Organizational factors associated with decreased mortality among veterans affairs patients with an ICU stay

In-hospital mortality rates associated with an ICU stay are high and vary widely among units. This variation may be related to organizational factors such as staffing patterns, ICU structure, and care processes. We aimed to identify organizational factors associated with variation in in-hospital mortality for patients with an ICU stay. This was a retrospective observational cross-sectional study using administrative data from 34 093 patients from 171 ICUs in 119 Veterans Health Administration hospitals. Staffing and patient data came from Veterans Health Administration national databases. ICU characteristics came from a survey in 2004 of ICUs within the Veterans Health Administration. We conducted multilevel multivariable estimation with patient-, unit-, and hospital-level data. The primary outcome was in-hospital mortality. Of 34 093 patients, 2141 (6.3%)died in the hospital. At the patient level, risk of complications and having a medical diagnosis were significantly associated with a higher risk of mortality. At the unit level, having an interface with the electronic medical record was significantly associated with a lower risk of mortality. The finding that electronic medical records integrated with ICU information systems are associated with lower in-hospital mortality adds support to existing evidence on organizational characteristics associated with in-hospital mortality among ICU patients.

Wi-Fi security : wireless with confidence

Since the IEEE ratification of the 802.11 standard in 1999, continuous exploits have been discovered compromising the confidentiality, integrity and availability of 802.11 networks. This paper describes the justification for a project to assess the security status of wireless network usage in society. It reviews the status of both commercial and residential approaches to wireless network security in three major Victorian cities, Melbourne, Geelong and Mornington, in Australia. By War Driving these suburbs, actual data was gathered to indicate the security status of wireless networks and give a representation of modern attitudes towards wireless security for the sample population. Preliminary results are presented to demonstrate the extent to which commercial or residential suburbs address wireless security. At this stage in the research further work is required to completely analyse the results. It is anticipated that the results will be useful for providing input into a defence and attack methodology for improving the security of both residential and commercial use of wireless networks.

A labour of love: mothers, emotional capital and homework

This paper develops a new analysis of homework by building on feminist scholarship which documents the invisible labour done by women in support of their children's education. While numerous studies have examined the relationship between homework and achievement, little attention has been paid to the largely gendered and potentially stressful nature of ‘parental involvement’. The analytic focus in this paper is on the complex emotional and pedagogical dimensions of homework and the ways it is shaped by socio-cultural contexts. Videotaped homework interactions between one working-class and two middle-class mothers and their children are examined using Bourdieu's concepts of habitus and capital. The analysis distinguishes between productive pedagogical relationships and those that promote extensive anxiety and are counterproductive to learning. The paper argues that the reserves of cultural and emotional capital required for homework completion are significant and that class position does not necessarily guarantee the ways in which these capitals are mobilised.

Real-time motion capture interactive, 3D stereoscopic visualization

Vincs, McCormick and dancers Steph Hutchinson & Megan Beckwith present live motion capture interactive pipelines that visualise the kinematics of a performer’s movement in stereoscopic environments created using the Unity game engine, and discuss their use in Choreotopography (2010) and Choreotopography (2011). This work forms part of Vincs’ ARC Discovery Project Capturing Dance: using motion capture to enhance the creation of innovative Australian dance (DP0987101).

Pre-visualization techniques with live lensing system enhances workflow for interactive performance creation.

Vincs & Divers, with dancer Steph Hutchinson, present a new system for real-time previsualization in Motion Builder that enables choreographers and artists making interactive 3D work to make on-the-fly lensing decisions. Using motion capture to drive a ‘character’ created from a cloth simulation in real time, the presentation highlights the advantage of live lensing for interactive work-flow in creating 3D dance visualizations. This work forms part of Vincs’ ARC Discovery project ‘Building innovative capacity in Australian dance through new visualization technologies’ (DP120101695).

An agile IT security model for project risk assessment

There are two fundamental challenges in effectively performing security risk assessment in today's IT projects.The first is the project manager's need to know what IT security risks face the project before the project begins. At this stage IT security staff are unable to answer this question without first knowing the system requirements for the project which are yet to be defined. Second organisations that deal with a large project throughput each year find the current IT security risk assessment process to be tedious and expensive, especially when the same process has to be repeated for each individual project. This also makes it difficult for an organisation to prioritise which projects require more investment in IT security in order to fit within budget constraints. This paper presents a conceptual model that is based on an agile approach to alleviate these challenges. We do this by first analysing two online database resources of vulnerabilities by comparing them to each other, and then compare them to the agile criteria of the conceptual model which we define. The conceptual model is then presented and an example is given of how it can be applied to an actual project. We then briefly discuss what further work needs to be done to implement the conceptual model and validate it against an existing IT project.

