Emergency Health Services (EHS) : demand and service delivery models. [Monograph 2 : Queensland EHS users’ profile]

Emergency health is a critical component of Australia’s health system and one which is increasingly congested from growing demand and blocked access to inpatient beds. The Emergency Health Services Queensland (EHSQ) study aims to identify the factors driving increased demand for emergency health and to evaluate strategies which may safely reduce the future demand growth. This monograph addresses the characteristics of users of emergency health services with an aim to identify those that appear to contribute to demand growth. This study utilises data on patients treated by Emergency Departments (ED) and Queensland Ambulance Service (QAS) across Queensland. ED data was derived from the Emergency Department Information System (EDIS) for the period 2001-02 through to 2010-11. Ambulance data was extracted from the QAS’ Ambulance Information Management System (AIMS) and electronic Ambulance Report Form (eARF) for the period 2001-02 through to 2009-10. Due to discrepancies and comparability issues for ED data, this monograph compares data from the 2003-04 time period with 2010-11 data for 21 of the reporting EDs. Also a snapshot of users for the 2010-11 financial year for 31 reporting EDs is used to describe the characteristics of users and to compare those characteristics with population demographics. For QAS data, the 2002-03 and 2009-10 time periods were selected for detailed analyses to identify trends. • Demand for emergency health care services is increasing, representing both increased population and increased relative utilisation. Per capita demand for ED attention has increased by 2% per annum over the last decade and for ambulance attention by 3.7% per annum. • The growth in ED demand is prominent in more urgent triage categories with actual decline in less urgent patients. An estimated 55% of patients attend hospital EDs outside of normal working hours. There is no evidence that patients presenting out of hours are significantly different to those presenting within working hours; they have similar triage assessments and outcomes. • Patients suffering from injuries and poisoning comprise 28% of the ED workload (an increase of 65% in the study period), whilst declines of 32% in cardiovascular and circulatory conditions, and musculoskeletal problems have been observed. • 25.6% of patients attending EDs are admitted to hospital. 19% of admitted patients and 7% of patients who die in the ED are triage category 4 or 5 on arrival. • The average age of ED patients is 35.6 years. Demand has grown in all age groups and amongst both men and women. Men have higher utilisation rates for ED in all age groups. The only group where the growth rate in women has exceeded men is in the 20-29 age group; this growth is particularly in the injury and poisoning categories. • Considerable attention has been paid publicly to ED performance criteria. It is worth noting that 50% of all patients were treated within 33 minutes of arrival. • Patients from lower socioeconomic areas appear to have higher utilisation rates and the utilisation rate for indigenous people appears to exceed those of European and other backgrounds. The utilisation rates for immigrant people is generally less than that of Australian born however it has not been possible to eliminate the confounding impact of different age and socioeconomic profiles. • Demand for ambulance service is also increasing at a rate that exceeds population growth. Utilisation rates have increased by an average of 5% per annum in Queensland compared to 3.6% nationally, and the utilisation rate in Queensland is 27% higher than the national average. • The growth in ambulance utilisation has also been amongst the more urgent categories of dispatch and utilisation rates are higher in rural and regional areas than in the metropolitan area. The demand for ambulance increases with age but the growth in demand for ambulance service has been more prominent in younger age groups. These findings contribute significantly to an understanding of the growth in demand for emergency health. It shows that the growth is amongst patients in genuine need of emergency healthcare and public rhetoric that the congestion of emergency health services is due to inappropriate attendees is unable to be substantiated. The consistency of the growth in demand over the last decade reflects not only the changing demographics of the Australian population but also the changes in health status, standards of acute health care and other social factors. The growth is also amongst patients with acute injury and poisoning which is inconsistent with rates of chronic disease as a fundamental driver. We have also interviewed patients in regard to their decision making choices for acute health care and the factors that influence these decisions and this will be the subject of a third Monograph and publications.

