Exploring the process of implementing a smoking cessation intervention in pregnancy training program for midwives

The question of how to implement evidence effectively reveals a deficiency in our knowledge and understanding of the compound factors involved in such a process (Kitson, Rycroft-Malone et al. 2008). Although there is some awareness of the complexities of the process, there has been little exploration of the effectiveness of implementing evidence-based programs in health care. Despite public awareness of the dangers of smoking in pregnancy, and widespread public health measures to prevent smoking-related disease, women still continue to smoke in pregnancy (Ananth, Savitz et al. 1997; Laws and Hilder 2008). Evaluation of public health measures concludes that smoking cessation interventions during pregnancy increase quit rates among pregnant women (Melvin, Dolan-Mullen et al. 2000; Albrecht, Maloni et al. 2004; Lumley, Oliver et al. 2007). Notwithstanding the potential for improvement in health outcomes for pregnant women and their unborn babies, smoking interventions are often conducted poorly or not at all. Although midwives understand why women smoke in pregnancy and parenthood and are aware of the risks of smoking to both the pregnancy and the unborn child, they require specific knowledge and skills in the provision of support and advice on smoking for pregnant women (Bull and Whitehead 2006) . Organisational-change research demonstrates the complexity of the process of planned change in professionalised institutions such as health care (Greenhalgh, Robert et al. 2005). Some innovations and interventions are never accepted, and others are poorly supported (Greenhalgh, Robert et al. 2004). Comprehension of the change process around health promotion is crucial to the implementation of new health promotion interventions within health care (Riley, Taylor et al. 2003). This study utilised a case study approach to explore the process of implementing a smoking cessation training program for midwives in Queensland metropolitan and regional clinical areas, who attended a ‘Train-the-Trainer program’. The study draws on the organisational change work of Greenhalgh et al (2004) as the theoretical framework through which situational and structural factors are explored and examined as they inform the implementation of smoking cessation programs. The research data constituted staged interviews with midwives who instituted training programs for midwives, as well as organisational and policy documentation. Analysis of the data identified some areas that were not fully addressed in the theoretical model; these formed the basis of the Discussion and Implications for Future Research.

Structural and thermal performance of cold-formed steel stud wall systems under fire conditions

Cold-formed steel stud walls are a major component of Light Steel Framing (LSF) building systems used in commercial, industrial and residential buildings. In the conventional LSF stud wall systems, thin steel studs are protected from fire by placing one or two layers of plasterboard on both sides with or without cavity insulation. However, there is very limited data about the structural and thermal performance of stud wall systems while past research showed contradicting results, for example, about the benefits of cavity insulation. This research was therefore conducted to improve the knowledge and understanding of the structural and thermal performance of cold-formed steel stud wall systems (both load bearing and non-load bearing) under fire conditions and to develop new improved stud wall systems including reliable and simple methods to predict their fire resistance rating. Full scale fire tests of cold-formed steel stud wall systems formed the basis of this research. This research proposed an innovative LSF stud wall system in which a composite panel made of two plasterboards with insulation between them was used to improve the fire rating. Hence fire tests included both conventional steel stud walls with and without the use of cavity insulation and the new composite panel system. A propane fired gas furnace was specially designed and constructed first. The furnace was designed to deliver heat in accordance with the standard time temperature curve as proposed by AS 1530.4 (SA, 2005). A compression loading frame capable of loading the individual studs of a full scale steel stud wall system was also designed and built for the load-bearing tests. Fire tests included comprehensive time-temperature measurements across the thickness and along the length of all the specimens using K type thermocouples. They also included the measurements of load-deformation characteristics of stud walls until failure. The first phase of fire tests included 15 small scale fire tests of gypsum plasterboards, and composite panels using different types of insulating material of varying thickness and density. Fire performance of single and multiple layers of gypsum plasterboards was assessed including the effect of interfaces between adjacent plasterboards on the thermal performance. Effects of insulations such as glass fibre, rock fibre and cellulose fibre were also determined while the tests provided important data relating to the temperature at which the fall off of external plasterboards occurred. In the second phase, nine small scale non-load bearing wall specimens were tested to investigate the thermal performance of conventional and innovative steel stud wall systems. Effects of single and multiple layers of plasterboards with and without vertical joints were investigated. The new composite panels were seen to offer greater thermal protection to the studs in comparison to the conventional panels. In the third phase of fire tests, nine full scale load bearing wall specimens were tested to study the thermal and structural performance of the load bearing wall assemblies. A full scale test was also conducted at ambient temperature. These tests showed that the use of cavity insulation led to inferior fire performance of walls, and provided good explanations and supporting research data to overcome the incorrect industry assumptions about cavity insulation. They demonstrated that the use of insulation externally in a composite panel enhanced the thermal and structural performance of stud walls and increased their fire resistance rating significantly. Hence this research recommends the use of the new composite panel system for cold-formed LSF walls. This research also included steady state tensile tests at ambient and elevated temperatures to address the lack of reliable mechanical properties for high grade cold-formed steels at elevated temperatures. Suitable predictive equations were developed for calculating the yield strength and elastic modulus at elevated temperatures. In summary, this research has developed comprehensive experimental thermal and structural performance data for both the conventional and the proposed non-load bearing and load bearing stud wall systems under fire conditions. Idealized hot flange temperature profiles have been developed for non-insulated, cavity insulated and externally insulated load bearing wall models along with suitable equations for predicting their failure times. A graphical method has also been proposed to predict the failure times (fire rating) of non-load bearing and load bearing walls under different load ratios. The results from this research are useful to both fire researchers and engineers working in this field. Most importantly, this research has significantly improved the knowledge and understanding of cold-formed LSF walls under fire conditions, and developed an innovative LSF wall system with increased fire rating. It has clearly demonstrated the detrimental effects of using cavity insulation, and has paved the way for Australian building industries to develop new wall panels with increased fire rating for commercial applications worldwide.