Nursing home administrators’ perspectives on a study feedback report : a cross sectional survey

Background
This project is part of the Translating Research in Elder Care (TREC) program of research, a multi-level and longitudinal research program being conducted in 36 nursing homes in three Canadian Prairie Provinces. The overall goal of TREC is to improve the quality of care for older persons living in nursing homes and the quality of work life for care providers. The purpose of this paper is to report on development and evaluation of facility annual reports (FARs) from facility administrators’ perspectives on the usefulness, meaningfulness, and understandability of selected data from the TREC survey.
Methods
A cross sectional survey design was used in this study. The feedback reports were developed in collaboration with participating facility administrators. FARs presented results in four contextual areas: workplace culture, feedback processes, job satisfaction, and staff burnout. Six weeks after FARs were mailed to each administrator, we conducted structured telephone interviews with administrators to elicit their evaluation of the FARs. Administrators were also asked if they had taken any actions as a result of the FAR. Descriptive and inferential statistics, as well as content analysis for open-ended questions, were used to summarize findings.
Results
Thirty-one facility administrators (representing thirty-two facilities) participated in the interviews. Six administrators had taken action and 18 were planning on taking action as a result of FARs. The majority found the four contextual areas addressed in FAR to be useful, meaningful, and understandable. They liked the comparisons made between data from years one and two and between their facility and other TREC study sites in their province. Twenty-two indicated that they would like to receive information on additional areas such as aggressive behaviours of residents and information sharing. Twenty-four administrators indicated that FARs contained enough information, while eight found FARs ‘too short’. Administrators who reported that the FAR contained enough information were more likely to take action within their facilities than administrators who reported that they needed more information.
Conclusions
Although the FAR was brief, the presentation of the four contextual areas was relevant to the majority of administrators and prompted them to plan or to take action within their facility.

Feedback reporting of survey data to healthcare aides

Background

This project occurred during the course of the Translating Research in Elder Care (TREC) program of research. TREC is a multilevel and longitudinal research program being conducted in the three Canadian Prairie Provinces of Alberta, Saskatchewan, and Manitoba. The main purpose of TREC is to increase understanding about the role of organizational context in influencing knowledge use in residential long-term care settings. The purpose of this study was to evaluate healthcare aides’ (HCAs) perceptions of a one-page poster designed to feed back aggregated data (including demographic information and perceptions about influences on best practice) from the TREC survey they had recently completed.

Methods
A convenience sample of 7 of the 15 nursing homes participating in the TREC research program in Alberta were invited to participate. Specific facility-level summary data were provided to each facility in the form of a one-page poster report. Two weeks following delivery of the report, a convenience sample of HCAs was surveyed using one-to-one structured interviews.

Results
One hundred twenty-three HCAs responded to the evaluation survey. Overall, HCAs’ opinions about presentation of the feedback report and the understandability, usability, and usefulness of the content were positive. For each report, analysis of data and production and inspection of the report took up to one hour. Information sessions to introduce and explain the reports averaged 18 minutes. Two feedback reports (minimum) were supplied to each facility at a cost of CAN$2.39 per report, for printing and laminating.

Conclusions
This study highlights not only the feasibility of producing understandable, usable, and useful feedback reports of survey data but also the value and importance of providing feedback to survey respondents. More broadly, the findings suggest that modest strategies may have a positive and desirable effect in participating sites.

Realist synthesis : illustrating the method for implementation research

Background
Realist synthesis is an increasingly popular approach to the review and synthesis of evidence, which focuses on understanding the mechanisms by which an intervention works (or not). There are few published examples of realist synthesis. This paper therefore fills a gap by describing, in detail, the process used for a realist review and synthesis to answer the question 'what interventions and strategies are effective in enabling evidence-informed healthcare?' The strengths and challenges of conducting realist review are also considered.
Methods
The realist approach involves identifying underlying causal mechanisms and exploring how they work under what conditions. The stages of this review included: defining the scope of the review (concept mining and framework formulation); searching for and scrutinising the evidence; extracting and synthesising the evidence; and developing the narrative, including hypotheses.
Results
Based on key terms and concepts related to various interventions to promote evidenceinformed healthcare, we developed an outcome-focused theoretical framework. Questions were tailored for each of four theory/intervention areas within the theoretical framework and were used to guide development of a review and data extraction process. The search for literature within our first theory area, change agency, was executed and the screening procedure resulted in inclusion of 52 papers. Using the questions relevant to this theory area, data were extracted by one reviewer and validated by a second reviewer. Synthesis involved organisation of extracted data into evidence tables, theming and formulation of chains of inference, linking between the chains of inference, and hypothesis formulation. The narrative was developed around the hypotheses generated within the change agency theory area.
Conclusions
Realist synthesis lends itself to the review of complex interventions because it accounts for context as well as outcomes in the process of systematically and transparently synthesising relevant literature. While realist synthesis demands flexible thinking and the ability to deal with complexity, the rewards include the potential for more pragmatic conclusions than alternative approaches to systematic reviewing. A separate publication will report the findings of the review.