Anomalous event detection using a semi-two dimensional hidden Markov model

The rapid increase in the deployment of CCTV systems has led to a greater demand for algorithms that are able to process incoming video feeds. These algorithms are designed to extract information of interest for human operators. During the past several years, there has been a large effort to detect abnormal activities through computer vision techniques. Typically, the problem is formulated as a novelty detection task where the system is trained on normal data and is required to detect events which do not fit the learned `normal' model. Many researchers have tried various sets of features to train different learning models to detect abnormal behaviour in video footage. In this work we propose using a Semi-2D Hidden Markov Model (HMM) to model the normal activities of people. The outliers of the model with insufficient likelihood are identified as abnormal activities. Our Semi-2D HMM is designed to model both the temporal and spatial causalities of the crowd behaviour by assuming the current state of the Hidden Markov Model depends not only on the previous state in the temporal direction, but also on the previous states of the adjacent spatial locations. Two different HMMs are trained to model both the vertical and horizontal spatial causal information. Location features, flow features and optical flow textures are used as the features for the model. The proposed approach is evaluated using the publicly available UCSD datasets and we demonstrate improved performance compared to other state of the art methods.

Combinatorial design of key distribution mechanisms for wireless sensor networks

Secure communications in wireless sensor networks operating under adversarial conditions require providing pairwise (symmetric) keys to sensor nodes. In large scale deployment scenarios, there is no prior knowledge of post deployment network configuration since nodes may be randomly scattered over a hostile territory. Thus, shared keys must be distributed before deployment to provide each node a key-chain. For large sensor networks it is infeasible to store a unique key for all other nodes in the key-chain of a sensor node. Consequently, for secure communication either two nodes have a key in common in their key-chains and they have a wireless link between them, or there is a path, called key-path, among these two nodes where each pair of neighboring nodes on this path have a key in common. Length of the key-path is the key factor for efficiency of the design. This paper presents novel deterministic and hybrid approaches based on Combinatorial Design for deciding how many and which keys to assign to each key-chain before the sensor network deployment. In particular, Balanced Incomplete Block Designs (BIBD) and Generalized Quadrangles (GQ) are mapped to obtain efficient key distribution schemes. Performance and security properties of the proposed schemes are studied both analytically and computationally. Comparison to related work shows that the combinatorial approach produces better connectivity with smaller key-chain sizes.

Early evidence for direct and indirect effects of the infant rotavirus vaccine program in Queensland

Objective: To assess the impact of introducing a publicly funded infant rotavirus vaccination program on disease notifications and on laboratory testing and results. Design and setting: Retrospective analysis of routinely collected data (rotavirus notifications [2006–2008] and laboratory rotavirus testing data from Queensland Health laboratories [2000–2008]) to monitor rotavirus trends before and after the introduction of a publicly funded infant rotavirus vaccination program in Queensland in July 2007. Main outcome measures: Age group-specific rotavirus notification trends; number of rotavirus tests performed and the proportion positive. Results: In the less than 2 years age group, rotavirus notifications declined by 53% (2007) and 65% (2008); the number of laboratory tests performed declined by 3% (2007) and 15% (2008); and the proportion of tests positive declined by 45% (2007) and 43% (2008) compared with data collected before introduction of the vaccination program. An indirect effect of infant vaccination was seen: notifications and the proportion of tests positive for rotavirus declined in older age groups as well. Conclusions: The publicly funded rotavirus vaccination program in Queensland is having an early impact, direct and indirect, on rotavirus disease as assessed using routinely collected data. Further observational studies are required to assess vaccine effectiveness. Parents and immunisation providers should ensure that all Australian children receive the recommended rotavirus vaccine doses in the required timeframe.