Raising the voice of dissatisfaction : a qualitative study of the Queensland acute health care consumer and the experience of complaining

Research into complaints handling in the health care system has predominately focused on examining the processes that underpin the organisational systems. An understanding of the cognitive decisions made by patients that influence whether they are satisfied or dissatisfied with the care they are receiving has had limited attention thus far. This study explored the lived experiences of Queensland acute care patients who complained about some aspect of their inpatient stay. A purposive sample of sixteen participants was recruited and interviewed about their experience of making a complaint. The qualitative data gathered through the interview process was subjected to an Interpretative Phenomenological Analysis (IPA) approach, guided by the philosophical influences of Heidegger (1889-1976). As part of the interpretive endeavour of this study, Lazarus’ cognitive emotive model with situational challenge was drawn on to provide a contextual understanding of the emotions experienced by the study participants. Analysis of the research data, aided by Leximancer™ software, revealed a series of relational themes that supported the interpretative data analysis process undertaken. The superordinate thematic statements that emerged from the narratives via the hermeneutic process were ineffective communication, standards of care were not consistent, being treated with disrespect, information on how to complain was not clear, and perceptions of negligence. This study’s goal was to provide health services with information about complaints handling that can help them develop service improvements. The study patients articulated the need for health care system reform; they want to be listened to, to be acknowledged, to be believed, for people to take ownership if they had made a mistake, for mistakes not to occur again, and to receive an apology. For these initiatives to be fully realised, the paradigm shift must go beyond regurgitating complaints data metrics in percentages per patient contact, towards a concerted effort to evaluate what the qualitative complaints data is really saying. An opportunity to identify a more positive and proactive approach in encouraging our patients to complain when they are dissatisfied has the potential to influence improvements.

Joined-up governance in Australia : how the past can inform the future

Joined-up enterprises have become a cornerstone of the institutional architecture to facilitate closer linkages within and between departments and across sectors. Some of these initiatives are now mainstream enterprises, while others struggled to gain purchase or effect. Since the future is likely to be characterized by an ongoing emphasis on joined-up initiatives, an assessment of past efforts can provide a valuable backdrop for the development of new approaches and the fine tuning of existing ones. Drawing on ten years of research data, this article tracks the ebbs and flows of joined-up or integrated practice in Queensland. In doing so, it examines the drivers for integration, preferred models, and the language used to engender change. It also assesses what has worked and why and whether integrated reform has been sustained. Based on these insights, an extended integration framework is presented, which will assist those responsible for the design, monitoring, and evaluation of joined-up processes.

