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.

Network

Network has emerged from a contempory worldwide phenomenon, culturally manifested as a consequence of globalization and the knowledge economy. It is in this context that the internet revolution has prompted a radical re-ordering of social and institutional relations and the associated structures, processes and places which support them. Within the duality of virtual space and the augmentation of traditional notions of physical place, the organizational structures pose new challenges for the design professions. Technological developments increasingly permit communication anytime and anywhere, and provide the opportunity for both synchronous and asynchronous collaboration. The resultant ecology formed through the network enterprise has resulted in an often convolted and complex world wherein designers are forced to consider the relevance and meaning of this new context. The role of technology and that of space are thus interwined in the relation between the network and the individual workplace. This paper explores a way to inform the interior desgn process for contemporary workplace environments. It reports on both theoretical and practical outcomes through an Australia-wide case study of three collaborating, yet independent business entities. It further suggests the link between workplace design and successful business innovation being realized between partnering organizations in Great Britain. Evidence presented indicates that, for architects and interior designers, the scope of the problem has widened, the depth of knowledge required to provide solutions has increased, and the rules of engagement are required to change. The ontological and epistemological positions adopted in the study enabled the spatial dimensions to be examined from both within and beyond the confines of a traditional design only viewpoint. Importantly it highlights the significance of a trans-disiplinary collaboration in dealing with the multiple layers and complexity of the contemporary social and business world, from both a research and practice perspective.

Spatial stimulus : Model making in the architectural design studio

This action research examines the enhancement of visual communication within the architectural design studio through physical model making. „It is through physical model making that designers explore their conceptual ideas and develop the creation and understanding of space,‟ (Salama & Wilkinson 2007:126). This research supplements Crowther‟s findings extending the understanding of visual dialogue to include physical models. „Architecture Design 8‟ is the final core design unit at QUT in the fourth year of the Bachelor of Design Architecture. At this stage it is essential that students have the ability to communicate their ideas in a comprehensive manner, relying on a combination of skill sets including drawing, physical model making, and computer modeling. Observations within this research indicates that students did not integrate the combination of the skill sets in the design process through the first half of the semester by focusing primarily on drawing and computer modeling. The challenge was to promote deeper learning through physical model making. This research addresses one of the primary reasons for the lack of physical model making, which was the limited assessment emphasis on the physical models. The unit was modified midway through the semester to better correlate the lecture theory with studio activities by incorporating a series of model making exercises conducted during the studio time. The outcome of each exercise was assessed. Tutors were surveyed regarding the model making activities and a focus group was conducted to obtain formal feedback from students. Students and tutors recognised the added value in communicating design ideas through physical forms and model making. The studio environment was invigorated by the enhanced learning outcomes of the students who participated in the model making exercises. The conclusions of this research will guide the structure of the upcoming iteration of the fourth year design unit.

Reproduction, mediation, and experience : virtual reality, motion capture and early modern theatre

This article investigates virtual reality representations of performance in London’s late sixteenth-century Rose Theatre, a venue that, by means of current technology, can once again challenge perceptions of space, performance, and memory. The VR model of The Rose represents a virtual recreation of this venue in as much detail as possible and attempts to recover graphic demonstrations of the trace memories of the performance modes of the day. The VR model is based on accurate archeological and theatre historical records and is easy to navigate. The introduction of human figures onto The Rose’s stage via motion capture allows us to explore the relationships between space, actor and environment. The combination of venue and actors facilitates a new way of thinking about how the work of early modern playwrights can be stored and recalled. This virtual theatre is thus activated to intersect productively with contemporary studies in performance; as such, our paper provides a perspective on and embodiment of the relation between technology, memory and experience. It is, at its simplest, a useful archiving project for theatrical history, but it is directly relevant to contemporary performance practice as well. Further, it reflects upon how technology and ‘re-enactments’ of sorts mediate the way in which knowledge and experience are transferred, and even what may be considered ‘knowledge.’ Our work provides opportunities to begin addressing what such intermedial confrontations might produce for ‘remembering, experiencing, thinking and imagining.’ We contend that these confrontations will enhance live theatre performance rather than impeding or disrupting contemporary performance practice. Our ‘paper’ is in the form of a video which covers the intellectual contribution while also permitting a demonstration of the interventions we are discussing.