Research data finder : an institutional metadata repository

QUT’s new metadata repository (data registry), Research Data Finder, has been designed to promote the visibility and discoverability of QUT research datasets. Funded by the Australian National Data Service (ANDS), it will provide a qualitative snapshot of research data outputs created or collected by members of the QUT research community that are available via open or mediated access. As a fully integrated metadata repository Research Data Finder aligns with institutional sources of truth, such as QUT’s research administrative system, ResearchMaster, as well as QUT’s Academic Profiles system to provide high quality data descriptions that increase awareness of, and access to, shareable research data. In addition, the repository and its workflows are designed to foster smoother data management practices, enhance opportunities for collaboration and research, promote cross-disciplinary research and maximize existing research datasets. The metadata schema used in Research Data Finder is the Registry Interchange Format - Collections and Services (RIF-CS), developed by ANDS in 2009. This comprehensive schema is potentially complex for researchers; unlike metadata for publications, which are often made publicly available with the official publication, metadata for datasets are not typically available and need to be created. Research Data Finder uses a hybrid self-deposit and mediated deposit system. In addition to automated ingests from ResearchMaster (research project information) and Academic Profiles system (researcher information), shareable data is identified at a number of key “trigger points” in the research cycle. These include: research grant proposals; ethics applications; Data Management Plans; Liaison Librarian data interviews; and thesis submissions. These ingested records can be supplemented with related metadata including links to related publications, such as those in QUT ePrints. Records deposited in Research Data Finder are harvested by ANDS and made available to a national and international audience via Research Data Australia, ANDS’ discovery service for Australian research data. Researcher and research group metadata records are also harvested by the National Library of Australia (NLA) and these records are then published in Trove (the NLA’s digital information portal). By contributing records to the national infrastructure, QUT data will become more visible. Within Australia and internationally, many funding bodies have already mandated the open access of publications produced from publicly funded research projects, such as those supported by the Australian Research Council (ARC), or the National Health and Medical Research Council (NHMRC). QUT will be well placed to respond to the rapidly evolving climate of research data management. This project is supported by the Australian National Data Service (ANDS). ANDS is supported by the Australian Government through the National Collaborative Research Infrastructure Strategy Program and the Education Investment Fund (EIF) Super Science Initiative.

In defence of Victoria's Children's Court : its value and role in the child protection system

Australian child protection systems have been subject to sustained and significant criticism for many decades. As a central part of that system Children’s Courts have been implicated: three recent inquiries into the child protection system in Victoria all criticised the Family Division of the Children’s Court.1 In the resulting debate two diametrically opposed points of view surfaced about the Children’s Court and the role that legal procedures and professionals should play in child protection matters. On one side bodies like the Children’s Court of Victoria, Victoria Legal Aid (‘VLA’), the Law Institute of Victoria (‘LIV’), and the Federation of Community Legal Centres (‘FCLC’) argued that the Children’s Court plays a vital role in child protection and should continue to play that role.2 On the other side a coalition of human service and child protection agencies called for major change including the removal of the Children’s Court from the child protection system. Victoria’s Department of Human Services (‘DHS’) has been critical of the Court3 as have community sector organisations like Anglicare, Berry Street, MacKillop Family Services and the Salvation Army — all agencies the DHS funds to deliver child protection services.4 Victoria’s Child Safety Commissioner has also called for major reform, publicly labelling the Court a ‘lawyers’ playground’ and recommending abolishing the Court’s involvement in child protection completely.

OpenRatSLAM : an open source brain-based SLAM system

RatSLAM is a navigation system based on the neural processes underlying navigation in the rodent brain, capable of operating with low resolution monocular image data. Seminal experiments using RatSLAM include mapping an entire suburb with a web camera and a long term robot delivery trial. This paper describes OpenRatSLAM, an open-source version of RatSLAM with bindings to the Robot Operating System framework to leverage advantages such as robot and sensor abstraction, networking, data playback, and visualization. OpenRatSLAM comprises connected ROS nodes to represent RatSLAM’s pose cells, experience map, and local view cells, as well as a fourth node that provides visual odometry estimates. The nodes are described with reference to the RatSLAM model and salient details of the ROS implementation such as topics, messages, parameters, class diagrams, sequence diagrams, and parameter tuning strategies. The performance of the system is demonstrated on three publicly available open-source datasets.

