Mapping Services to Support a Patient's Journey through Evidence-Based Care Pathways After a Cardiac Event

Background: There are inequalities in geographical access and delivery of health care services in Australia, particularly for cardiovascular disease (CVD), Australia's major cause of death. Analyses and models that can inform and positively influence strategies to augment services and preventative measures are needed. The Cardiac-ARIA project is using geographical spatial technology (GIS) to develop a national index for each of Australia's 13,000 population centres. The index will describe the spatial distribution of CVD health care services available to support populations at risk, in a timely manner, after a major cardiac event. Methods: In the initial phase of the project, an expert panel of cardiologists and an emergency physician have identified key elements of national and international guidelines for management of acute coronary syndromes, cardiac arrest, life-threatening arrhythmias and acute heart failure, from the time of onset (potentially dial 000) to return from the hospital to the community (cardiac rehabilitation). Results: A systematic search has been undertaken to identify the geographical location of, and type of, cardiac services currently available. This has enabled derivation of a master dataset of necessary services, e.g. telephone networks, ambulance, RFDS, helicopter retrieval services, road networks, hospitals, general practitioners, medical community centres, pathology services, CCUs, catheterisation laboratories, cardio-thoracic surgery units and cardiac rehabilitation services. Conclusion: This unique and innovative project has the potential to deliver a powerful tool to both highlight and combat the burden of disease of CVD in urban and regional Australia.

The beliefs which influence young males to speed and strategies to slow them down : informing the content of anti-speeding messages

Young male drivers are over-represented in road-related fatalities. Speeding represents a pervasive and significant contributor to road trauma. Anti-speeding messages represent a long-standing strategy aimed at discouraging drivers from speeding. These messages, however, have not always achieved their persuasive objectives which may be due, in part, to them not always targeting the most salient beliefs underpinning the speeding behavior of particular driver groups. The current study elicited key beliefs underpinning speeding behavior as well as strategies used to avoid speeding, using a well-validated belief-based model, the Theory of Planned Behavior and in-depth qualitative methods. To obtain the most comprehensive understanding about the salient beliefs and strategies of young male drivers, how such beliefs and strategies compared with those of drivers of varying ages and gender, was also explored. Overall, 75 males and females (aged 17-25 or 30-55 years) participated in group discussions. The findings revealed beliefs that were particularly relevant to young males and that would likely represent key foci for developing message content. For instance, the need to feel in control and the desire to experience positive affect when driving were salient advantages; while infringements were a salient disadvantage and, in particular, the loss of points and the implications associated with potential licence loss as opposed to the monetary (fine) loss (behavioral beliefs). For normative influences, young males appeared to hold notable misperceptions (compared with other drivers, such as young females); for instance, young males believed that females/girlfriends were impressed by their speeding. In the case of control beliefs, the findings revealed low perceptions of control with respect to being able to not speed and a belief that something “extraordinary” would need to happen for a young male driver to lose control of their vehicle while speeding. The practical implications of the findings, in terms of providing suggestions for devising the content of anti-speeding messages, are discussed.

An Investigation of Cognitive, Emotional and Negative Behavioural Responses to Service Recovery Strategies

Despite the best intentions of service providers and organisations, service delivery is rarely error-free. While numerous studies have investigated specific cognitive, emotional or behavioural responses to service failure and recovery, these studies do not fully capture the complexity of the services encounter. Consequently, this research develops a more holistic understanding of how specific service recovery strategies affect the responses of customers by combining two existing models—Smith & Bolton’s (2002) model of emotional responses to service performance and Fullerton and Punj’s (1993) structural model of aberrant consumer behaviour—into a conceptual framework. Specific service recovery strategies are proposed to influence consumer cognition, emotion and behaviour. This research was conducted using a 2x2 between-subjects quasi-experimental design that was administered via written survey. The experimental design manipulated two levels of two specific service recovery strategies: compensation and apology. The effect of the four recovery strategies were investigated by collecting data from 18-25 year olds and were analysed using multivariate analysis of covariance and multiple regression analysis. The results suggest that different service recovery strategies are associated with varying scores of satisfaction, perceived distributive justice, positive emotions, negative emotions and negative functional behaviour, but not dysfunctional behaviour. These finding have significant implications for the theory and practice of managing service recovery.