Technology, memory and experience : virtual reality, motion capture and early modern theatre

This paper investigates virtual reality representations of performance in London’s late sixteenth-century Rose Theatre, a venue that, by means of current technology, can once again challenge perceptions of space, performance, and memory. The VR model of The Rose becomes a Camillo device in that it represents a virtual recreation of this venue in as much detail as possible and attempts to recover graphic demonstrations of the trace memories of the performance modes of the day. The VR model is based on accurate archeological and theatre historical records and is easy to navigate. The introduction of human figures onto The Rose’s stage via motion capture allows us to explore the relationships between space, actor and environment. The combination of venue and actors facilitates a new way of thinking about how the work of early modern playwrights can be stored and recalled. This virtual theatre is thus activated to intersect productively with contemporary studies in performance; as such, our paper provides a perspective on and embodiment of the relation between technology, memory and experience. It is, at its simplest, a useful archiving project for theatrical history, but it is directly relevant to contemporary performance practice as well. Further, it reflects upon how technology and ‘re-enactments’ of sorts mediate the way in which knowledge and experience are transferred, and even what may be considered ‘knowledge.’ Our work provides opportunities to begin addressing what such intermedial confrontations might produce for ‘remembering, experiencing, thinking and imagining.’ We contend that these confrontations will enhance live theatre performance rather than impeding or disrupting contemporary performance practice. This paper intersects with the CFP’s ‘Performing Memory’ and ‘Memory Lab’ themes. Our presentation (which includes a demonstration of the VR model and the motion capture it requires) takes the form of two closely linked papers that share a single abstract. The two papers will be given by two people, one of whom will be physically present in Utrecht, the other participating via Skype.

Spatial literacies, design texts and emergent pedagogies in purposeful literacy curriculum

There has recently been an emphasis within literacy studies on both the spatial dimensions of social practices (Leander & Sheehy, 2004) and the importance of incorporating design and multiple modes of meaning-making into contemporary understandings of literacy (Cope & Kalantzis, 2000; New London Group, 1996). Kress (2003) in particular has outlined the potential implications of the cultural shift from the dominance of writing, based on a logic of time and sequence in time, to the dominance of the mode of the image, based on a logic of space. However, the widespread re-design of curriculum and pedagogy by classroom teachers to allow students to capitalise on the various affordances of different modes of meaning-making – including the spatial – remains in an emergent stage. We report on a project in which university researchers’ expertise in architecture, literacy and communications enabled two teachers in one school to expand the forms of literacy that primary school children engaged in. Starting from the school community’s concerns about an urban renewal project in their neighbourhood, we worked together to develop a curriculum of spatial literacies with real-world goals and outcomes.

Contemporary children's literature and film : engaging with theory

Bringing together the voices of leading and emerging scholars, this book provides critical approaches for reading children's literature and film. It argues for the significance of theory for reading texts written and produced for young people and integrates a wide range of critical perspectives, including schema theory, theories of space and place, cultural globalization, feminism, ecocriticism, adaptation theory, postcolonialism, and posthumanism.

Intimate transactions : art, exhibition and interaction within distributed network environments

The broad research questions of the book are: How can successful, interdisciplinary collaboration contribute to research innovation through Practice-led research? What contributes to the design, production and curation of successful new media art? What are the implications of exhibiting it across dual sites for artists, curators and participant audiences? Is it possible to create an 'intimate transaction' between people who are separated by vast distances but joined by interfaces and distributed networks? Centred on a new media work of the same name by the Transmute Collective (led by Keith Armstrong), this book provides insights from multidisciplinary perspectives. Visual, sound and performance artists, furniture designers, spatial architects, technology systems designers, and curators who collaborated in the production of Intimate Transactions discuss their design philosophies, working processes and resolution of this major new media work. Analytical and philosophical essays by international writers complement these writings on production. They consider how new media art, like Intimate Transactions, challenges traditional understandings of art, curatorial installation and exhibition experience because of the need to take into account interaction, the reconfiguration of space, co-presence, performativity and inter-site collaboration.

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.

