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.

Improving service innovation through structured process-oriented knowledge infrastructure design

Formalised service innovation is a central tenet of enterprise systems lifecycle phases. Event driven process models extended with knowledge objects are found to be not useful in early lifecycle phases. When an upgrade is required, a map of the knowledge infrastructure is needed to better design further service innovation because functional maps no longer adequately describe the context adequately. By looking at formal changes to business processes as service innovations, and recognising the knowledge infrastructure inherent in services generally, changes driven through technology such as ES can be better understood with the application of frameworks such as B-KIDE.

Enduring documents : improving the forms, improving the outcomes

Most Australian states have introduced legislation to provide for enduring documents for financial, personal and health care decision making in the event of incapacity. Since the introduction of Enduring Powers of Attorney (EPAs) and Advance Health Directives (AHDs) in Queensland in 1998, concerns have continued to be raised by service providers, professionals and individuals about the uptake, understanding and appropriate use of these documents. In response to these concerns, the Department of Justice and Attorney-General (DJAG) convened a Practical Guardianship Initiatives Working Party. This group identified the limited evidence base available to address these concerns. In 2009, a multidisciplinary research team from the University of Queensland and the Queensland University of Technology was awarded $90,000 from the Legal Practitioners Interest on Trust Account Fund to undertake a review of the current EPA and AHD forms. The goal of the research was to gather data on the content and useability of the forms from the perspectives of a range of stakeholders, particularly those completing the EPA and AHD, witnesses of these documents, attorneys appointed under an EPA, and health professionals involved in the completion of an AHD or dealing with it in a clinical context. The researchers also sought to gather information from the perspective of Aboriginal and Torres Strait Islander (ATSI) individuals as well people from culturally and linguistically diverse (CALD) groups. Although the focus of the research was on the forms and the extent to which the current design, content and format represents a barrier to uptake, in the course of the research, some broader issues were identified which have an impact on the effectiveness of the EPA and AHD in achieving the goals of planning for financial and personal and health care in advance of losing capacity. The data gathered enabled the researchers to achieve the primary goal of the research: to make recommendations to improve the content and useability of the forms which hopefully will lead to an increased uptake and appropriate use of the forms. However, the researchers thought it was important not to ignore broader policy issues that were identified in the course of the research. These broader issues have been highlighted in this Report, and the researchers have responded to them in a variety of ways. For some issues, the researchers have suggested alterations that could be made to the forms to address the particular concerns. For other issues, the researchers have suggested that Government may need to take specific action such as educating the broader community with some attention to strategies that engage particular groups within communities. Other concerns raised can only be dealt with by legislative reform and, in some of these cases, the researchers have identified issues that Government may wish to consider further. We do note, however, that it is beyond the scope of this Report to recommend changes to the law. This three stage mixed methods project aimed to provide systematic evidence from a broad range of stakeholders in regard to: (i) which groups use and do not use these documents and why, (ii) the contribution of the length/complexity/format/language of the forms as barriers to their completion and/or effective use, and (iii) the issues raised by the current documents for witnesses and attorneys. Understanding and use of EPAs and AHDs were generally explored in separate but parallel processes. A purposive sampling strategy included users of the documents as principals and attorneys, and professionals, witnesses and service providers who assist others to execute or use the forms. The first component of this study built on existing knowledge using a Critical Reference Group and material provided by the DJAG Practical Guardianship Initiatives Working Party. This assisted in the development of the data collection tools for subsequent stages. The second component comprised semi-structured interviews and focus groups with a targeted sample of current users of the forms, potential users, witnesses and other professionals to provide in-depth information on critical issues. Outreach to Aboriginal and Torres Strait Islander Elders and individuals and workers with CALD groups ensured a broad sample of potential users of the two documents. Fifty individual interviews and three focus groups were completed. Most interviews and focus groups focused on perceptions of, and experiences with, either the EPA or the AHD form. In the interviews with Indigenous people and the CALD focus groups, however, respondents provided their perceptions and experiences of both documents. In general, these respondents had not used the forms and were responding to the documents made available in the interview or focus group. In total, seventy-seven individuals were involved in interviews or focus groups. The final component comprised on-line surveys for EPA principals, EPA attorneys, AHD principals, witnesses of EPAs and AHDs and medical practitioners with experience of AHDs as nominated and/or treating doctors. The surveys were developed from the initial component and the qualitative analysis of the interview and focus group data. A total of 116 surveys were returned from major cities and regional Queensland. The survey data was analysed descriptively for patterns and trends. It is important to note that the aim of the survey was to gain insight into issues and concerns relating to the documents and not to make generalisations to the broader population.