Cultural selection and its influence on perceptions of reputation within organisations

The capacity to identify, interpret, and prioritise environmental issues is critical in the management of corporate reputation. In spite of the significance of these abilities for corporate reputation management, there has been little effort to document and describe internal organizational influences on these capacities. Contrary to this state of affairs in the discipline of public relations, a long history of ethnographic research in cultural anthropology documents how sets of shared environmental perceptions can influence and moderate environmental factors in cultural populations (see for example, Durham, 1991 ). This study explores how cultural “frames of reference” derived from shared values and assumptions among organizational members influence organizational perceptions, and consequently, organizational actions. Specifically, this study explores how a central attribute of organizational culture--the property of cultural selection-- influences perceptions of organizational reputation held by organizational members. Perceptions of reputation among organizational members are obvious drivers to both the nature of and rationale for organizational communication strategies and responses. These perceptions are the result of collective processes that synthesise (with varying degrees of consensus) member conceptualisations, interpretations, and representations of the environmental realities in which their organization operate. To explore how cultural selection influences member perceptions of organizational reputation, this study employs ethnographic research including 20 depth interviews and six months of organizational observation in the focal organization. We argue that while external indicators of organizational reputation are acknowledged by members as significant, the internal action of cultural selection is a far stronger influence on organizational action.

Students’ perceptions of teaching and learning: the influence of students’ approaches to learning and teachers’ approaches to teaching

Nearly 500 secondary students in 24 classes were surveyed and four students in each class interviewed concerning their approaches to learning and perceptions of their classroom environment. While interviewed students with deep approaches to learning generally demonstrated a more sophisticated understanding of the learning opportunities offered to them than did students with surface approaches, teaching strategies also influenced students' perceptions. When teachers focused strongly on actively engaging students and creating a supportive environment, students with both deep and surface approaches focused on student-centred aspects of the class. In contrast, when traditional expository teaching methods were used exclusively, students with deep and surface approaches both focused on transmission and reproduction.

Celebrity capital as a strategic asset : implications for new venture strategies

Despite an increase in businesses started by celebrities, we have limited understanding as to how celebrity entrepreneurs benefit new ventures. Drawing on a reputational capital perspective, we develop the notion of celebrity capital and show how it can be used to uniquely differentiate the venture and to overcome liabilities of newness. We discuss how celebrity capital can negatively influence the venture when negative information about the celebrity surfaces and in terms of limiting the scope of the venture. We discuss the different strategic implications of celebrity capital for ventures using celebrity entrepreneurs versus endorsers.

Targeting injury prevention strategies to adolescents of Pacific Islander descent : what will work?

Background: Ethnicity is rarely considered in injury prevention program development, even though this is known to impact on participation in injury risk behaviour. An understanding of injury, risk behaviour and risk and protective factors specific to adolescents of Pacific Islander descent will inform the development of prevention strategies appropriate to this group.----- Aims: To determine patterns of injury and associated risk behaviour among adolescents of Pacific Islander descent, and to understand the risk and protective factors that influence injury rates among this group.----- Methods: A total of 875 Year 9 students from five Queensland high schools completed a survey during health classes. Seventy-one students (n = 38 male) identified as Pacific Islander. The survey consisted of scales examining injury, risk taking behaviour, and relationships with family, school and police.----- Results: The leading causes of injury among adolescents of Pacific Islander descent were sports (48%) and transport (e.g. 45% reported bicycle injuries). Interpersonal violence related injuries were also relatively frequent, with 28% having been injured in a fight. Reports of alcohol use were relatively low (20% c.f. 40% of the remaining sample), however reports of other risk behaviours were relatively high (e.g. 43% c.f. 25% of remaining sample reported a group fight).----- Discussion and conclusions: Conclusions will be drawn regarding risk-related injuries reported by adolescents of Pacific Islander descent and those of other ethnic backgrounds. Additionally, risk and protective factors relating to family, school and police will be explored, in order to inform prevention strategies appropriate to this group.

