Hospital beds : A primer for counting and comparing

There is considerable public, political and professional debate about the need for additional hospital beds in Australia. However, there is no clarity in regard to the definition, meaning and significance of hospital bed counts. Relative to population, there has been a total decline in bed availability in Australia over the past 15 years of 14.6% (22.9% for public hospital beds). This decline is partly offset by reductions in length of stay and changes to models of care; however, the net effect is increased bed occupancy which has in turn resulted in system-wide congestion. Future bed capability needs to be better planned to meet growing demands while at the same time continuing trends for more efficient use. Future planning should be based in part on weighted bed capability matched to need.

Terrestrial invertebrates of dry river beds are not simply subsets of riparian assemblages

Dry river beds are common worldwide and are rapidly increasing in extent due to the effects of water management and prolonged drought periods due to climate change. While attention has been given to the responses of aquatic invertebrates to drying rivers, few studies exist on the terrestrial invertebrates colonizing dry river beds. Dry river beds are physically harsh and they often differ substantially in substrate, topography, microclimate and inundation frequency from adjacent riparian zones. Given these differences, we predicted that dry river beds provide a unique habitat for terrestrial invertebrates, and that their assemblage composition differs from that in adjacent riparian zones. Dry river beds and riparian zones in Australia and Italy were sampled for terrestrial invertebrates with pitfall traps. Sites differed in substrate type, climate and flow regime. Dry river beds contained diverse invertebrate assemblages and their composition was consistently different from adjacent riparian zones, irrespective of substrate, climate or hydrology. Although some taxa were shared between dry river beds and riparian zones, 66 of 320 taxa occurred only in dry river beds. Differences were due to species turnover, rather than shifts in abundance, indicating that dry river bed assemblages are not simply subsets of riparian assemblages. Some spatial patterns in invertebrate assemblages were associated with environmental variables (irrespective of habitat type), but these associations were statistically weak. We suggest that dry river beds are unique habitats in their own right. We discuss potential human stressors and management issues regarding dry river beds and provide recommendations for future research.

A study of vibration and vibration control of ship structures

This paper examines the vibration characteristics and vibration control of complex ship structures. It is shown that input mobilities of a ship structure at engine supports, due to out-of-plane force or bending moment excitations, are governed by the flexural stiffness of the engine supports. The frequency averaged input mobilities of the ship structure, due to such excitations, can be represented by those of the corresponding infinite beam. The torsional moment input mobility at the engine support can be estimated from the torsional response of the engine bed section under direct excitation. It is found that the inclusion of ship hull and deck plates in the ship structure model has little effect on the frequency-averaged response of the ship structure. This study also shows that vibration propagation in complex ship structures at low frequencies can be attenuated by imposing irregularities to the ring frame locations in ships. Vibration responses of ship structures due to machinery excitations at higher frequencies can be controlled by structural modifications of the local supporting structures such as engine beds in ships.

The economic rationale for infection control in Australian hospitals

The objective of the present study was to predict the economic consequences of healthcare-acquired infections arising among admissions to Australian acute care hospitals. A quantitative algorithm informed by epidemiological and economic data was developed. All acute care hospitals in Australia were included in the study and the participants included all admissions to general medical and general surgical specialties. The main outcome measures were the numbers of cases of healthcare-acquired infection and bed days lost annually. It was estimated that there are 175 153 (95% credible interval 155 911 : 195 168) cases of healthcare-acquired infection among admissions to Australian hospitals annually, and the extra stay in hospital to treat symptoms accounts for 854 289 bed days (95% credible interval 645 091 : 1 096 244). If rates were reduced by 1%, then 150 158 bed days would be released for alternative uses. This would allow ~38 500 new admissions. Healthcare-acquired infections in patients cause bed blocks in Australian hospitals. The cost-effectiveness of hospital services might be improved by allocating more resources to infection control, releasing beds and allowing new admissions. There exists an opportunity to improve the efficiency of the Australian health care system.

Staff perspectives of a cardiology short stay unit

Objective To evaluate staff perceptions about working environment, efficiency and the clinical safety of a cardiovascular intervention short stay unit (SSU) during the first year of operation. Design Postal questionnaire. Setting Cardiac catheterisation laboratory (CCL), coronary care unit (CCU), general cardiology ward (GCW) and the short stay unit (SSU) of a tertiary referral hospital situated in the mid coastal region of NSW. Subjects Cardiologists (including visiting medical officers [VMO]), cardiology fellows, cardiology advanced trainees and nurses. Results Responses on the working environment of the SSU and the discharge process were statistically significant. A substantial proportion of both nurses and doctors had concerns about patient safety, even though no adverse events were formally recorded in the database. Conclusions Though the participants of the survey agree on the efficiency of the SSU in providing beds to the hospital, they disagree on aspects that are important in the functioning of the SSU, including the working environment, patient selection and clinical safety. The results highlight potential issues that could be improved or addressed and are relevant to the rollout of SSUs across NSW.

