Improving the outcomes of foot and ankle surgery. Professional impact of the Australasian College of Podiatric Surgeons' audit tool

Background Surgery is an example of expanded practice scope that enhances podiatry and incorporates inter-professional collaboration. By 2050 demand for foot and ankle procedures is predicted to rise nationally by 61.9%. Performance management of this increase motivated the development of an online audit tool. Developed in collaboration with the Australasian College of Podiatric Surgeons (ACPS), the ACPS audit tool provides real-time data capture and reporting. It is the first audit tool designed in Australia to support and improve the outcomes of foot and ankle surgery. Methods Audit activity in general, orthopaedic, plastic and podiatric surgery was examined using a case study design. Audit participation enablers and barriers were explored. Case study results guided a Delphi survey of international experts experienced or associated with foot and ankle surgery. Delphi survey-derived consensus informed modification of a generic data set from the Royal Australasian College of Surgeons (RACS). Based on the Delphi survey findings the ACPS online audit tool was developed and piloted. Reliability and validity of data entry and usability of this new tool was then assessed with an online survey. Results The case study found surgeon attitudes and behaviours positively impacted audit participation, and also indicated that audit data should be: (1) available in real time, (2) identify practice change, (3) applicable for safety and quality management, and; (4) useful for peer review discussion. The Delphi process established consensus on audit variables to be captured, including the modified RACS generic data set. 382 cases of foot and ankle surgery were captured across 3 months using the new tool. Data entry was found to be valid and reliable. Real-time outcome reporting and practice change identification impacted positively on safety and quality management and assisted peer review discussion. An online survey showed high levels of usability. Conclusions Surgeon contribution to audit tool development resulted in 100% audit participation. The data from the ACPS audit tool supported the ACPS submission to the Medical Services Advisory Committee to list podiatric surgery under Medicare, an outcome noted by the Federal Minister of Health.

Sharism and social awareness of the Chinese One Child Generation: Urban youth and digital networks

This thesis is a study of Chinese One Child Generation's digital and social sharing. It examines urban youth grassroots communities, including an urban farmers' community and volunteers in educational camps. These case studies explain the emergence of 'sharism' in reaction to the growing risks in China, such as food safety and environmental degradation emanating from China's rapid economic development, and growing urbanism, globalisation, and consumerism. The new forms of 'sharism' are linked to guanxi (social relations) and connected youth communities, which are made possible by increasing accessibility to digital and networked technologies.

Measuring route passenger load diversity for capacity and quality of service assessment

This paper develops theory that quantifies transit route passenger-relative load factor and distinguishes it from occupancy load factor. The ratio between these measures is defined as the load diversity coefficient, which as a single measure characterizes the diversity of passenger load factor between route segments according to the origin-destination profile. The relationship between load diversity coefficient and route coefficient of variation in occupancy load factor is quantified. Two tables are provided that enhance passenger capacity and quality of service (QoS) assessment regarding onboard passenger load. The first expresses the transit operator’s perspective of load diversity and the passengers’ perspective of load factor relative to the operator’s, across six service levels corresponding to ranges of coefficient of variation in occupancy load factor. The second interprets the relationships between passenger average travel time and each of passenger-relative load factor and occupancy load factor. The application of this methodology is illustrated using a case study of a premium radial bus route in Brisbane, Australia. The methodology can assist in benchmarking and decision making regarding route and schedule design. Future research will apply value of time to QoS measurement, reflecting perceived passenger comfort through crowding and average time spent aboard. This would also assist in transit service quality econometric modeling.

Measuring route passenger load diversity for capacity and quality of service assessment

This poster introduces Passenger Relative Load Factor for a route or individual bus service as a capacity and quality of service measure, distinguishing it from Occupancy Load Factor. It introduces Load Diversity Coefficient as the ratio of Passenger Relative Load Factor to Occupancy Load Factor, and relates Load Diversity Coefficient to Coefficient of Variation in Occupancy Load Factor. It qualifies the operator’s and passengers’ perspectives of load factor based on Coefficient of Variation in Occupancy Load Factor along a route. A case study using weekday Automatic Fare Collection (AFC) data on a premium bus line in Brisbane, Australia illustrates the methodology. The compendium paper also qualifies the operator’s and passengers’ perspectives of these load factors along with Passengers’ Average Travel Time for capacity and quality of service assessment.