How do other people influence your driving speed? Exploring the 'who' and the 'how' of social influences on speeding from a qualitative perspective

Using only legal sanctions to manage the speed at which people drive ignores the potential benefits of harnessing social factors such as the influence of others. Social influences on driver speeds were explored in this qualitative examination of 67 Australian drivers. Focus group interviews with 8 driver types (young, mid-age and older males and females, and self-identified Excessive and Rare speeders) were guided by Akers’ social learning theory (Akers, 1998). Findings revealed two types of influential others: people known to the driver (passengers and parents), and unknown other drivers. Passengers were generally described as having a slowing influence on drivers: responsibility for the safety of people in the car and consideration for passenger comfort were key themes. In contrast, all but the Rare speeders reported increasing their speed when driving alone. Parental role modelling was also described. In relation to other drivers, key themes included speeding to keep up with traffic flow and perceived pressure to drive faster. This ‘pressure’ from others to ‘speed up’ was expressed in all groups and reported strategies for managing this varied. Encouragingly, examples of actual or anticipated social rewards for speeding were less common than examples of social punishments. Three main themes relating to social punishments were embarrassment, breaching the trust of others, and presenting an image of a responsible driver. Impression management and self-presentation are discussed in light of these findings. Overall, our findings indicate scope to exploit the use of social sanctions for speeding and social praise for speed limit compliance to enhance speed management strategies.

Speeding in Australia and China : a comparison of the influence of legal sanctions and enforcement practices on car drivers

Despite increasingly sophisticated speed management strategies, speeding remains a significant contributing factor in 25% of Australia’s fatal crashes. Excessive speed is also a recognised contributor to road trauma in rapidly motorising countries such as China, where increases in vehicle ownership and new drivers, and a high proportion of vulnerable road users all contribute to a high road trauma rate. Speed choice is a voluntary behaviour. Therefore, driver perceptions are important to our understanding of the nature of speeding. This paper reports preliminary qualitative (focus groups) and quantitative (survey) investigations of the perceptions of drivers in Queensland and Beijing. Drivers’ definitions of speeding as well as their perceptions of the influence of legal factors on their reported speeds were explored. Survey participants were recruited from petrol stations (Queensland, n=833) and car washes (Beijing, n=299). Similarities were evident in justifications for exceeding speed limits across samples. Excessive speeds were not deemed as ‘speeding’ when drivers considered that they were safe and under their control, or when speed limits were seen as unreasonably low. This appears linked to perceptions of enforcement tolerances in some instances with higher perceived enforcement thresholds noted in China. Encouragingly, drivers in both countries reported a high perceived risk of apprehension if speeding. However, a substantial proportion of both samples also indicated perceptions of low certainty of receiving penalties when apprehended. Chinese drivers considered sanctions less severe than did Australian drivers. In addition, strategies to avoid detection and penalties were evident in both samples, with Chinese drivers reporting a broader range of avoidant techniques. Implications of the findings for future directions in speed management in both countries are discussed.

