Why nurses are resigning from rural and remote Queensland health facilities

This paper presents a selection of the results reported in the study “Factors Influencing the Recruitment and Retention of Rural and Remote Area Nurses in Queensland” (Hegney et al 2001). The main aim of this study was to determine why nurses in those rural and remote areas of Queensland that reported higher than State average turnover rates between February 1999 and May 2000, chose to leave their employment. The study therefore investigated the factors that influenced nurses' decisions to leave rural and remote area practice, the factors that influenced them to remain in practice and those factors nurses considered irrelevant to leaving or staying in rural/remote area nursing. This paper reports those factors the participants believed influenced them to leave rural and remote area nursing in Queensland. While the findings cannot be generalised to the Australian nursing workforce or to nurses not employed by Queensland Health, the study does confirm the findings of previous Australian research and formulates recommendations to assist future nursing workforce planning and policy.

Retaining rural and remote area nurses : The Queensland, Australia experience

Because higher-than-average turnover rates for nurses who work in remote and rural areas are the norm, the authors conducted a study to identify professional and personal factors that influenced rural nurses’ decisions to resign. Using a mail survey, the authors gathered qualitative and quantitative data from nurses who had resigned from rural and remote areas in Queensland, Australia. Their findings, categorized into professional and rural influences, highlight the importance of work force planning strategies that capitalize on the positive aspects of rural and remote area practice, to retain nurses in nonmetropolitan areas.

Developing an evidence-based clinical pathway for the assessment, diagnosis and management of acute Charcot Neuro-Arthropathy : a systematic review

Background: Charcot Neuro-Arthropathy (CN) is one of the more devastating complications of diabetes. To the best of the authors' knowledge, it appears that no clinical tools based on a systematic review of existing literature have been developed to manage acute CN. Thus, the aim of this paper was to systematically review existing literature and develop an evidence-based clinical pathway for the assessment, diagnosis and management of acute CN in patients with diabetes. Methods: Electronic databases (Medline, PubMed, CINAHL, Embase and Cochrane Library), reference lists, and relevant key websites were systematically searched for literature discussing the assessment, diagnosis and/or management of acute CN published between 2002-2012. At least two independent investigators then quality rated and graded the evidence of each included paper. Consistent recommendations emanating from the included papers were then fashioned in a clinical pathway. Results: The systematic search identified 267 manuscripts, of which 117 (44%) met the inclusion criteria for this study. Most manuscripts discussing the assessment, diagnosis and/or management of acute CN constituted level IV (case series) or EO (expert opinion) evidence. The included literature was used to develop an evidence-based clinical pathway for the assessment, investigations, diagnosis and management of acute CN. Conclusions: This research has assisted in developing a comprehensive, evidence-based clinical pathway to promote consistent and optimal practice in the assessment, diagnosis and management of acute CN. The pathway aims to support health professionals in making early diagnosis and providing appropriate immediate management of acute CN, ultimately reducing its associated complications such as amputations and hospitalisations.

Registration of clinical trials: Challenges for global regulation

In 2004 the International Committee of Medical Journal Editors (ICMJE) issued a statement indicating that from 1 July 2005 registration in a publicly accessible trials registry would be a condition of publication in an ICMJE member journal. The World Health Organisation is coordinating the International Clinical Trials Registry Platform (ICTRP) as a means of providing a standardised framework for registration. This article considers the practical challenges and opportunities that arise from these developments and considers the relevance of trial registration for women and minorities and for developing countries.

Gender inequities in health research : an Australian perspective

This chapter presents the current challenges facing legislators, regulators, researchers, and ethics committees in determining how and when to include women appropriately in research, and ensure that sex analysis of research results is routinely performed. It offers five issues that require attention to address these challenges: that national regulatory statements could provide researchers with definitions of the terms ‘sex’ , ‘gender’, and ‘gender equity’ in research; that sex and gender analysis should be built into health research protocols; the lack of internationally comparable data regarding the rates of inclusion of men and women presents a major hurdle for analysing the efficacy of different regulatory strategies; the accessibility of data would be facilitated by a requirement for publication of the results of health research to include descriptions of sex analysis performed on research data; and that institutional review boards, research ethics committees, and researchers themselves require better education about the scientific and ethical importance of including of women in clinical research.

Introduction - research ethics : women, sex, and gender in biomedical research

The ethical governance of biomedical research is an area of intense international debate. Scholars argue about who should regulate and how, the appropriate role for ethics committees, what kind of research should be included, and who should be involved in monitoring compliance. A particular aspect of these debates concerns the inclusion of women as research participants and the efforts to ensure that researchers consistently investigate questions of sex and gender in health research. There is increasing evidence of the role of sex in the manifestation and course of some illnesses and their treatment. Moreover, evidence suggests that gendered expectations also affect health outcomes. This special issue investigates how researchers are addressing these issues and debates the appropriate roles of policy makers, ethicists, and lawyers in ensuring that sex and gender differences are taken into account in the development, conduct, and reporting of health research.