Labyrinthine literacies : navigating cultural agency in the arrival and requiem for a beast

The OED reminds us as surely as Ovid that a labyrinth is a “structure consisting of a number of intercommunicating passages arranged in bewildering complexity, through which it is it difficult or impossible to find one’s way without guidance”. Both Shaun Tan’s The Arrival (2006) and Matt Ottley’s Requiem for a Beast: A Work for Image, Word and Music (2007) mark a kind of labyrinthine watershed in Australian children’s literature. Deploying complex, intercommunicating logics of story and literacy, these books make high demands of their reader but also offer guidance for the successful navigation of their stories; for their protagonists as surely as for readers. That the shared logic of navigation in each book is literacy as privileged form of meaning-making is not surprising in the sense that within “a culture deeply invested in myths of individualism and self-sufficiency, it is easy to see why literacy is glorified as an attribute of individual control and achievement” (Williams and Zenger 166). The extent to which these books might be read as exemplifying desired norms of contemporary Australian culture seems to be affirmed by the fact of Tan and Ottley winning the Australian “Picture Book of the Year” prize awarded by the Children’s Book Council of Australia in 2007 and 2008 respectively. However, taking its cue from Ottley’s explicit intertextual use of the myth of Theseus and from Tan’s visual rhetoric of lostness and displacement, this paper reads these texts’ engagement with tropes of “literacy” in order to consider the ways in which norms of gender and culture seemingly circulated within these texts might be undermined by constructions of “nation” itself as a labyrinth that can only partly be negotiated by a literate subject. In doing so, I argue that these picture books, to varying degrees, reveal a perpetuation of the “literacy myth” (Graff 12) as a discourse of safety and agency but simultaneously bear traces of Ariadne’s story, wherein literacy alone is insufficient for safe navigation of the labyrinth of culture.

Improving patient privacy and confidentiality in one regional Emergency Department – a quality project

Background: Patient privacy and confidentiality (PPaC) is an important consideration for nurses and other members of the health care team. Can a patient expect to have confidentiality and in particular privacy in the current climate of emergency health care? Do staff who work in the Emergency Department (ED) see confidentiality as an important factor when providing emergency care? These questions are important to consider. Methods: This is a two phased quality improvement project, developed and implemented over a six month period in a busy regional, tertiary referral ED. Results: Issues identified for this department included department design and layout, overcrowding due to patient flow and access block, staff practices and department policies which were also impacted upon by culture of the team, and use of space. Conclusions: Changes successful in improving this issue include increased staff awareness about PPaC, intercom paging prior to nursing handover to remove visitors during handover, one visitor per patient policy, designated places for handover, allocated bed space for patient reviews/assessment and a strategy to temporarily move the patient if procedures would have been undertaken in shared bed space. These are important issues when considering policy, practice and department design in the ED.

Using strategic movement to calibrate a neural compass : a spiking network for tracking head direction in rats and robots

The head direction (HD) system in mammals contains neurons that fire to represent the direction the animal is facing in its environment. The ability of these cells to reliably track head direction even after the removal of external sensory cues implies that the HD system is calibrated to function effectively using just internal (proprioceptive and vestibular) inputs. Rat pups and other infant mammals display stereotypical warm-up movements prior to locomotion in novel environments, and similar warm-up movements are seen in adult mammals with certain brain lesion-induced motor impairments. In this study we propose that synaptic learning mechanisms, in conjunction with appropriate movement strategies based on warm-up movements, can calibrate the HD system so that it functions effectively even in darkness. To examine the link between physical embodiment and neural control, and to determine that the system is robust to real-world phenomena, we implemented the synaptic mechanisms in a spiking neural network and tested it on a mobile robot platform. Results show that the combination of the synaptic learning mechanisms and warm-up movements are able to reliably calibrate the HD system so that it accurately tracks real-world head direction, and that calibration breaks down in systematic ways if certain movements are omitted. This work confirms that targeted, embodied behaviour can be used to calibrate neural systems, demonstrates that ‘grounding’ of modeled biological processes in the real world can reveal underlying functional principles (supporting the importance of robotics to biology), and proposes a functional role for stereotypical behaviours seen in infant mammals and those animals with certain motor deficits. We conjecture that these calibration principles may extend to the calibration of other neural systems involved in motion tracking and the representation of space, such as grid cells in entorhinal cortex.