Growing demand for emergency health services in Queensland, Australia

Introduction: The demand for emergency health services (EHS), both in the prehospital (ambulance) and hospital (emergency departments) settings, is growing rapidly in Australia. Broader health system changes have reduced available health infrastructure, particularly hospital beds, resulting in reduced access to and congestion of the EHS as demonstrated by longer waiting times and ambulance “ramping”. Ambulance ramping occurring when patients have a prolonged wait on the emergency vehicle due to the unavailability of hospital beds. This presentation will outline the trends in EHS demand in Queensland compared with the rest of Australia and factors that appear to be contributing to the growth in demand. Methods: Secondary analysis was conducted using data from publicly available sources. Data from the Queensland Ambulance Service and Queensland Health Emergency Department Information System (EDIS) also were analyzed. Results: The demand for ambulance services and emergency departments has been increasing at 8% and 4% per year over the last decade, respectively; while accessible hospital beds have reduced by almost 10% contributing to the emergency department congestion and possibly contributing to the prehospital demand. While the increase in the proportion of the elderly population seems to explain a great deal of the demand for EHS, other factors also influence this growth including patient characteristics, institutional and societal factors, economic, EHS arrangements, and clinical factors. Conclusions: Overcrowding of facilities that provide EHS are causing considerable community concern. This overcrowding is caused by the growing demand and reduced access. The causes of this growing demand are complex, and require further detailed analysis in order to quantify and qualify these causes in order to provide a resilient foundation of evidence for future policy direction.

A robust reactive scheduling model for intensive care units

The ICU is an integral part of any hospital and is under great load from patient arrivals as well as resource limitations. Scheduling of patients in the ICU is complicated by the two general types; elective surgery and emergency arrivals. This complicated situation is handled by creating a tentative initial schedule and then reacting to uncertain arrivals as they occur. For most hospitals there is little or no flexibility in the number of beds that are available for use now or in the future. We propose an integer programming model to handle a parallel machine reacting system for scheduled and unscheduled arrivals.

Integrity determination of RTK solutions in precision farming applications

Integrity of Real Time Kinematic (RTK) positioning solutions relates to the confidential level that can be placed in the information provided by the RTK system. It includes the ability of the RTK system to provide timely valid warnings to users when the system must not be used for the intended operation. For instance, in the controlled traffic farming (CTF) system that controls traffic separates wheel beds and root beds, RTK positioning error causes overlap and increases the amount of soil compaction. The RTK system’s integrity capacity can inform users when the actual positional errors of the RTK solutions have exceeded Horizontal Protection Levels (HPL) within a certain Time-To-Alert (TTA) at a given Integrity Risk (IR). The later is defined as the probability that the system claims its normal operational status while actually being in an abnormal status, e.g., the ambiguities being incorrectly fixed and positional errors having exceeded the HPL. The paper studies the required positioning performance (RPP) of GPS positioning system for PA applications such as a CTF system, according to literature review and survey conducted among a number of farming companies. The HPL and IR are derived from these RPP parameters. A RTK-specific rover autonomous integrity monitoring (RAIM) algorithm is developed to determine the system integrity according to real time outputs, such as residual square sum (RSS), HDOP values. A two-station baseline data set is analyzed to demonstrate the concept of RTK integrity and assess the RTK solution continuity, missed detection probability and false alarm probability.

In Bed with Autobiography: Unravelling the Fabric of Gender and Genre in Women’s Bed(room) Confessions

This thesis consists of a confessional narrative, What My Mother Doesn’t Know, and an accompanying exegesis, And Why I Should (Maybe) Tell Her. The creative piece employs the confessional mode as a subversive device in three separate narratives, each of which situates the bed as a site of resistance. The exegesis investigates how this self-disclosure in a domestic space flouts the governing rules of self-representation, specifically: telling the truth, respecting privacy and displaying normalcy. The female confession, I argue, creates an alternative space in women’s autobiography where notions of truth-telling can be undermined, the political dimensions of personal experience can be uncovered and the discourse of normality can be negotiated. In particular, women’s confessions told in, on or about the bed, dismantle the genre’s illusion of self and confirm the representative aspects of women’s experience. Framed within these parameters of power and powerlessness, the exegesis includes textual analyses of Charlotte Perkins Gilman’s The Yellow Wallpaper (1892), Tracey Emin’s My Bed (1999) and Lauren Slater’s Lying (2000), each of which exposes in a bedroom space, the author’s most obscure, intimate and traumatic experiences. Situated firmly within and against the genre’s traditional masculine domain, the exegesis also includes mediations on the creative work that validate the bed as my fabric for confession.