Good Practice Report : Blended Learning

In early 2011, the Australian Learning and Teaching Council Ltd (ALTC) commissioned a series of Good Practice Reports on completed ALTC projects and fellowships. This report will: • Provide a summative evaluation of the good practices and key outcomes for teaching and learning from completed ALTC projects and fellowships relating to blended learning • Include a literature review of the good practices and key outcomes for teaching and learning from national and international research • Identify areas in which further work or development are appropriate. The literature abounds with definitions; it can be argued that the various definitions incorporate different perspectives, but there is no single, collectively accepted definition. Blended learning courses in higher education can be placed somewhere on a continuum, between fully online and fully face-to-face courses. Consideration must therefore be given to the different definitions for blended learning presented in the literature and by users and stakeholders. The application of this term in these various projects and fellowships is dependent on the particular focus of the team and the conditions and situations under investigation. One of the key challenges for projects wishing to develop good practice in blended learning is the lack of a universally accepted definition. The findings from these projects and fellowships reveal the potential of blended learning programs to improve both student outcomes and levels of satisfaction. It is clear that this environment can help teaching and learning engage students more effectively and allow greater participation than traditional models. Just as there are many definitions, there are many models and frameworks that can be successfully applied to the design and implementation of such courses. Each academic discipline has different learning objectives and in consequence there can’t be only one correct approach. This is illustrated by the diversity of definitions and applications in the ALTC funded projects and fellowships. A review of the literature found no universally accepted guidelines for good practice in higher education. To inform this evaluation and literature review, the Seven Principles for Good Practice in Undergraduate Education, as outlined by Chickering and Gamson (1987), were adopted: 1. encourages contacts between students and faculty 2. develops reciprocity and cooperation among students 3. uses active learning techniques 4. gives prompt feedback 5. emphasises time on task 6. communicates high expectations 7. respects diverse talents and ways of learning. These blended learning projects have produced a wide range of resources that can be used in many and varied settings. These resources include: books, DVDs, online repositories, pedagogical frameworks, teaching modules. In addition there is valuable information contained in the published research data and literature reviews that inform good practice and can assist in the development of courses that can enrich and improve teaching and learning.

Managing large collections of business process models - Current techniques and challenges

Nowadays, business process management is an important approach for managing organizations from an operational perspective. As a consequence, it is common to see organizations develop collections of hundreds or even thousands of business process models. Such large collections of process models bring new challenges and provide new opportunities, as the knowledge that they encapsulate requires to be properly managed. Therefore, a variety of techniques for managing large collections of business process models is being developed. The goal of this paper is to provide an overview of the management techniques that currently exist, as well as the open research challenges that they pose.

Understanding neighbourhood liveability for older urban Australians

As with other major developed cities, the sub-tropical and fastest growing Australian capital city of Brisbane has adopted policies designed to increase residential densities and meet the liveability and sustainability goal of decreasing car dependence and greenhouse gas emissions. This goal hinges on a pedestrian friendly environment and walkable proximity to satisfy everyday needs. While older people are particularly attracted to sub-tropical urban environments, there has been little empirical evidence linking liveability satisfaction and perceived and actual use of older people’s urban neighbourhood. Using qualitative (diaries and in-depth interviews) and quantitative (Global Positioning Systems and Geographical Information Systems mapping) liveability research data this paper explores whether high density supports liveability and is sustainable for older people living in a sub-tropical urban environment. This paper links satisfaction and perceived use of the sub-tropical urban Brisbane environment with actual mapped characteristics and use. Linking the two methods (both quantitative and qualitative) is important in obtaining a greater understanding of human behaviour and the lived world of older urban Australians and in providing a wider picture of sub-tropical urban neighbourhoods for a significant population group within those neighbourhoods. What emerges from the research is an uneven standard of design, provision of amenities and maintenance of the public realm which negatively impacts on local neighbourhood participation by older urban Australians. By highlighting these issues this research furthers the understanding of design factors which make the sub-tropical urban neighbourhood more liveable and sustainable for older people and will inform actionable and implementable policies, programs and designs.