A human capital framework : designed for convergence

The 21" century business environment is dominated by unprecedented change across a broad spectrum of social, economic, technological and cultural factors (Nowotny, Scott & Gibbons 2001). Among these, two broad trends -economic globalisation and rising knowledge intensity (Hart 2006)have come to distinguish organisational life. Under the weight of these transformational influences, the developed world, it seems, has arrived at a transformational moment. The far-reaching effects of the global financial crisis and its shadowy twin: the threat of a double dip recession, continue to exert an unsteadying influence on global and corporate finances. Growth in developed economies has slumped, share prices have declined, the market value of corporations has slipped and unemployment rates, in the vast majority of developed economies, have risen. Gross domestic product (GDP) growth has retreated from the strong growth experienced in the late 1990s to negative growth in 2009 and a sluggish and unsteady recovery in 2010. In response, the reach of Government in terms of its participation in markets has been extended, bringing with it the need to transition to new governance and regulatory arrangements. Ongoing concerns regarding the pace and sustainability of the recovery remains a front-of-mind concern with bailouts, buybacks, borrowings and BP dominating news services: 'We are witnessing the reweaving of the social, political and economic fabric that binds our planet, with long-term consequences that are as or more profound than those of the industrial era' (Tapscott & Williams 2006, p. 59).

Improving self organizing capabilities of local communities for sustainable development in decentralized Indonesia : the roles of procedural justice and social learning

The development planning process introduced under Law No. 25/2004 is said to be a better approach to increase public participation in decentralised Indonesia. This Law has introduced planning mechanisms, called Musyawarah Perencanaan Pembangunan (musrenbang), to provide a forum for development planning. In spite of the expressed intention of these mechanisms to improve public participation, some empirical observations have cast doubt on the outcomes. As a result, some local governments have tried to provide alternative mechanisms for participatory local development planning processes. Since planning constitutes one of the most effective ways to improve community empowerment, this paper aims to examine the extent to which the alternative local development planning process in Indonesia provides sufficient opportunities to improve the self organising capabilities of communities to sustain development programs to meet local needs. In so doing, this paper explores the key elements and approaches of the concept of community empowerment and shows how they can be incorporated within planning processes. Based on this, it then examines the problems encountered by musrenbang in increasing community empowerment. Having done this, it is argued that to change current unfavourable outcomes, procedural justice and social learning approaches need to be incorporated as pathways to community empowerment. Lastly the capacity of an alternative local planning process, called Sistem Dukungan (SISDUK), introduced in South Sulawesi, offering scope to incorporate procedural justice and social learning is explored as a means to improve the self organizing capabilities of local communities.

Improving self-report measures of speeding

There is continuing debate regarding the psychometric properties of self-report measures of behaviour, particularly in road safety research. Practical considerations often preclude the use of objective assessments, leading to reliance on self-report measures. Acknowledging that such measures are likely to remain commonly used, this pilot project sought not to argue whether self-report measures should continue to be used, but to explore factors associated with how individuals respond to self-reported speeding measures. This paper reports preliminary findings from a qualitative study (focus groups and in-depth interviews) conducted with licensed drivers to explore the operational utility of self-reported speeding behaviour measures. Drawing upon concepts from the Theory of Planned Behaviour (TPB; Ajzen, 1991) and Agency Theory (Bandura, 2001), we identified four dimensions of self-reported speeding: including timeframe, speed zone, degree over the speed limit and, overall frequency of the behaviour, and examined participants’ perceptions of the operational utility of these factors. Issues related to comprehensibility, perceived accuracy, response format and layout were also explored. Results indicated that: heterogeneity in the timeframe of behavioural reflections suggests a need to provide a set timeframe for participants to consider when thinking about their previous speeding behaviour; response categories and formats should be carefully considered to ensure the most accurate representations of the frequency and degree of speeding are captured; the need to clearly articulate “low-level” speeding on self-report measures; and, that self-reports of speeding behaviour are typically context-irrelevant unless stipulated in the question. Limitations and directions for further research are discussed.

Improving web database search incorporating users query information

The growing importance and need of data processing for information extraction is vital for Web databases. Due to the sheer size and volume of databases, retrieval of relevant information as needed by users has become a cumbersome process. Information seekers are faced by information overloading - too many result sets are returned for their queries. Moreover, too few or no results are returned if a specific query is asked. This paper proposes a ranking algorithm that gives higher preference to a user’s current search and also utilizes profile information in order to obtain the relevant results for a user’s query.

Improving cyclodiode - a risk factor analysis of complications

PURPOSE: The purpose of this study is to identify risk factors for developing complications following treatment of refractory glaucoma with transscleral diode laser cyclophotocoagulation (cyclodiode), to improve the safety profile of this treatment modality. METHOD: A retrospective analysis of 72 eyes from 70 patients who were treated with cyclodiode. RESULTS: The mean pre-treatment IOP was 37.0 mmHg (SD 11.0), with a mean post-treatment reduction in intraocular pressure (IOP) of 19.8 mmHg, and a mean IOP at last follow-up of 17.1 mmHg (SD 9.7). Mean total power delivered during treatment was 156.8 Joules (SD 82.7) over a mean of 1.3 treatments (SD 0.6). Sixteen eyes (22.2% of patients) developed complications from the treatment, with the most common being hypotony, occurring in 6 patients, including 4 with neovascular glaucoma. A higher pre-treatment IOP and higher mean total power delivery also were associated with higher complications. CONCLUSIONS: Cyclodiode is an effective treatment option for glaucoma that is refractory to other treatment options. By identifying risk factors for potential complications, cyclodiode can be modified accordingly for each patient to improve safety and efficacy.

