Implementation of a medication guideline to improve medication safety for patients

Although the incidence of medication error remains unknown, in Australian hospitals, they are thought to occur in 5-20 % of drug administrations 1. Not surprisingly, international debate has focused on the mechanisms to improve the safety of patients. Thus a new National Inpatient Medication Chart (NIMC) was endorsed to improve communication and reduce medication errors 2. This study aimed to investigate the documentation practices of clinicians following the implementation of a medication guideline and NIMC.
A pre and post-test design was used to evaluate the adoption of and adherence to the medication guideline at Western Health, an 850 bed healthcare network in Australia. Audits of inpatient medication charts (N=265) were conducted at 3 months prior to and repeated 4 months (N=290) after implementation. The pre-test data was used to formulate an interdisciplinary organizational strategy that included mandatory education for all clinical staff, practice reminders, decision prompts, a telephone hotline for support, an intranet information website and electronically distributed Frequently Asked Questions.
Pre and post implementation audits highlighted areas of potential medication error. The post-test showed an overall trend towards improvement in documentation. There were significant improvements in 4 critical practices: Drug name clear (p=0.0003); Drug dose clear (p=0.0002); Prescribed frequency equals documented frequency (p=0) and; No signature by administrator (p=0).
The majority of documentation errors showed poor attention to detail and would be considered a slip or lapse in skill based judgment 3. Although this study was designed to evaluate documentation practices, future research should include observation methods to increase our understanding of the context behind the judgments such as work place interruptions, skill mix and knowledge levels. While evidence based guidelines enable work, they are not the actual work or substance of patient care. Organisational systems can assist in preventing unconscious aberrations that lead to error.

Indigenous entrepreneurship as a research field : developing a definitional framework from the emerging canon

This study defines Indigenous entrepreneurship as a distinct disciplinary field of science and charts for it a pre-paradigmatic framework. A strategy of literature search and examination was utilized to argue that Indigenous entrepreneurship is sufficiently distinguished from both mainstream entrepreneurship and other social and management sciences to constitute a legitimate, well-defined sub-field of research in its own right. The study provides both a formal definition of the field and diagrammatic framework to describe it.

'The C Words': clitorises, childhood and challenging compulsory heterosexuality discourses with pre-service primary teachers

This paper reports on accidental ethnographic research. It arose unexpectedly out of the everyday teaching of first-year pre-service primary teachers at an Australian university. Via narrative, self-reflexivity, and student responses, we explore the interwoven workings of heteronormative, gendernormative and misogynist discourses when a chapter from Queering Elementary Education in the Course Reader created controversy, moral panic and resistance among students. The paper then charts the implementation of various strategies and interventions by the three authors of the paper: Greg, the lecturer; Maria, the Reading's author; and Steph, the Reading's protagonist. While outlining the subsequent shifts in student responses and discourses, we also problematise particular aspects of the processes of intervention where they still point to the insidious power and overarching framework of heteronormativity and gendernormativity that require ongoing challenges.

Meteorological influences on coastal sea levels west of Port Phillip and their engineering significance

This report presents the results of an analysis of three years of tide and meteorological data aimed at delineating the influences of atmospheric pressure, waves, onshore winds and longshore winds on coastal sea levels West of Port Phillip Bay, Victoria« The data was used to develop predictive and hindcasting techniques for meteorological tides on the Otway Coast, using statistical methods, an empirical method and a mathematical model. The nature and magnitude of contributions of the various components of the meteorological tide, and the general variability of monthly and seasonal variations were also studied. It was found that meteorological tides on the Otway Coast can account for significant sea level changes, with the main factors being wind and atmospheric pressure. The wind component of the meteorological tide was found to be approximately twice the pressure component, and longshore winds were found to be more significant than onshore winds for wind setup on the Otway Coast. The meteorological tide models developed enable estimates of wind setup and atmospheric pressure setup on the Otway Coast to be readily computed using data from synoptic charts. The wave setup component could not be separated from the meteorological tide and is included in the wind setup component. The results of the investigation are relevant to the design and maintenance of coastal engineering works, and point to the need for the establishment and operation of coastal management schemes on the Otway Coast.

Lateral strength of zero bond masonry walls subjected to wind loads

Masonry walls are usually laid with the individual masonry units along a course overlapping units in the course below. Commonly, the perpend joints in the course occur above the mid-points of the units below to form a ‘half-bond’ or above a third point to form a ‘third-bond’. The amount of this overlap has a profound influence on the strength of a wall supported on three or four sides, where lateral pressures from wind cause combined vertical and horizontal flexure. Where masonry units are laid with mortar joints, the torsional shear bond resistance between the mortar and overlapping units largely determines the horizontal flexural strength. If there is zero bond strength between units, then the horizontal flexural strength is derived from the frictional resistance to torsion on the overlapping bed-faces of the units. This thesis reports a theoretical and experimental investigation into the frictional properties of overlapping units when subjected to combinations of vertical and horizontal moments and vertical axial compression. These basic properties were used to develop a theory to predict the lateral strength of walls supported on two, three or four sides. A plastic theory of behaviour was confirmed by experiment. The theory was then used to determine maximum unbraced panel sizes for particular boundary conditions. Design charts were developed to determine temporary bracing requirements for panels during construction.