Development and testing of an iPad application for teaching self-management to heart failure patients. (Nursing/Allied Health Professional Investigator Award)- Abstract

Purpose: Heart failure (HF) is the leading cause of hospitalization and significant burden to the health care system in Australia. To reduce hospitalizations, multidisciplinary approaches and enhance self-management programs have been strongly advocated for HF patients globally. HF patients who can effectively manage their symptoms and adhere to complex medicine regimes will experience fewer hospitalizations. Research indicates that information technologies (IT) have a significant role in providing support to promote patients' self-management skills. The iPad utilizes user-friendly interfaces and to date an application for HF patient education has not been developed. This project aimed to develop the HF iPad teaching application in the way that would be engaging, interactive and simple to follow and usable for patients' carers and health care workers within both the hospital and community setting. Methods: The design for the development and evaluation of the application consisted of two action research cycles. Each cycle included 3 phases of testing and feedback from three groups comprising IT team, HF experts and patients. All patient education materials of the application were derived from national and international evidence based practice guidelines and patient self-care recommendations. Results: The iPad application has animated anatomy and physiology that simply and clearly teaches the concepts of the normal heart and the heart in failure. Patient Avatars throughout the application can be changed to reflect the sex and culture of the patient. There is voice-over presenting a script developed by the heart failure expert panel. Additional engagement processes included points of interaction throughout the application with touch screen responses and the ability of the patient to enter their weight and this data is secured and transferred to the clinic nurse and/or research data set. The application has been used independently, for instance, at home or using headphones in a clinic waiting room or most commonly to aid a nurse-led HF consultation. Conclusion: This project utilized iPad as an educational tool to standardize HF education from nurses who are not always heart failure specialists. Furthermore, study is currently ongoing to evaluate of the effectiveness of this tool on patient outcomes and to develop several specifically designed cultural adaptations [Hispanic (USA), Aboriginal (Australia), and Maori (New Zealand)].

Experimental study of load bearing cold-formed steel wall systems under fire conditions

Light Gauge Steel Framing (LSF) walls made of cold-formed and thin-walled steel lipped channel studs with plasterboard linings on both sides are commonly used in commercial, industrial and residential buildings. However, there is limited data about their structural and thermal performance under fire conditions while past research showed contradicting results about the benefits of using cavity insulation. A new composite wall panel was recently proposed to improve the fire resistance rating of LSF walls, where an insulation layer was used externally between the plasterboards on both sides of the wall frame instead of using it in the cavity. In this research 11 full scale tests were conducted on conventional load bearing steel stud walls with and without cavity insulation, and the new composite panel system to study their thermal and structural performance under standard fire conditions. These tests showed that the use of cavity insulation led to inferior fire performance of walls, and provided supporting research data. They demonstrated that the use of insulation externally in a composite panel enhanced the thermal and structural performance of LSF walls and increased their fire resistance rating. This paper presents the details of the LSF wall tests and the thermal and structural performance data and fire resistance rating of load-bearing wall assemblies lined with varying plasterboard-insulation configurations under two different load ratios. Fire test results including the time–temperature and deflection profiles are presented along with the failure times and modes.