Understanding parental physical activity : meanings, habits, and social role influence

Objectives: The research aimed to explore parents’ understandings of physical activity (PA), patterns of PA-related behaviour, and how constructions of social role expectations might influence their PA behaviour. Design and Method: Using a qualitative descriptive design and adopting a social constructionism approach to broaden interpretations of parents’ understandings, 40 adults (21 mothers, 19 fathers; aged 23 to 49 years) living in South East Queensland, Australia participated in semi-structured individual and group interviews. The interviews were analysed using thematic analysis. Results: Parents had clear understandings of what constitutes PA and engaged in various activities which were integrated with or independent of the children. Being active with children, however, was not always constructed favourably in which many parents described the difficulties of being active with their children. All individuals experienced changes in their PA behaviours after having children. For most, a decline in PA level, intensity, and structure was experienced; however, some did experience parenthood as a time to be active. A level of acceptance for the lack of activity performed was also expressed as were feelings of resentment and envy for those who maintained previous activity habits. Parenting and partner roles were considered most influential on PA-related behaviour and were constructed in ways that had both positive and negative influences on activity performance. Parents, however, were empowered to construct strategies to resolve conflicts between social role performance and being active. Conclusion: Results show that parents experience unique difficulties that intervention work should consider when designing programs aimed at increasing parental PA.

Property development cycle and acquisition strategies

This presenation is part of the UDIA (Qld) Property Development Essentials program, which is a two-day introductory course designed for new entrants to the property industry. The course provides practical advice and direction for those looking to take the first steps into the development industry. This presentation identifies economic factors and their influence on land acquisitions, as well as providing an understanding the property development and business cycles and their impacts on acquisition strategies (long v. short term projects)

Influence of all-out and fast start of 5-min cycling time trial performance

Purpose: To examine the influence of two different fast-start pacing strategies on performance and oxygen consumption (V˙O2) during cycle ergometer time trials lasting ∼5 min. Methods: Eight trained male cyclists performed four cycle ergometer time trials whereby the total work completed (113 ± 11.5 kJ; mean ± SD) was identical to the better of two 5-min self-paced familiarization trials. During the performance trials, initial power output was manipulated to induce either an all-out or a fast start. Power output during the first 60 s of the fast-start trial was maintained at 471.0 ± 48.0 W, whereas the all-out start approximated a maximal starting effort for the first 15 s (mean power: 753.6 ± 76.5 W) followed by 45 s at a constant power output (376.8 ± 38.5 W). Irrespective of starting strategy, power output was controlled so that participants would complete the first quarter of the trial (28.3 ± 2.9 kJ) in 60 s. Participants performed two trials using each condition, with their fastest time trial compared. Results: Performance time was significantly faster when cyclists adopted the all-out start (4 min 48 s ± 8 s) compared with the fast start (4 min 51 s ± 8 s; P < 0.05). The first-quarter V˙O2 during the all-out start trial (3.4 ± 0.4 L·min-1) was significantly higher than during the fast-start trial (3.1 ± 0.4 L·min-1; P < 0.05). After removal of an outlier, the percentage increase in first-quarter V˙O2 was significantly correlated (r = -0.86, P < 0.05) with the relative difference in finishing time. Conclusions: An all-out start produces superior middle distance cycling performance when compared with a fast start. The improvement in performance may be due to a faster V˙O2 response rather than time saved due to a rapid acceleration.