Everything

Everything (2008) is a looped 3 channel digital video (extracted from a 3D computer animation) that appropriates a range of media including photography, drawing, painting, and pre-shot video. The work departs from traditional time-based video which is generally based on a recording of an external event. Instead, “Everything” constructs an event and space more like a painting or drawing might. The works combines constructed events (including space, combinations of objects, and aesthetic relationship of forms) with pre-recorded video footage and pre-made paintings and drawings. The result is a montage of objects, images – both still and moving – and abstracted ‘painterly’ gestures. This technique creates a complex temporal displacement. 'Past' refers to pre-recorded media such as painting and photography, and 'future' refers to a possible virtual space not in the present, that these objects may occupy together. Through this simultaneity between the real and the virtual, the work comments on a disembodied sense of space and time, while also puncturing the virtual with a sense of materiality through the tactility of drawing and painting forms and processes. In so doing, te work challenges the perspectival Cartesian space synonymous with the virtual. In this work the disembodied wandering virtual eye is met with an uncanny combination of scenes, where scale and the relationships between objects are disrupted and changed. Everything is one of the first international examples of 3D animation technology being utilised in contemporary art. The work won the inaugural $75,000 Premier of Queensland National New Media Art Award and was subsequently acquired by the Queensland Art Gallery. The work has been exhibited and reviewed nationally and internationally.

Rare chicken rescue

Sound design for documentary is an under-researched field. The specific context of representation of emotional or mental states is particularly open to clichéd treatment. Such treatment in the media often ‘perpetuates inaccurate or negative assumptions about mental health issues in the wider community’ (Francis et al 2005: 11) by employing, for example, either jarring sound/music combinations to signify ‘madness’ or overtly saccharine music to educe sympathy. This project adopted a practice-based approach to discovering a considered aesthetic treatment designed to elicit a more empathetic audience response. A more discriminating engagement with the intentions of the film was cultivated by abandoning both the ‘representational naturalism’ and the ‘distilled, evocative realism’ of documentary sound design (Davies 2007: 18) in favour of a more lyrical or musical approach. To achieve this we manipulated perspective, tonal character and perceptions of space in the final mixing stage. The project was funded by the Film Australia National Interest Program, ABC TV and the Pacific Film and Television Commission. As a crucial contributor to the aesthetic of the project I was nominated in the funding application, and ultimately received an AFI Award for Best Sound in a Documentary in 2008. The film was honoured by The Film Critics Circle of Australia, The Slamdance Film Festival in Utah and The Sydney Film Festival. It has been favourably reviewed in national and international print media (The Age, Sydney Morning Herald, among others) as well as online film/culture zines and blogs.

Relics

Relics is a single-channel video derived from a 3D computer animation that combines a range of media including photography, drawing, painting, and pre-shot video. It is constructed around a series of pictorial stills which become interlinked by the more traditionally filmic processes of panning, zooming and crane shots. In keeping with these ideas, the work revolves around a series of static architectural forms within the strangely menacing enclosure of a geodesic dome. These clinical aspects of the work are complemented by a series of elements that evoke fluidity : fireworks, mirrored biomorphic forms and oscillating projections. The visual dimension of the work is complemented by a soundtrack of rainforest bird calls. Through its ambiguous combination of recorded and virtual imagery, Relics explores the indeterminate boundaries between real and virtual space. On the one hand, it represents actual events and spaces drawn from the artist studio and image archive; on the other it represents the highly idealised spaces of drawing and 3D animation. In this work the disembodied wandering virtual eye is met with an uncanny combination of scenes, where scale and the relationships between objects are disrupted and changed. Through this simultaneity between the real and the virtual, the work conveys a disembodied sense of space and time that carries a powerful sense of affect. Relics was among the first international examples of 3D animation technology in contemporary art. It was originally exhibited in the artist’s solo show, ‘Places That Don’t Exist’ (2007, George Petelin Gallery, Gold Coast) and went on to be included in the group shows ‘d/Art 07/Screen: The Post Cinema Experience’ (2007, Chauvel Cinema, Sydney) , ‘Experimenta Utopia Now: International Biennial of Media Art’ (2010, Arts Centre, Melbourne and national touring venues) and ‘Move on Asia’ (2009, Alternative space Loop, Seoul and Para-site Art Space, Hong Kong) and was broadcast on Souvenirs from Earth (Video Art Cable Channel, Germany and France). The work was analysed in catalogue texts for ‘Places That Don’t Exist’ (2007), ‘d/Art 07’ (2007) and ‘Experimenta Utopia Now’ (2010) and the’ Souvenirs from Earth’ website.