Collaborative governance and innovation in social enterprises

While social enterprises have gained increasing policy attention as vehicles for generating innovative responses to complex social and environmental problems, surprisingly little is known about them. In particular, the social innovation produced by social enterprises (Mulgan, Tucker, Ali, & Sander, 2007) has been presumed rather than demonstrated, and remains under-investigated in the literature. While social enterprises are held to be inherently innovative as they seek to response to social needs (Nicholls, 2010), there has been conjecture that the collaborative governance arrangements typical in social enterprises may be conducive to innovation (Lumpkin, Moss, Gras, Kato, & Amezcua, In press), as members and volunteers provide a source of creative ideas and are unfettered in such thinking by responsibility to deliver organisational outcomes (Hendry, 2004). However this is complicated by the sheer array of governance arrangements which exist in social enterprises, which range from flat participatory democratic structures through to hierarchical arrangements. In continental Europe, there has been a stronger focus on democratic participation as a characteristic of Social Enterprises than, for example, the USA. In response to this gap in knowledge, a research project was undertaken to identify the population of social enterprises in Australia. The size, composition and the social innovations initiated by these enterprises has been reported elsewhere (see Barraket, 2010). The purpose of this paper is to undertake a closer examination of innovation in social enterprises – particularly how the collaborative governance of social enterprises might influence innovation. Given the pre-paradigmatic state of social entrepreneurship research (Nicholls, 2010), and the importance of drawing draw on established theories in order to advance theory (Short, Moss, & Lumpkin, 2009), a number of conceptual steps are needed in order to examine how collaborative governance might influence by social enterprises. In this paper, we commence by advancing a definition as to what a social enterprise is. In light of our focus on the potential role of collaborative governance in social innovation amongst social enterprises, we go on to consider the collaborative forms of governance prevalent in the Third Sector. Then, collaborative innovation is explored. Drawing on this information and our research data, we finally consider how collaborative governance might affect innovation amongst social enterprises.

Leadership of public education : an exploration of executive leaders in education Queensland

Education reform aimed at achieving improved student learning is a demanding challenge for leaders at all levels of education across the globe. In Queensland, Australia, Assistant Regional Directors, School Performance (ARD-SP) of public schools are executive leaders at the forefront of this challenge, working with groups, clusters, or networks of schools and one-on-one with principals, focusing on the performance of their schools. The ARD-SP role was recently established to positively impact student learning across the entire public school system in Queensland. The proposed study aimed to capture how ARDs-SP conceptualise and enact their leadership role. The study utilised a micropolitical perspective of leadership to understand the way in which these leaders talked about their leadership practices, their challenges, and the wider contextual factors impacting upon their work. A case study methodology guided the study and allowed ARDs-SP to share their understandings and enactment of executive leadership. A conceptual framework drawing upon the micropolitical leadership framework of Blase and Anderson (1995) was employed to analyse the research data gathered. Data were collected from Education Queensland (EQ) (i.e. that sector of the Department of Education and Training in Queensland responsible for public schools) policy material and reports and two rounds of semi-structured interviews with 18 ARD-SP participants and two senior EQ executives. The findings of this study were initially presented as four themes: performance, supervision, professional challenge, and system sustainability. They were then considered in the light of the literature and explored through the macro, meso, and micro layers within the conceptual framework. The key findings of this study found that ARDs-SP referred to using two different leadership approaches (i.e. an adversarial approach and/or a facilitative approach) when supervising school principals and the approach employed depended primarily upon the perceived performance of the principal. It was also found that the notion of supervision embedded within the role was perceived by ARDs-SP as problematic. These findings imply opportunities to refine the role and in doing so harness other system improvement strategies for EQ. An important contribution of this study was a reconceptualised conceptual framework that showed leadership approaches used by ARDs-SP as falling upon a continuum.

Exploring the challenges to industrialized residential building in China

Industrialised building (IB) is considered by many to have an important role to play in China's residential construction industry due to its potential for improved quality, productivity, efficiency, safety and sustainability. It is surprising, therefore, that although a large number of construction programmes have been completed in the country in recent years, very few have been built in this manner. Quite why this situation exists is unknown. The well-known problems with IB, such as the constraints placed on designer freedom, may be the cause. It is equally possible that, as is typical with developing countries such as China, cost or government issues dominate. On the other hand, in comparison with other countries, the construction industry in China has been widely criticised for its lack of modernity. Either way, there is an urgent need to assess and understand the hindrances to the adoption of IB in residential construction in order to identify what corrective measures, if any, need to be taken. Towards this end, we first identify a set of critical factors (CFs) for assessing the hindrances to IB adoption in China. This involves the analysis of research data collected by a questionnaire survey of experienced housing developers and professionals working in China's construction industry sector. Fuzzy set theory is used in the selection of the CFs. These CFs comprise, in rank order: higher initial cost; lack of skilled labour in IB; manufacturing capability and involvement issues and product quality problems; lack of supply chain; lack of codes and standards; and lack of government incentives, directives and promotion. The establishment of the CFs provides a basis for local construction sectors to better equip themselves for future implementation of IB. The findings also indicate a current need for formulating improved policies and strategies to encourage the further development of IB in China at present.