State convergence and the effectiveness of time-memory-data tradeoffs

Various time-memory tradeoffs attacks for stream ciphers have been proposed over the years. However, the claimed success of these attacks assumes the initialisation process of the stream cipher is one-to-one. Some stream cipher proposals do not have a one-to-one initialisation process. In this paper, we examine the impact of this on the success of time-memory-data tradeoff attacks. Under the circumstances, some attacks are more successful than previously claimed while others are less. The conditions for both cases are established.

Improving recall in appearance-based visual SLAM using visual expectation

In this paper, we present a new algorithm for boosting visual template recall performance through a process of visual expectation. Visual expectation dynamically modifies the recognition thresholds of learnt visual templates based on recently matched templates, improving the recall of sequences of familiar places while keeping precision high, without any feedback from a mapping backend. We demonstrate the performance benefits of visual expectation using two 17 kilometer datasets gathered in an outdoor environment at two times separated by three weeks. The visual expectation algorithm provides up to a 100% improvement in recall. We also combine the visual expectation algorithm with the RatSLAM SLAM system and show how the algorithm enables successful mapping

Points of convergence and divergence : normative, institutional and operational relationships between R2P and POC

As an international norm, the Responsibility to Protect (R2P) has gained substantial influence and institutional presence—and created no small controversy—in the ten years since its first conceptualisation. Conversely, the Protection of Civilians in Armed Conflict (PoC) has a longer pedigree and enjoys a less contested reputation. Yet UN Security Council action in Libya in 2011 has thrown into sharp relief the relationship between the two. UN Security Council Resolutions 1970 and 1973 follow exactly the process envisaged by R2P in response to imminent atrocity crimes, yet the operative paragraphs of the resolutions themselves invoke only PoC. This article argues that, while the agendas of PoC and R2P converge with respect to Security Council action in cases like Libya, outside this narrow context it is important to keep the two norms distinct. Peacekeepers, humanitarian actors, international lawyers, individual states and regional organisations are required to act differently with respect to the separate agendas and contexts covered by R2P and PoC. While overlap between the two does occur in highly visible cases like Libya, neither R2P nor PoC collapses normatively, institutionally or operationally into the other.

Towards improving mission execution for autonomous gliders with an ocean model and Kalman filter

In this paper, we examine the use of a Kalman filter to aid in the mission planning process for autonomous gliders. Given a set of waypoints defining the planned mission and a prediction of the ocean currents from a regional ocean model, we present an approach to determine the best, constant, time interval at which the glider should surface to maintain a prescribed tracking error, and minimizing time on the ocean surface. We assume basic parameters for the execution of a given mission, and provide the results of the Kalman filter mission planning approach. These results are compared with previous executions of the given mission scenario.

State convergence in the initialisation of the Sfinks stream cipher

Sfinks is a shift register based stream cipher designed for hardware implementation. The initialisation state update function is different from the state update function used for keystream generation. We demonstrate state convergence during the initialisation process, even though the individual components used in the initialisation are one-to-one. However, the combination of these components is not one-to-one.

Improving posture and decreasing pain with novel shoe insoles

A single subject longevity study is presented as a case study for the Medical Device Partnering Program (MDPP). The MDPP supports the development of cutting-edge medical devices and assistive technologies, through unique collaborations between researchers, industry, clinical end-users and government. The study aimed to identify what effect the innersole has on specific muscles that may influence stability and whether the innersole had any influence on gait. Three tests were conducted; a standard gait test, dynamic balance test and a standing balance test. Results from the kinematic analysis showed reduced variability in post testing results when compared to pre testing results. Reductions in muscle activation levels were also found across all tests. Further testing with a larger sample size is required to determine if these effects are due to the innersole.

Improving Usability of Software Refactoring Tools

Post-deployment maintenance and evolution can account for up to 75% of the cost of developing a software system. Software refactoring can reduce the costs associated with evolution by improving system quality. Although refactoring can yield benefits, the process includes potentially complex, error-prone, tedious and time-consuming tasks. It is these tasks that automated refactoring tools seek to address. However, although the refactoring process is well-defined, current refactoring tools do not support the full process. To develop better automated refactoring support, we have completed a usability study of software refactoring tools. In the study, we analysed the task of software refactoring using the ISO 9241-11 usability standard and Fitts' List of task allocation. Expanding on this analysis, we reviewed 11 collections of usability guidelines and combined these into a single list of 38 guidelines. From this list, we developed 81 usability requirements for refactoring tools. Using these requirements, the software refactoring tools Eclipse 3.2, Condenser 1.05, RefactorIT 2.5.1, and Eclipse 3.2 with the Simian UI 2.2.12 plugin were studied. Based on the analysis, we have selected a subset of the requirements that can be incorporated into a prototype refactoring tool intended to address the full refactoring process.