Language affects length of stay in emergency departments in Queensland public hospitals

BACKGROUND: A long length of stay (LOS) in the emergency department (ED) associated with overcrowding has been found to adversely affect the quality of ED care. The objective of this study is to determine whether patients who speak a language other than English at home have a longer LOS in EDs compared to those whose speak only English at home. METHODS: A secondary data analysis of a Queensland state-wide hospital EDs dataset (Emergency Department Information System) was conducted for the period, 1 January 2008 to 31 December 2010. RESULTS: The interpreter requirement was the highest among Vietnamese speakers (23.1%) followed by Chinese (19.8%) and Arabic speakers (18.7%). There were significant differences in the distributions of the departure statuses among the language groups (Chi-squared=3236.88, P<0.001). Compared with English speakers, the Beta coeffi cient for the LOS in the EDs measured in minutes was among Vietnamese, 26.3 (95%CI: 22.1–30.5); Arabic, 10.3 (95%CI: 7.3–13.2); Spanish, 9.4 (95%CI: 7.1–11.7); Chinese, 8.6 (95%CI: 2.6–14.6); Hindi, 4.0 (95%CI: 2.2–5.7); Italian, 3.5 (95%CI: 1.6–5.4); and German, 2.7 (95%CI: 1.0–4.4). The fi nal regression model explained 17% of the variability in LOS. CONCLUSION: There is a close relationship between the language spoken at home and the LOS at EDs, indicating that language could be an important predictor of prolonged LOS in EDs and improving language services might reduce LOS and ease overcrowding in EDs in Queensland's public hospitals.

Designing Innovative Business Models : A Design Catalyst Learning Resource

The term Design Led Innovation is emerging as a fundamental business process, which is rapidly being adopted by large as well as small to medium sized firms. The value that design brings to an organisation is a different way of thinking, of framing situations and possibilities, doing things and tackling problems: essentially a cultural transformation of the way the firm undertakes its business. Being Design Led is increasingly being seen by business as a driver of company growth, allowing firms to provide a strong point of difference to its stakeholders. Achieving this Design Led process, requires strong leadership to enable the organisation to develop a clear vision for top line growth. Specifically, based on deep customer insights and expanded through customer and stakeholder engagements, the outcomes of which are then adopted by all aspects of the business. To achieve this goal, several tools and processes are available, which need to be linked to new organisational capabilities within a business transformation context. The Design Led Innovation Team focuses on embedding tools and processes within an organisation and matching this with design leadership qualities to enable companies to create breakthrough innovation and achieve sustained growth, through ultimately transforming their business model. As all information for these case studies was derived from publicly accessed data, this resource is not intended to be used as reference material, but rather is a learning tool for designers to begin to consider and explore businesses at a strategic level. It is not the results that are key, but rather the process and philosophies that were used to create these case studies and disseminate this way of thinking amongst the design community. It is this process of unpacking a business guided by the framework of Osterwalder’s Business Model Canvas* which provides an important tool for designers to gain a greater perspective of a company’s true innovation potential.

