corneal staining were noted by 69 and 68 per cent of respondents, respectively. A numerical grade was assigned by 44 per cent of respondents. Only three per cent nominated the grading scale used. The standard deviation of assigned grades was � 0.6. The condition was sketched by 35 per cent of respondents and two per cent stated that they would take a photograph of the eye. Ten per cent noted the eye in which the condition was being observed. Opinions of the level of severity at which treatment for corneal staining should be instigated varied considerably between practitioners, ranging from ‘any sign of corneal staining’ to ‘grade 4 staining’. Conclusion: Although most practitioners made a sensible note of the condition and properly recorded the location of corneal staining, serious deficiencies were evident regarding other aspects of record-keeping. Ongoing programs of professional optometric education should reinforce good practice in relation to clinical record-keeping.

The art of careful listening : children as co-artists in the making of live performance

Since 2007 Kite Arts Education Program (KITE), based at Queensland Performing Arts Centre (QPAC), has been engaged in delivering a series of theatre-based experiences for children in low socio-economic primary schools in Queensland. The twelve-week workshop experience culminates in a performance developed by the children with the assistance of the teacher artists from KITE for their community and parents/carers in a peak community cultural institution. Using Wartella’s notion of the socially competent child this analysis interrogates the performance product Precious, child participation modes, the intersection between the professional artists, teacher artists and child artists and outcomes in terms of building capacities for the development of social competencies in children.

The cultural and creative industries

A critical and Historical account of the cultural and creative industries as a policy discourse. It argues that the emergence of a cultural policy discourse was part of a progressive democratic politics from the 1960s onwards, taking cognizance of the emergence of new kinds of commercial popular culture. It suggests that this period saw the merging of aesthetics and culture in particular ways. The creative industries come from a different source which combined innovation theory, embedded economics and entrepreneurialism in ways that resulted in a much less progressive politics. The chapter ends by suggesting the the idea of the creative industries is now at an end.

Arts and creative industries

The book examines the relationship between the notion of 'art' and of 'the creative industries'. Staring with a brief overview of some contemporary views from Australia's leading creative and artistic people it goes on to give an historical account of this long and complex relationship. In the last two chapters it outlines how we might approach the relationship between art,design and media and understand their complex location within an urban ecosystem.

Tea ceremony and Sukiya : negating social hierarchy

There is a widely held view that architecture is very strongly and even primarily determined by the society and culture rather than geographical, technical, economic or cli-matic factors. This is especially evident in societies where rituals, customs and tradition play a significant role in the design of built forms. One such society was that of Feudal Japan under the rule of samurai warriors. The strictly controlled hierarchical society of Feudal Japan, isolated from the rest of the world for over 250 years, was able to develop the art and architecture borrowed from neighboring older cultures of China and Korea into what is now considered uniquely Japanese. One such architecture is the Sukiya style tea houses where the ritual of tea ceremony took place. This ritual was developed by the tea masters who were Zen monks or the merchants who belonged to the lowest class in the hierarchical feudal society. The Sukiya style developed from 14th to 16th century and became an architectural space that negated all the rules imposed on commoners by the samurai rulers. The tea culture had a major influence on Japanese architecture, the concept of space and aesthetics. It extended into the design of Japanese gardens, clothes, presentation of food, and their manners in day to day life. The focus of this paper is the Japanese ritual of tea ceremony, the architecture of the tea house it inspired, the society responsible for its creation and the culture that promoted its popularity and its continuation into the 21st century.

Heroes & harmony

The first practice-led research project 'Heroes of the Club', through collaboration with business and community, involved portraying the stories on canvas of heroes of the Australian Surf Life Saving movement. The second project 'Crossing the intersection… art and life' researched a post-modernist approach to a fusion of the aesthetics of Abstract Expressionism and Pop Art. This study resulted in a body of work 'Long Playing' which sought to harmoniously reconcile two apparent polarities of style and context between high and low art characteristics, through personal narrative and with reference to artistic tradition.

Bouncing back : the role of design in facilitating students to understand and deal with adversity

After state-wide flooding and a category-5 tropical cyclone, three-quarters of the state of Queensland was declared a disaster zone in early 2011. This deluge of adversity had a significant impact on university students, a few weeks prior to the start of the academic semester. The purpose of this paper is to examine the role that design plays in facilitating students to understand and respond to, adversity. The participants of this study were second and fourth year architectural design students at a large Australian University, in Queensland. As a part of their core architectural design studies, students were required to provide architectural responses to the recent catastrophic events in Queensland. Qualitative data was obtained through student surveys, work design work submitted by students and a survey of guests who attending an exhibition of the student work. The results of this research showed that the students produced more than just the required set of architectural drawings, process journals and models, but also recognition of the important role that the affective dimension of the flooding event and the design process played in helping them to both understand and respond to, adversity. They held the ‘real world’ experience and practical aspect of the assessment in higher regard than their typical focus on aesthetics and the making of iconic design. Perhaps most importantly, the students recognised that this process allowed them to have a voice, and a means to respond to adversity through the powerful language of design.