Design tools for event-driven software systems

Proposes a design method for the development of software in Visual BASIC whose programming environment is multi-paradigm. Extensions to structure charts and pseudocode to incorporate the three paradigms have been developed based on the premise that procedural models, event-driven forms and objects are mutually exclusive in operation.

Reducing obesity in early childhood : results from romp & chomp, an Australian community-wide intervention program

Background: There is growing evidence that community-based interventions can reduce childhood obesity in older children.
Objective: We aimed to determine the effectiveness of the Romp & Chomp intervention in reducing obesity and promoting healthy eating and active play in children aged 0–5 y.
Design: Romp & Chomp was a community-wide, multisetting, multistrategy intervention conducted in Australia from 2004 to 2008. The intervention occurred in a large regional city (Geelong) with a target group of 12,000 children and focused on community capacity building and environmental (political, sociocultural, and physical) changes to increase healthy eating and active play in early-childhood care and educational settings. The evaluation was repeat cross-sectional with a quasiexperimental design and comparison sample. Main outcome measures were body mass index (BMI), standardized BMI (zBMI; according to the Centers for Disease Control and Prevention 2000 reference charts), and prevalence of overweight/obesity and obesity-related behaviors in children aged 2 and 3.5 y.
Results: After the intervention there was a significantly lower mean weight, BMI, and zBMI in the 3.5-y-old subsample and a significantly lower prevalence of overweight/obesity in both the 2- and 3.5-y-old subsamples (by 2.5 and 3.4 percentage points, respectively) than in the comparison sample (a difference of 0.7 percentage points; P < 0.05) compared with baseline values. Intervention child-behavioral data showed a significantly lower intake of packaged snacks (by 0.23 serving), fruit juice (0.52 serving), and cordial (0.43 serving) than that in the comparison sample (all P < 0.05).
Conclusion: A community-wide multisetting, multistrategy intervention in early-childhood settings can reduce childhood obesity and improve young children's diets. This trial was registered with the Australian Clinical Trials Registry at anzctr.org.au as ACTRN12607000374460.

Aboriginal women and reconciliation in Australia : communication strategies and symbolism

This thesis explores the voices of Aboriginal women in the Reconciliation movement from 1991to 2001. It charts their success and failure, the power of the media and Reconciliation symbolism. Some of these women leaders retain a passionate commitment to Reconciliation while others have totally withdrawn from the process.

The longitudinal influence of home and neighbourhood environments on children's body mass index and physical activity over 5 years : the CLAN study

Objective: To determine the independent contributions of family and neighbourhood environments to changes in youth physical activity and body mass index (BMI) z-score over 5 years.

Methods: In 2001, 2004 and 2006, 301 children (10–12 years at baseline) had their height and weight measured (BMI was converted to z-scores using Centers for Disease Control and Prevention reference charts; see http://www.cdc.gov/growthcharts) and moderate-to-vigorous physical activity (MVPA) assessed using accelerometers. In 2001, parents reported on the home environment (social support, role modelling, rules and restrictions, physical environment) and perceived neighbourhood environment (local traffic, road safety, sporting venues, public transport), and Geographic Information Systems were used to map features of the neighbourhood environment (destinations, road connectivity, traffic exposure). Generalized estimating equations were used to predict average BMI z-score and MVPA over time from baseline home and perceived and objective neighbourhood environment factors.

Results: Among boys, maternal education and heavy traffic were inversely associated, and sibling physical activity, maternal role modelling of MVPA and the presence of dead-end roads were positively associated with MVPA. Having unmarried parents, maternal MVPA role modelling and number of home sedentary items were positively associated with BMI z-score among boys. Among girls, having siblings, paternal MVPA role modelling, physical activity rules and parental physical activity co-participation were positively associated with MVPA. Having unmarried parents and maternal sedentary behaviour role modelling were positively associated, and number of sedentary behaviour rules and physical activity items were inversely associated with BMI z-score among girls.

Conclusion: The home environment seems more important than the neighbourhood environment in influencing children's physical activity and BMI z-score over 5 years. Physical activity and weight gain programmes among youth should focus on parental role modelling, rules around sedentary and active pursuits, and parental support for physical activity. Intervention studies to investigate these strategies are warranted.