The modulation of outdoor running speed : the influence of gradient

This thesis aimed to investigate the way in which distance runners modulate their speed in an effort to understand the key processes and determinants of speed selection when encountering hills in natural outdoor environments. One factor which has limited the expansion of knowledge in this area has been a reliance on the motorized treadmill which constrains runners to constant speeds and gradients and only linear paths. Conversely, limits in the portability or storage capacity of available technology have restricted field research to brief durations and level courses. Therefore another aim of this thesis was to evaluate the capacity of lightweight, portable technology to measure running speed in outdoor undulating terrain. The first study of this thesis assessed the validity of a non-differential GPS to measure speed, displacement and position during human locomotion. Three healthy participants walked and ran over straight and curved courses for 59 and 34 trials respectively. A non-differential GPS receiver provided speed data by Doppler Shift and change in GPS position over time, which were compared with actual speeds determined by chronometry. Displacement data from the GPS were compared with a surveyed 100m section, while static positions were collected for 1 hour and compared with the known geodetic point. GPS speed values on the straight course were found to be closely correlated with actual speeds (Doppler shift: r = 0.9994, p < 0.001, Δ GPS position/time: r = 0.9984, p < 0.001). Actual speed errors were lowest using the Doppler shift method (90.8% of values within ± 0.1 m.sec -1). Speed was slightly underestimated on a curved path, though still highly correlated with actual speed (Doppler shift: r = 0.9985, p < 0.001, Δ GPS distance/time: r = 0.9973, p < 0.001). Distance measured by GPS was 100.46 ± 0.49m, while 86.5% of static points were within 1.5m of the actual geodetic point (mean error: 1.08 ± 0.34m, range 0.69-2.10m). Non-differential GPS demonstrated a highly accurate estimation of speed across a wide range of human locomotion velocities using only the raw signal data with a minimal decrease in accuracy around bends. This high level of resolution was matched by accurate displacement and position data. Coupled with reduced size, cost and ease of use, the use of a non-differential receiver offers a valid alternative to differential GPS in the study of overground locomotion. The second study of this dissertation examined speed regulation during overground running on a hilly course. Following an initial laboratory session to calculate physiological thresholds (VO2 max and ventilatory thresholds), eight experienced long distance runners completed a self- paced time trial over three laps of an outdoor course involving uphill, downhill and level sections. A portable gas analyser, GPS receiver and activity monitor were used to collect physiological, speed and stride frequency data. Participants ran 23% slower on uphills and 13.8% faster on downhills compared with level sections. Speeds on level sections were significantly different for 78.4 ± 7.0 seconds following an uphill and 23.6 ± 2.2 seconds following a downhill. Speed changes were primarily regulated by stride length which was 20.5% shorter uphill and 16.2% longer downhill, while stride frequency was relatively stable. Oxygen consumption averaged 100.4% of runner’s individual ventilatory thresholds on uphills, 78.9% on downhills and 89.3% on level sections. Group level speed was highly predicted using a modified gradient factor (r2 = 0.89). Individuals adopted distinct pacing strategies, both across laps and as a function of gradient. Speed was best predicted using a weighted factor to account for prior and current gradients. Oxygen consumption (VO2) limited runner’s speeds only on uphill sections, and was maintained in line with individual ventilatory thresholds. Running speed showed larger individual variation on downhill sections, while speed on the level was systematically influenced by the preceding gradient. Runners who varied their pace more as a function of gradient showed a more consistent level of oxygen consumption. These results suggest that optimising time on the level sections after hills offers the greatest potential to minimise overall time when running over undulating terrain. The third study of this thesis investigated the effect of implementing an individualised pacing strategy on running performance over an undulating course. Six trained distance runners completed three trials involving four laps (9968m) of an outdoor course involving uphill, downhill and level sections. The initial trial was self-paced in the absence of any temporal feedback. For the second and third field trials, runners were paced for the first three laps (7476m) according to two different regimes (Intervention or Control) by matching desired goal times for subsections within each gradient. The fourth lap (2492m) was completed without pacing. Goals for the Intervention trial were based on findings from study two using a modified gradient factor and elapsed distance to predict the time for each section. To maintain the same overall time across all paced conditions, times were proportionately adjusted according to split times from the self-paced trial. The alternative pacing strategy (Control) used the original split times from this initial trial. Five of the six runners increased their range of uphill to downhill speeds on the Intervention trial by more than 30%, but this was unsuccessful in achieving a more consistent level of oxygen consumption with only one runner showing a change of more than 10%. Group level adherence to the Intervention strategy was lowest on downhill sections. Three runners successfully adhered to the Intervention pacing strategy which was gauged by a low Root Mean Square error across subsections and gradients. Of these three, the two who had the largest change in uphill-downhill speeds ran their fastest overall time. This suggests that for some runners the strategy of varying speeds systematically to account for gradients and transitions may benefit race performances on courses involving hills. In summary, a non – differential receiver was found to offer highly accurate measures of speed, distance and position across the range of human locomotion speeds. Self-selected speed was found to be best predicted using a weighted factor to account for prior and current gradients. Oxygen consumption limited runner’s speeds only on uphills, speed on the level was systematically influenced by preceding gradients, while there was a much larger individual variation on downhill sections. Individuals were found to adopt distinct but unrelated pacing strategies as a function of durations and gradients, while runners who varied pace more as a function of gradient showed a more consistent level of oxygen consumption. Finally, the implementation of an individualised pacing strategy to account for gradients and transitions greatly increased runners’ range of uphill-downhill speeds and was able to improve performance in some runners. The efficiency of various gradient-speed trade- offs and the factors limiting faster downhill speeds will however require further investigation to further improve the effectiveness of the suggested strategy.