Visceral hedonic rhetoric

Emotional responses can incite and entice consumers to select a particular product from a row of similar items and thus have a considerable impact on purchase decisions. Consequently, more and more companies are challenging designers to address the emotional impact of their work and to design for emotion and consumerproduct relationships. Furthermore, the creation of emotional attachment to one’s possessions is one way of approaching a sustainable consumer-product relationship. The aim of this research is to gain a deeper understanding of the instantaneous emotional attachment that consumers form with products and its subsequent implications for product development. The foci of the study are visceral design, consumer hedonics and product rhetoric. Studied in a conglomerate they become an area of new investigation: visceral hedonic rhetoric. In this context, the term “visceral hedonic rhetoric” is defined as the properties of a product that persuasively elicit the pursuit of pleasure at an instinctual level of cognition. This study explores visceral hedonic rhetoric evident in the design of interactive products and resides within the context of emotional design research. It employs an empirical approach to understand how consumers respond hedonically on a visceral level to rhetoric in products. Specifically, it examines visceral hedonic responses given by thirty participants to the stimuli of six mobile telephones, six Mp3 players and six USB memory flash drives. The study findings demonstrate a hierarchy of visceral hedonic rhetoric evident in interactive products. This hierarchy of visceral hedonic attributes include: colour, size, shape, intrigue, material, perceived usability, portability, perceived function, novelty, analogy, brand, quality, texture and gender. However, it is the interrelationships between these visceral hedonic attributes that are the most significant findings of this research. Certain associations were revealed between product attribute combinations and consumer perception. The most predominant of these were: gender bias associated with colour selection; the creation of intrigue through a vibrant attention-grabbing colour; perceived ease of use and function; product confidence as a result of brand familiarity and perceived usability; analogous association through familiarity with similar objects and shapes; and the association of longevity with quality, novelty or recent technology. A significant outcome of the research is the distillation of visceral hedonic rhetoric design principles, and a tool to assist designers in harnessing the full potential of visceral hedonic rhetoric. This study contributes to the identification of the emerging research field of visceral hedonic rhetoric. Application of this study’s findings has the potential to provide a hedonic consumer-product relationship that is more meaningful, less disposable and more sustainable. This theory of visceral hedonic rhetoric is not only a significant contribution to design knowledge but is also generally transferable to other research domains, as later suggested in future research avenues.

Regimes and rebels

The end of the recent Communist occupation of the many countries bordering Russia marked an end to the tyranny of illegal and forced annexation. Amid these countries are my parents’ homelands, the small Baltic nations of Latvia and Estonia. Their occupation contravenes many of the numerous Articles listed by The Office of the High Commissioner for Human Rights in The Universal Declaration of Human Rights (2008), constituting many acts of violation. As a filmmaker, I was unusually incognizant of these events, despite my relationship to them. My parents never discussed the war, while during the ensuing Communist era, information was conspicuously absent. However, this lack of knowledge provided the incentive that compelled a journey of discovery that resulted in the making of Regimes and Rebels. This Masters project is presented is two parts. The film equates to 70% of the project (52 minutes in length), whilst the exegesis represents the remaining 30%. The film is a ‘human rights’, ‘video diary’ styled documentary film about the Communist occupation of my parents’ homelands, Latvia and Estonia, and the resonating effect of the occupation on our family living in Australia and family still living in the homelands. The production of the video diary is contextualised by this exegesis, which concurrently discusses the burgeoning video diary format as the basis for making a ‘human rights’ documentary film. A discussion about the latter genre of documentary film ensues, encompassing modes of representation, followed by various issues related to production including: issues of aesthetics, styles, digital media, lack of evidence and subjectivity analogous with both filmmaker and audience. Next, work by other filmmakers in the ‘human rights’ genre, linked to the proliferation of Communism in Europe, is discussed and analysed in terms of production and modes of representation. The exegesis ends with my experience as filmmaker and an analysis of factors that arose in making Regimes and Rebels.

The influence of glass types on the performance of air-conditioned office buildings in Australia

Windows are one of the most significant elements in the design of buildings. Whether there are small punched openings in the facade or a completely glazed curtain wall, windows are usually a dominant feature of the building's exterior appearance. From the energy use perspective, windows may also be regarded as thermal holes for a building. Therefore, window design and selection must take both aesthetics and serviceability into consideration. In this paper, using building computer simulation techniques, the effects of glass types on the thermal and energy performance of a sample air-conditioned office building in Australia are studied. It is found that a glass type with lower shading coefficient will have a lower building cooling load and total energy use. Through the comparison of results between current and future weather scenarios, it is identified that the pattern found from the current weather scenario would also exist in the future weather scenario, although the scale of change would become smaller. The possible implication of glazing selection in face of global warming is also examined. It is found that compared with its influence on building thermal performance, its influence on the building energy use is relatively small or insignificant.