Cultural safety and diversity: Refocusing our energies in mental health nursing practice, education and research

INTRODUCTION AND BACKGROUND: This presentation draws on a body of work assessing cultural safety's potential to generate change in mental health nursing research (Cox and Simpson 2015), in education and in clinical practice (Cox and Taua 2013, 2016; Happell, Cowin, Roper, Lakeman & Cox 2013). It presents evidence to suggest that cultural safety could resolve the conceptual confusion surrounding culture and diversity in nursing curricular, in clinical and in research practice. The history and nature of mental health work recommend cultural safety to focus attention on diversity, power imbalance, racism, cultural dominance, and structural inequality, identified as barriers and tensions in clinical practice and in service user participation. Cultural safety gives mental health nursing a well theorized and articulated model, which is evolving to improve practice into the future. DESCRIPTION: This work involved an immersion in the literature on cultural safety and the Service User Research movement. It draws on 5 months' work with a service users' research group in the UK and reflections on 9 years of cultural safety teaching. POLICY/PRACTICE CHANGE: This work provokes a crucial change of emphasis from locating the source of issues in the diversity of people to locating it in how society responds to diversity: a change from individualistic to systemic concerns. IMPLICATIONS FOR MENTAL HEALTH NURSING: Cultural safety in clinical practice, education, and research is specifically concerned with awareness of the impact of systemic workplace cultures and with staff cultural self-awareness to bring about cultural change and person-centred care of individuals' unique needs and aspirations within their life context.

The experience of Indigenous students in a Bachelor of Nursing Program in Australia: cultural safety and decolonising nurse education

Background In Australia significant health inequalities, such as an 11year life expectancy gap, impact on the continent’s traditional owners, the Aboriginal peoples and Torres Strait Islanders. Evidence suggests links between improved Indigenous health and a greater proportion of Indigenous people employed in all sectors. Achieving a greater proportion of Indigenous people in health services and in the health education workforce, requires improved higher education completion rates. Currently Indigenous people are under-represented in higher education and attrition rates amongst those who do participate are high. We argue these circumstances make health and education matters of social justice, largely related to unexamined relations of power within universities where the pedagogical and social environment revolve around the norms and common-sense of the dominant culture. Project Research at Queensland University of Technology in 2010-2012, aimed to gain insights into attrition/retention in the Bachelor of Nursing. A literature review on Indigenous participation in higher education in nursing contextualised a mixed methods study. The project examined enrolment, attrition and success by an analysis of enrolment data from 1984-2012. Using Indigenous Research Assistants we then conducted 20 in-depth interviews with Indigenous students followed by a thematic analysis seeking to gain insights into the impact of students’ university experience on retention. Our findings indicate that cultural safety, mentorship, acceptance and support are crucial in student academic success. They also indicate that inflexible systems based on ethnocentric assumptions exacerbate the structural issues that impact on the students’ everyday life and are also part of the story of attrition. The findings reinforced the assumption that educational environments and processes are inherently cultural and political. This perspective calls into question the role of the students’ cultural experience at university in attrition rates. A partnership between the School of Nursing and the Indigenous Education Unit is working to better support Indigenous students.

Multi-morbidity, obesity and quality of life among physically inactive Australians accessing physiotherapy clinics for musculoskeletal disorders

The benefits of physical activity are established and numerous, including improved musculoskeletal health and reduced risk of cardiovascular disease, diabetes, some cancers, and a range of other chronic conditions. While sedentary lifestyles are becoming increasingly prevalent among populations internationally, people with musculoskeletal disorders may face additional challenges to undertaking exercise and physically activities. Unfortunately, interventions in ambulatory hospital clinics for people with musculoskeletal disorders primarily focus on their presenting musculoskeletal complaint with cursory attention given to lifestyle risk factors; including physical inactivity.