Liability in negligence and the failure to disclose multiple risks in surgery : I would have been willing to run the risk

It has been 21 years since the decision in Rogers v Whitaker and the legal principles concerning informed consent and liability for negligence are still strongly grounded in this landmark High Court decision. This paper considers more recent developments in the law concerning the failure to disclose inherent risks in medical procedures, focusing on the decision in Wallace v Kam [2013] HCA 19. In this case, the appellant underwent a surgical procedure that carried a number of risks. The surgery itself was not performed in a sub-standard way, but the surgeon failed to disclose two risks to the patient, a failure that constituted a breach of the surgeon’s duty of care in negligence. One of the undisclosed risks was considered to be less serious than the other, and this lesser risk eventuated causing injury to the appellant. The more serious risk did not eventuate, but the appellant argued that if the more serious risk had been disclosed, he would have avoided his injuries completely because he would have refused to undergo the procedure. Liability was disputed by the surgeon, with particular reference to causation principles. The High Court of Australia held that the appellant should not be compensated for harm that resulted from a risk he would have been willing to run. We examine the policy reasons underpinning the law of negligence in this specific context and consider some of the issues raised by this unusual case. We question whether some of the judicial reasoning adopted in this case, represents a significant shift in traditional causation principles.

A new distributed control strategy to coordinate multiple dstatcoms in LV network

Voltage rise is the main issue which limits the capacity of Low Voltage (LV) network to accommodate more Renewable Energy (RE) sources. In addition, voltage drop at peak load period is a significant power quality concern. This paper proposes a new robust voltage support strategy based on distributed coordination of multiple distribution static synchronous compensators (DSTATCOMs). The study focuses on LV networks with PV as the RE source for customers. The proposed approach applied to a typical LV network and its advantages are shown comparing with other voltage control strategies.

Ion-molecule reactions of O,S-Dimethyl methylphosphonothioate : Evidence for intramolecular sulfur oxidation during VX perhydrolysis

The alkaline perhydrolysis of the nerve agent O-ethyl S-[2-(diisopropylamino)ethyl] methylphosphonothioate (VX) was investigated by studying the ion-molecule reactions of HOO(-) with O,S-dimethyl methylphosphonothioate in a modified linear ion-trap mass spectrometer. In addition to simple proton transfer, two other abundant product ions are observed at m/z 125 and 109 corresponding to the S-methyl methylphosphonothioate and methyl methylphosphonate anions, respectively. The structure of these product ions is demonstrated by a combination of collision-induced dissociation and isotope-labeling experiments that also provide evidence for their formation by nucleophilic reaction pathways, namely, (i) S(N)2 at carbon to yield the S-methyl methylphosphonothioate anion and (ii) nucleophilic addition at phosphorus affording a reactive pentavalent intermediate that readily undergoes internal sulfur oxidation and concomitant elimination of CH(3)SOH to yield the methyl methylphosphonate anion. Consistent with previous Solution phase observations of VX perhydrolysis, the toxic P-O cleavage product is not observed in this VX model system and theoretical calculations identify P-O cleavage to be energetically uncompetitive. Conversely, intramolecular sulfur oxidation is calculated to be extremely exothermic and kinetically accessible explaining its competitiveness with the facile gas phase proton transfer process. Elimination of a sulfur moiety deactivates the nerve agent VX and thus the intramolecular sulfur oxidation process reported here is also able to explain the selective perhydrolysis of the nerve agent to relatively nontoxic products.

Never too old : engaging retired people inventing the future with MaKey MaKey

Within HCI, aging is often viewed in terms of designing assistive technologies to improve the lives of older people, such as those who are suffering from frailty or memory loss. Our research adopts a very different approach, reframing the relationship in terms of wisdom, creativity and invention. We ran a series of workshops where groups of retirees, aged between early 60s and late 80s, used the MaKey MaKey inventor's toolkit. We asked them to think about inventing the future and suggest ideas for new technologies. Our findings showed that they not only rose to the challenge but also mastered the technology, collaborated intensely together while using it and freely and at length discussed their own, their family's and others' relationship with technology. We discuss the value of empowering people in this way and consider what else could be invented to enable more people to be involved in the design and use of creative technologies.