Investigating homework as a social practice : a qualitative approach

This thesis examines the social practice of homework. It explores how homework is shaped by the discourses, policies and guidelines in circulation in a society at any given time with particular reference to one school district in the province of Newfoundland and Labrador, Canada. This study investigates how contemporary homework reconstitutes the home as a pedagogical site where the power of the institution of schooling circulates regularly from school to home. It examines how the educational system shapes the organization of family life and how family experiences with homework may be different in different sites depending on the accessibility of various forms of cultural capital. This study employs a qualitative approach, incorporating multiple case studies, and is complemented by insights from institutional ethnography and critical discourse analysis. It draws on the theoretical concepts of Foucault including power and power relations, and governmentality and surveillance, as well as Bourdieu’s concepts of economic, social and cultural capital for analysis. It employs concepts from Bourdieu’s work as they have been expanded on by researchers including Reay (1998), Lareau (2000), and Griffith and Smith (2005). The studies of these researchers allowed for an examination of homework as it related to families and mothers’ work. Smith’s (1987; 1999) concepts of ruling relations, mothers’ unpaid labour, and the engine of inequality were also employed in the analysis. Family interviews with ten volunteer families, teacher focus group sessions with 15 teachers from six schools, homework artefacts, school newsletters, homework brochures, and publicly available assessment and evaluation policy documents from one school district were analyzed. From this analysis key themes emerged and the findings are documented throughout five data analysis chapters. This study shows a change in education in response to a system shaped by standards, accountability and testing. It documents an increased transference of educational responsibility from one educational stakeholder to another. This transference of responsibility shifts downward until it eventually reaches the family in the form of homework and educational activities. Texts in the form of brochures and newsletters, sent home from school, make available to parents specific subject positions that act as instruments of normalization. These subject positions promote a particular ‘ideal’ family that has access to certain types of cultural capital needed to meet the school’s expectations. However, the study shows that these resources are not equally available to all and some families struggle to obtain what is necessary to complete educational activities in the home. The increase in transference of educational work from the school to the home results in greater work for parents, particularly mothers. As well, consideration is given to mother’s role in homework and how, in turn, classroom instructional practices are sometimes dependent on the work completed at home with differential effects for children. This study confirms previous findings that it is mothers who assume the greatest role in the educational trajectory of their children. An important finding in this research is that it is not only middle-class mothers who dedicate extensive time working hard to ensure their children’s educational success; working-class mothers also make substantial contributions of time and resources to their children’s education. The assignments and educational activities distributed as homework require parents’ knowledge of technical school pedagogy to help their children. Much of the homework being sent home from schools is in the area of literacy, particularly reading, but requires parents to do more than read with children. A key finding is that the practices of parents are changing and being reconfigured by the expectations of schools in regard to reading. Parents are now being required to monitor and supervise children’s reading, as well as help children complete reading logs, written reading responses, and follow up questions. The reality of family life as discussed by the participants in this study does not match the ‘ideal’ as portrayed in the educational documents. Homework sessions often create frustrations and tensions between parents and children. Some of the greatest struggles for families were created by mathematical homework, homework for those enrolled in the French Immersion program, and the work required to complete Literature, Heritage and Science Fair projects. Even when institutionalized and objectified capital was readily available, many families still encountered struggles when trying to carry out the assigned educational tasks. This thesis argues that homework and education-related activities play out differently in different homes. Consideration of this significance may assist educators to better understand and appreciate the vast difference in families and the ways in which each family can contribute to their children’s educational trajectory.

Child sexual abuse prevention education : A review of school policy and curriculum provision in Australia

The past four decades have seen increasing public and professional awareness of child sexual abuse. Congruent with public health approaches to prevention, efforts to eliminate child sexual abuse have inspired the emergence of prevention initiatives which can be provided to all children as part of their standard school curriculum. However, relatively little is known about the scope and nature of child sexual abuse prevention efforts in government school systems internationally. This paper assesses and compares the policies and curriculum initiatives for child sexual abuse prevention education in primary (elementary) schools across state and territory Departments of Education in Australia. Using publicly available electronic data, a deductive qualitative content analysis of policy and curriculum documents was undertaken to examine the characteristics of child sexual abuse prevention education in these school systems. It was found that the system-level provision of child sexual abuse prevention education occurs unevenly across state and territory jurisdictions. This results in the potential for substantial inequity in Australian children’s access to learning opportunities in child abuse prevention education as a part of their standard school curriculum. In this research, we have developed a strategy for generating a set of theoretically-sound empirical criteria that may be more extensively applied in comparative research about prevention initiatives internationally.