A quasi-stationary approach to drying kinetics of different shaped food particulates in a heat pump assisted by fluid bed dryer

Experiments were undertaken to study drying kinetics of different shaped moist food particulates during heat pump assisted fluidised bed drying. Three particular geometrical shapes of parallelepiped, cylindrical and spheres were selected from potatoes (aspect ratio = 1:1, 2:1, 3:1), cut beans (length: diameter = 1:1, 2:1, 3:1) and peas respectively. A batch fluidised bed dryer connected to a heat pump system was used for the experimentation. A Heat pump and fluid bed combination was used to increase overall energy efficiency and achieve higher drying rates. Drying kinetics, were evaluated with non-dimensional moisture at three different drying temperatures of 30, 40 and 50o C. Due to complex hydrodynamics of the fluidised beds, drying kinetics are dryer or material specific. Numerous mathematical models can be used to calculate drying kinetics ranging from analytical models with simplified assumptions to empirical models built by regression using experimental data. Empirical models are commonly used for various food materials due to their simpler approach. However problems in accuracy, limits the applications of empirical models. Some limitations of empirical models could be reduced by using semi-empirical models based on heat and mass transfer of the drying operation. One such method is the quasi-stationary approach. In this study, a modified quasi-stationary approach was used to model drying kinetics of the cylindrical food particles at three drying temperatures.

Constructing the hallucinations of psychosis in Virtual Reality

Schizophrenia is a mental disorder affecting 1-2% of the population and it is estimated 12-16% of hospital beds in Australia are occupied by patients with psychosis. The suicide rate for patients with this diagnosis is higher than that of the general population. Any technique which enhances training and treatment of this disorder will have a significant societal and economic impact. A significant research project using Virtual Reality (VR), in which both visual and auditory hallucinations are simulated, is currently being undertaken at the University of Queensland. The virtual environments created by the new software are expected to enhance the experiential learning outcomes of medical students by enabling them to experience the inner world of a patient with psychosis. In addition the Virtual Environment has the potential to provide a technologically advanced therapeutic setting where behavioral, exposure therapies can be conducted with exactly controlled exposure stimuli with an expected reduction in risk of harm. This paper reports on the current work of the project, previous stages of software development and future educational and clinical applications of the Virtual Environments. (C) 2004 Elsevier Ltd. All rights reserved.

Nitrous oxide emissions from irrigated cotton soils of northern Australia

An automated gas sampling methodology has been used to estimate nitrous oxide (N2O) emissions from heavy black clay soil in northern Australia where split applications of urea were applied to furrow irrigated cotton. Nitrous oxide emissions from the beds were 643 g N/ha over the 188 day measurement period (after planting), whilst the N2O emissions from the furrows were significantly higher at 967 g N/ha. The DNDC model was used to develop a full season simulation of N2O and N2 emissions. Seasonal N2O emissions were equivalent to 0.83% of applied N, with total gaseous N losses (excluding NH3) estimated to be 16% of the applied N.

Benchmarking clinical indicators of quality for Australian residential aged care facilities

To undertake exploratory benchmarking of a set of clinical indicators of quality care in residential care in Australia, data were collected from 107 residents within four medium-sized facilities (40–80 beds) in Brisbane, Australia. The proportion of residents in each sample facility with a particular clinical problem was compared with US Minimum Data Set quality indicator thresholds. Results demonstrated variability within and between clinical indicators, suggesting breadth of assessment using various clinical indicators of quality is an important factor when monitoring quality of care. More comprehensive and objective measures of quality of care would be of great assistance in determining and monitoring the effectiveness of residential aged care provision in Australia, particularly as demands for accountability by consumers and their families increase. What is known about the topic? The key to quality improvement is effective quality assessment, and one means of evaluating quality of care is through clinical outcomes. The Minimum Data Set quality indicators have been credited with improving quality in United States nursing homes. What does this paper add? The Clinical Care Indicators Tool was used to collect data on clinical outcomes, enabling comparison of data from a small Australian sample with American quality benchmarks to illustrate the utility of providing guidelines for interpretation. What are the implications for practitioners? Collecting and comparing clinical outcome data would enable practitioners to better understand the quality of care being provided and whether practices required review. The Clinical Care Indicator Tool could provide a comprehensive and systematic means of doing this, thus filling a gap in quality monitoring within Australian residential aged care.