Multi-linear strategies for (re)presenting the complexity of young people in research

Within the current climate of unpredictability and constant change, young people at school are faced with a multitude of choices and contradictory influences. In this article, I argue that (re)presentations of young people in youth research need to reflect the complexity and multiplicity of their lives and changing priorities, and I attempt to (re)present a small group of young people in this particular milieu. I illustrate some of the competing influences in their lives, and I outline some specific strategies that are useful for (re)presenting these contextual worlds. The strategies I advocate disrupt the homogenous representations of ‘youth’ as a developmental phase and instead reflect the diverse spheres of influence which shape their subjectivities and practices.

Characterization of particle number concentrations and PM2.5 in a school : influence of outdoor air pollution on indoor air

Background, Aim and Scope The impact of air pollution on school children’s health is currently one of the key foci of international and national agencies. Of particular concern are ultrafine particles which are emitted in large quantities, contain large concentrations of toxins and are deposited deeply in the respiratory tract. Materials and methods In this study, an intensive sampling campaign of indoor and outdoor airborne particulate matter was carried out in a primary school in February 2006 to investigate indoor and outdoor particle number (PN) and mass concentrations (PM2.5), and particle size distribution, and to evaluate the influence of outdoor air pollution on the indoor air. Results For outdoor PN and PM2.5, early morning and late afternoon peaks were observed on weekdays, which are consistent with traffic rush hours, indicating the predominant effect of vehicular emissions. However, the temporal variations of outdoor PM2.5 and PN concentrations occasionally showed extremely high peaks, mainly due to human activities such as cigarette smoking and the operation of mower near the sampling site. The indoor PM2.5 level was mainly affected by the outdoor PM2.5 (r = 0.68, p<0.01), whereas the indoor PN concentration had some association with outdoor PN values (r = 0.66, p<0.01) even though the indoor PN concentration was occasionally influenced by indoor sources, such as cooking, cleaning and floor polishing activities. Correlation analysis indicated that the outdoor PM2.5 was inversely correlated with the indoor to outdoor PM2.5 ratio (I/O ratio) (r = -0.49, p<0.01), while the indoor PN had a weak correlation with the I/O ratio for PN (r = 0.34, p<0.01). Discussion and Conclusions The results showed that occupancy did not cause any major changes to the modal structure of particle number and size distribution, even though the I/O ratio was different for different size classes. The I/O curves had a maximum value for particles with diameters of 100 – 400 nm under both occupied and unoccupied scenarios, whereas no significant difference in I/O ratio for PM2.5 was observed between occupied and unoccupied conditions. Inspection of the size-resolved I/O ratios in the preschool centre and the classroom suggested that the I/O ratio in the preschool centre was the highest for accumulation mode particles at 600 nm after school hours, whereas the average I/O ratios of both nucleation mode and accumulation mode particles in the classroom were much lower than those of Aitken mode particles. Recommendations and Perspectives The findings obtained in this study are useful for epidemiological studies to estimate the total personal exposure of children, and to develop appropriate control strategies for minimizing the adverse health effects on school children.