Organisational culture and quality management system implementation in Indonesian construction companies

The study of the organisational culture in the construction industry is still in the stage of debate (Oney-Yazıcı et al., 2007). Despite the complexities involved in measuring the culture of the construction industry (Tijhuis and Fellows, 2012), this culture is regarded as being worthy of research, especially in relation to the organisational culture needed to support quality management systems (Koh and Low, 2008; Watson and Howarth, 2011) and to improve organisational effectiveness, and therefore, organisational performance (Coffey, 2010; Cheung et al., 2011). A number of recent studies have examined the construction companies’ organisational culture within the context of the use of Cameron and Quinn’s Competing Value Framework (CVF), as well as the use of their Organizational Culture Assessment Instrument (OCAI) as the conceptual paradigm for the analyses (Thomas et al., 2002; Nummelin, 2006; Oney- Yazıcı et al., 2007; Koh and Low, 2008). However, there has been little research based on the use of Cameron and Quinn’s CVF-OCAI tool for identifying types of construction companies’ organisational culture and their influences on the implementation of QMS-ISO 9001. Research output and information is also very limited relating to the strength of the companies’ organisational culture driving an effective QMS-ISO 9001 implementation, affecting the companies’ effectiveness. To rectify these research gaps, the research has been aimed to study organisational culture types (based on CVF) and their influences on the implementation of QMS-ISO 9001:2008 principles and elements, which eventually lead to improved companies’ quality performance. In order to fully examine the status of the QMS being implemented, the research has studied the relationships of the barriers of QMS implementation with the implementation of QMS-ISO 9001:2008 principles and elements and with the business performance of the companies, as well as the examination of the relationships of the implementation of QMS-ISO 9001:2008 principles and elements with the companies’ business performance. The research output has been the development of fundamental and original studies on the study topics, to provide the knowledge for improvements in Indonesian construction companies’ quality performance and quality outcomes.

Food price and affordability update

This presentation outlines recent achievements in development of tools, protocols and methods to monitoring and benchmark food prices and affordability globally under International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support(INFORMAS)

Symposium: Food pricing and affordability of ‘healthy’ versus ‘less healthy’ diets: An international approach to monitoring and surveillance

Symposium co-ordinated by The International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) Purpose Global monitoring of the price and affordability of foods, meals and diets is urgently needed. There are major methodological challenges in developing robust, cost-effective, standardized, and policy relevant tools, pertinent to nutrition, obesity, and diet-related non-communicable diseases and their inequalities. There is increasing pressure to take into account environmental sustainability. Changes in price differentials and affordability need to be comparable between and within countries and over time. Robust tools could provide baseline data for monitoring and evaluating structural, economic and social policies at the country/regional and household levels. INFORMAS offers one framework for consideration.

Sleep quantity and quality during heat-based training and the effects of cold-water immersion recovery