The University of Queensland St Lucia campus 1.22 MW photovoltaic array

At the time of its official opening on 15 July 2011, The University of Queensland 1.22 MW array was the largest flat-panel PhotoVoltaic (PV) array in Australia. This PV array consists of over 5000 Trina Solar 240 Wp polycrystalline silicon PV modules installed across four rooftops at the St Lucia campus. Grid connection was achieved with 85 12.5 kW three phase and four 5 kW single phase grid connect inverters manufactured by Power-One. The site also includes one 8.4 kWp SolFocus concentrating solar 2 axis tracking PV array. Site wide monitoring and data logging of all DC, AC and environmental quantities will allow this array to be a rich source of research data. The site will also include a 200 kW 400 kWh zinc bromine energy storage system by Redflow, and associated power quality metering and monitoring. This paper presents highlights of the project feasibility study which included a site survey, shading analysis, and technology and triple bottom line assessment. A detailed description of the final technical implementation including discussion of alterative options considered is given. Finally, example initial data showing yield, trends and early example experimental results are presented.

Effective technologies for noninvasive remote monitoring in heart failure

Background Trials of new technologies to remotely monitor for signs and symptoms of worsening heart failure are continually emerging. The extent to which technological differences impact the effectiveness of non-invasive remote monitoring for heart failure management is unknown. Objective To examine the effect of specific technology used for non-invasive remote monitoring of people with heart failure on all-cause mortality and heart failure-related hospitalisations. Methods A sub-analysis of a large systematic review and meta-analysis was conducted. Studies were stratified according to the specific type of technology used and separate meta-analyses were performed. Four different types of non-invasive remote monitoring technologies were identified including structured telephone calls, videophone, interactive voice response devices and telemonitoring. Results Only structured telephone calls and telemonitoring were effective in reducing the risk of all-cause mortality (RR 0.87; 95% CI=0.75-1.01; p=0.06 and 0.62; 95% CI=0.50-0.77; p<0.0001) and heart failure-related hospitalisations (RR 0.77; 95% CI=0.68-0.87; p<0.001) and 0.75; 95% CI=0.63-0.91; p=0.003). More research data is required for videophone and interactive voice response technologies. Conclusions This sub-analysis identified that only two of the four specific technologies used for non-invasive remote monitoring in heart failure improved outcomes. When results of studies that involved these disparate technologies were combined in previous meta-analyses, significant improvements in outcomes were identified. As such, this study has highlighted implications for future meta-analyses of randomised controlled trials focused on evaluating the effectiveness of remote monitoring in heart failure.

The effectiveness of non-pharmacological interventions in improving psychological outcomes for heart transplant recipients : a systematic review

Background Post-heart transplant psychological distress may both directly hinder physiological health as well as indirectly impact on clinical outcomes by increasing unhealthy behaviours, such as immunosuppression non-adherence. Reducing psychological distress for heart transplant recipients is therefore vitally important, in order to improve patients’ overall health and well-being but also clinical outcomes, such as morbidity and mortality. Evidence from other populations suggests that non-pharmacological interventions may be an effective strategy. Aim To appraise the efficacy of non-pharmacological interventions on psychological outcomes after heart transplant. Method A systematic review was conducted using the Joanna Briggs Institute methodology. Experimental and quasi-experimental studies that involved any non-pharmacological intervention for heart transplant recipients were included, provided that data on psychological outcomes were reported. Multiple electronic databases were searched for published and unpublished studies and reference lists of retrieved studies were scrutinized for further primary research. Data were extracted using a standardised data extraction tool. Included studies were assessed by two independent reviewers using standardised critical appraisal instruments. Results Three studies fulfilled the inclusion and exclusion criteria, which involved only 125 heart transplant recipients. Two studies reported on exercise programs. One study reported a web-based psychosocial intervention. While psychological outcomes significantly improved from baseline to follow-up for the recipients who received the interventions, between-group comparisons were not reported. The methodological quality of the studies was judged to be poor. Conclusions Further research is required, as we found there is insufficient evidence available to draw conclusions for or against the use of non-pharmacological interventions after heart transplant.