Essays on volatility and liquidity in financial markets

The price formation of financial assets is a complex process. It extends beyond the standard economic paradigm of supply and demand to the understanding of the dynamic behavior of price variability, the price impact of information, and the implications of trading behavior of market participants on prices. In this thesis, I study aggregate market and individual assets volatility, liquidity dimensions, and causes of mispricing for US equities over a recent sample period. How volatility forecasts are modeled, what determines intradaily jumps and causes changes in intradaily volatility and what drives the premium of traded equity indexes? Are they induced, for example, by the information content of lagged volatility and return parameters or by macroeconomic news, changes in liquidity and volatility? Besides satisfying our intellectual curiosity, answers to these questions are of direct importance to investors developing trading strategies, policy makers evaluating macroeconomic policies and to arbitrageurs exploiting mispricing in exchange-traded funds. Results show that the leverage effect and lagged absolute returns improve forecasts of continuous components of daily realized volatility as well as jumps. Implied volatility does not subsume the information content of lagged returns in forecasting realized volatility and its components. The reported results are linked to the heterogeneous market hypothesis and demonstrate the validity of extending the hypothesis to returns. Depth shocks, signed order flow, the number of trades, and resiliency are the most important determinants of intradaily volatility. In contrast, spread shock and resiliency are predictive of signed intradaily jumps. There are fewer macroeconomic news announcement surprises that cause extreme price movements or jumps than those that elevate intradaily volatility. Finally, the premium of exchange-traded funds is significantly associated with momentum in net asset value and a number of liquidity parameters including the spread, traded volume, and illiquidity. The mispricing of industry exchange traded funds suggest that limits to arbitrage are driven by potential illiquidity.

Accounting regulation for charities : international responses to IFRS adoption

This paper examines charity regulatory systems, including accounting standard setting, across five jurisdictions in varying stages of adoption of International Financial Reporting Standards, and identifies the challenges of this process. Design/methodology/approach Using a regulatory space approach, we rely on publicly available archival evidence from charity regulators and accounting standard setters in five common-law jurisdictions in advanced capitalist economies, all with vibrant charity sectors: United Kingdom, United States of America, Canada, Australia and New Zealand. Findings The study reveals the importance of co-operative interdependence and dialogue between charity regulators and accounting standard setters, indicating that jurisdictions with such inter-relationships will better manage the transition to IFRS. It also highlights the need for those jurisdictions with not-for-profit or charity-specific accounting standards to reconfigure those provisions as IFRSs are adopted. Research limitations/implications The study is limited to five jurisdictions, concentrating specifically on key charity regulators and accounting standard setters. Future research could widen the scope to other jurisdictions, or track changes in the jurisdictions longitudinally. Practical implications We provide a timely international perspective of charity regulation and accounting developments for regulators, accounting standard setters and charities, specifically of regulatory responses to IFRS adoption. Originality/value: The paper contributes fresh insights into the dynamics of charity accounting regulation in an international context by using regulatory space as an organising framework. While accounting regulation literature provides a rich interpretation of regulatory issues within the accounting arena, little attention has been paid to charity accounting regulation.

Nonparametric semantic segmentation for 3D street scenes

In this paper we propose a method to generate a large scale and accurate dense 3D semantic map of street scenes. A dense 3D semantic model of the environment can significantly improve a number of robotic applications such as autonomous driving, navigation or localisation. Instead of using offline trained classifiers for semantic segmentation, our approach employs a data-driven, nonparametric method to parse scenes which easily scale to a large environment and generalise to different scenes. We use stereo image pairs collected from cameras mounted on a moving car to produce dense depth maps which are combined into a global 3D reconstruction using camera poses from stereo visual odometry. Simultaneously, 2D automatic semantic segmentation using a nonparametric scene parsing method is fused into the 3D model. Furthermore, the resultant 3D semantic model is improved with the consideration of moving objects in the scene. We demonstrate our method on the publicly available KITTI dataset and evaluate the performance against manually generated ground truth.

Crime and the commodification of carbon

Carbon will be the world's biggest market. Barclays was the first UK bank to set up a dedicated carbon trading desk to help clients, and Barclays Capital is the most active player in the emissions trading market having traded 300 million tonnes as at February 2007. (Barclays, 2007: 1)