- Introduction Heat-based training (HT) is becoming increasingly popular as a means of inducing acclimation before athletic competition in hot conditions and/or to augment the training impulse beyond that achieved in thermo-neutral conditions. Importantly, current understanding of the effects of HT on regenerative processes such as sleep and the interactions with common recovery interventions remain unknown. This study aimed to examine sleep characteristics during five consecutive days of training in the heat with the inclusion of cold-water immersion (CWI) compared to baseline sleep patterns. - Methods Thirty recreationally-trained males completed HT in 32 ± 1 °C and 60% rh for five consecutive days. Conditions included: 1) 90 min cycling at 40 % power at VO2max (Pmax) (90CONT; n = 10); 90 min cycling at 40 % Pmax with a 20 min CWI (14 ± 1 °C; 90CWI; n = 10); and 30 min cycling alternating between 40 and 70 % Pmax every 3 min, with no recovery intervention (30HIT; n = 10). Sleep quality and quantity was assessed during HT and four nights of 'baseline' sleep (BASE). Actigraphy provided measures of time in and out of bed, sleep latency, efficiency, total time in bed and total time asleep, wake after sleep onset, number of awakenings, and wakening duration. Subjective ratings of sleep were also recorded using a 1-5 Likert scale. Repeated measures analysis of variance (ANOVA) was completed to determine effect of time and condition on sleep quality and quantity. Cohen's d effect sizes were also applied to determine magnitude and trends in the data. - Results Sleep latency, efficiency, total time in bed and number of awakenings were not significantly different between BASE and HT (P > 0.05). However, total time asleep was significantly reduced (P = 0.01; d = 1.46) and the duration periods of wakefulness after sleep onset was significantly greater during HT compared with BASE (P = 0.001; d = 1.14). Comparison between training groups showed latency was significantly higher for the 30HIT group compared to 90CONT (P = 0.02; d = 1.33). Nevertheless, there were no differences between training groups for sleep efficiency, total time in bed or asleep, wake after sleep onset, number of awakenings or awake duration (P > 0.05). Further, cold-water immersion recovery had no significant effect on sleep characteristics (P > 0.05). - Discussion Sleep plays an important role in athletic recovery and has previously been demonstrated to be influenced by both exercise training and thermal strain. Present data highlight the effect of HT on reduced sleep quality, specifically reducing total time asleep due to longer duration awake during awakenings after sleep onset. Importantly, although cold water recovery accelerates the removal of thermal load, this intervention did not blunt the negative effects of HT on sleep characteristics. - Conclusion Training in hot conditions may reduce both sleep quantity and quality and should be taken into consideration when administering this training intervention in the field.

Food aid and food production: A theoretical analysis

It has been claimed that food aid leads to permanent dependency as it depresses domestic food prices and thus farmers find it profitable to take land out of food production and into more lucrative activities. This paper develops two alternative scenarios under which the hypothesis about the damaging effect of food aid may not be true. Under the first scenario, it is argued that food production in developing countries is often low due to unfavourable trade policies and if food aid is tied to the removal of bias against the agricultural sector, food aid will not have any disincentive effect on food production. The second exercise argues that the revenue raised by the recipient government by selling aid could be used for R and D in agricultural production.

A definition of food literacy and its components

This chapter defines food literacy and its components using the empirical data collected in two studies undertaken in 2010 and 2011 as part of the author’s PhD thesis. The first was a Delphi study of Australian food experts and the second was a study of young adults across a spectrum of disadvantage. Defining food literacy and identifying its components was an iterative process. At different times throughout the research, each study informed the other. This chapter will describe the components of food literacy, the data used to identify them and how they combined to produce a definition of food literacy.

Strategies for improving safety and health of ethnic minority construction workers

The construction industries of developed countries are faced with an aging workforce and a shortage of recruits. It is common for migrant workers/ethnic minorities (EMs) who are already part of the society to join the construction industry. With increasing involvement of EMs in the construction industry, effective strategies for improving their safety and health are urgently needed. The existing body of knowledge is mainly derived from research conducted in English-speaking countries with Western cultures. Research on safety of migrant/EM construction workers in multidialect Asian countries with Eastern cultures has been lacking. This study aimed to identify various strategies for improving the safety and health of EM construction workers from the Asian perspective. Twenty-two face-to-face semistructured interviews were performed with safety professionals in Hong Kong followed by two rounds of Delphi survey with 18 safety experts to verify the interview findings and rank the relative importance of the strategies. The study unveiled 14 strategies for improving the safety performance of EM workers. The three most important ones identified were: (1) to provide safety training in EM native languages; (2) that government and industry associations should play an active role in promoting health and safety awareness of EM workers, and; (3) to encourage EM workers to learn the local language. This study contributes to filling the research gap by evaluating the strategies for improving safety of migrant/EM construction workers in Asian countries with Eastern cultures in which English is not the first language. Research findings would assist occupational health and safety experts and relevant stakeholders in designing strategies for improving the safety and health of EM workers, which will ultimately improve overall safety performance of the construction industry.