Autonomy in technology design

Issues of autonomy impact motivation, the user experience and even psychological wellbeing, yet many questions surrounding design for autonomy remain unanswered. This workshop will explore theory, issues and design strategies related to autonomy drawing on theoretical frameworks available in psychology and looking at autonomy from multiple levels. These include user autonomy within the context of software environments, technologies that increase autonomy in daily life, and how technologies might foster autonomy as a component of psychological development.

Fusiform activation to animals is driven by the process, not the stimulus

Previous studies have found that the lateral posterior fusiform gyri respond more robustly to pictures of animals than pictures of manmade objects and suggested that these regions encode the visual properties characteristic of animals. We suggest that such effects actually reflect processing demands arising when items with similar representations must be finely discriminated. In a positron emission tomography (PET) study of category verification with colored photographs of animals and vehicles, there was robust animal-specific activation in the lateral posterior fusiform gyri when stimuli were categorized at an intermediate level of specificity (e.g., dog or car). However, when the same photographs were categorized at a more specific level (e.g., Labrador or BMW), these regions responded equally strongly to animals and vehicles. We conclude that the lateral posterior fusiform does not encode domain-specific representations of animals or visual properties characteristic of animals. Instead, these regions are strongly activated whenever an item must be discriminated from many close visual or semantic competitors. Apparent category effects arise because, at an intermediate level of specificity, animals have more visual and semantic competitors than do artifacts.

Anterior temporal cortex and semantic memory : reconciling findings from neuropsychology and functional imaging

Studies of semantic impairment arising from brain disease suggest that the anterior temporal lobes are critical for semantic abilities in humans; yet activation of these regions is rarely reported in functional imaging studies of healthy controls performing semantic tasks. Here, we combined neuropsychological and PET functional imaging data to show that when healthy subjects identify concepts at a specific level, the regions activated correspond to the site of maximal atrophy in patients with relatively pure semantic impairment. The stimuli were color photographs of common animals or vehicles, and the task was category verification at specific (e.g., robin), intermediate (e.g., bird), or general (e.g., animal) levels. Specific, relative to general, categorization activated the antero-lateral temporal cortices bilaterally, despite matching of these experimental conditions for difficulty. Critically, in patients with atrophy in precisely these areas, the most pronounced deficit was in the retrieval of specific semantic information.

Contradictions and the Appropriation of ERP Packages

Enterprise Resource Planning (ERP) software typically takes the form of a package that is licensed for use to those in a client organisation and is sold as being able to automate a wide range of processes within organisations. ERP packages have become an important feature of information and communications technology (ICT) infrastructures in organizations. However, a number of highly publicised failures have been associated with the ERP packages too. For example: Hershey, Aero Group and Snap-On have blamed the implementation of ERP packages for negative impacts upon earnings (Scott and Vessey 2000); Cadbury Schweppes implemented plans to fulfil 250 orders where normally they would fulfil 1000 due to the increased complexity and the need to re-train staff post implementation (August 1999) and FoxMeyer drug company’s implementation of an ERP package has been argued to have lead to bankruptcy proceedings resulting in litigation against SAP, the software vendor in question (Bicknell 1998). Some have even rejected a single vendor approach outright (Light et. al. 2001). ERP packages appear to work for some and not for others, they contain contradictions. Indeed, if we start from the position that technologies do not provide their own explanation, then we have to consider the direction of a technological trajectory and why it moves in one way rather than another (Bijker and Law 1994). In other words, ERP appropriation cannot be predetermined as a success, despite the persuasive attempts of vendors via their websites and other marketing channels. Moreover, just because ERP exists, we cannot presume that all will appropriate it in the same fashion, if at all. There is more to the diffusion of innovations than stages of adoption and a simple demarcation between adoption and rejection. The processes that are enacted in appropriation need to be conceptualised as a site of struggle, political and imbued with power (Hislop et. al. 2000; Howcroft and Light, 2006). ERP appropriation and rejection can therefore be seen as a paradoxical phenomenon. In this paper we examine these contradictions as a way to shed light on the presence and role of inconsistencies in ERP appropriation and rejection. We argue that much of the reasoning associated with ERP adoption is pro-innovation biased and that deterministic models of the diffusion of innovations such as Rogers (2003), do not adequately take account of contradictions in the process. Our argument is that a better theoretical understanding of these contradictions is necessary to underpin research and practice in this area. In the next section, we introduce our view of appropriation. Following this is an outline of the idea of contradiction, and the strategies employed to ‘cope’ with this. Then, we introduce a number of reasons for ERP adoption and identify their inherent contradictions using these perspectives. From this discussion, we draw a framework, which illustrates how the interpretive flexibility of reasons to adopt ERP packages leads to contradictions which fuel the enactment of appropriation and rejection.