The client's complex decision-making environment on international mega projects

More than ever before, architectural, engineering and construction (AEC) firms are working on international mega projects. The mega project environment offers a range of opportunities for firms but is but is characterised by a high level of risk and uncertainty. International mega projects bring together networks of people with differing backgrounds and cultures to work in unfamiliar locations to integrate the social, economic, technical and political components of design and construction. Within such an intense environment there is a process of rapid relationship development at an unprecedented level. The interests and power relations on such projects are often very strong given the vast amount of money, jobs, environmental impacts, publicity and national prestige involved. Therefore in a field as costly or consequential as mega project design and construction there is an increased need to effectively manage these projects given the associated high risks of failure. Internationalisation is a relatively new field of research in the AEC sector and past research has tended to focus on explaining the attitudes and behaviour of the industry itself towards improving performance on such projects. To date there has been little research investigating the sophistication of the international client in terms of their regular business environment which is characterised by a set of social, economic and political responsibilities. The values that clients ascribe to their everyday practices and experiences inevitably condition how they act economically, which in turn impacts upon project decision-making. Clients establish the structural organisation of project teams through the procurement strategy and establish the context for effective decision-making. To a large extent they establish a unique culture that project team members need to work within and make decisions. Since clients establish the context within which firms operate the findings of past studies on the industry’s position and attitudes are more indicative than enlightening. Clients occupy a distinctly different position in the construction supply chain and therefore experience and respond to project matters based upon their environment and not the construction industry environment. Clients are confronted with uncertainties and need support to help them understand the critical role that they play in creating good decision-making environments. This theoretical paper seeks to develop a rationale for studying the client’s complex decision-making environment on international mega projects. Specifically it charts the quest for improved industry performance through client leadership as documented in various industry and government publications since the 1940s and highlights that there has been considerable attention to address industry problems through client leadership, however, with little evidence that the issues have been resolved. This paper is positioned within a PhD study, which seeks to move beyond the aspirations of policymakers and idealistic descriptions of how clients ought to behave to explain the reality of what really happens on mega project client decision-making based upon a critique of cultural political economy.

Using the psychrometric chart in building measurements

This paper centres around the presentation of multiple measured results on a psychrometric chart. The psychrometric chart was programmed in Microsoft Office Excel to accommodate measured results. It was written because existing programs appear not to cater for the researcher wishing to enter results electronically onto the chart. Furthermore, many existing charts are complex and cluttered displaying up to ten attributes, being intended for engineering design, whereas presenting the behaviour of living and working environments is focused on wet and dry bulb temperature and relative humidity. As well as results, users would also like to specify and adjust the ‘comfort zone’ (a shaded area on the chart) for different ‘adaptive’ or ‘seasonal’ conditions. The comfort zone is bounded by lines of constant heat loss from the skin, relative humidity and wet-bulb temperature. The paper presents various applications of the psychrometric chart for the analysis and reporting of research and discusses the programming of Microsoft Office Excel to generate the chart and display user data.

The roles, responsibilities and development needs of quality managers in Britain and Australia

This paper compares and contrasts the career experiences and development needs of 334 British quality managers compared with Australian quality managers based on two Australian surveys. The quality managers in both countries brought wide functional experience to their roles, with many coming in particular from production and operations and general management. In their current roles major sources of job satisfaction for managers in both countries were improving efficiency and problem solving, whereas aspects of employee relations was a source of least satisfaction. Both groups of quality managers utilised a very limited range of quality tools, the most popular being brainstorming, control charts and Pareto analysis, with virtually no mention of more sophisticated tools like Six sigma, which is in stark contrast to American managers. Also British and Australian managers showed little awareness in terms of their development needs for a broader background in quality, which could disadvantage their companies in global markets.

Website physical activity interventions : preferences of potential users

Information and communication technologies (particularly websites and e-mail) have the potential to deliver health behavior change programs to large numbers of adults at low cost. Controlled trials using these new media to promote physical activity have produced mixed results. User-centered development methods can assist in understanding the preferences of potential participants for website functions and content, and may lead to more effective programs. Eight focus group discussions were conducted with 40 adults after they had accessed a previously trialed physical activity website. The discussions were audio taped, transcribed and interpreted using a themed analysis method. Four key themes emerged: structure, interactivity, environmental context and content. Preferences were expressed for websites that include simple interactive features, together with information on local community activity opportunities. Particular suggestions included online community notice boards, personalized progress charts, e-mail access to expert advice and access to information on specific local physical activity facilities and services. Website physical activity interventions could usefully include personally relevant interactive and environmentally focused features and services identified through a user-centered development process.

Application of computational media aesthetics methodology to extracting color semantics in film

Using film grammar as the underpinning, we study the extraction of structures in video based on color using a wide configuration of clustering methods combined with existing and new similarity measures. We study the visualisation of these structures, which we call Scene-Cluster Temporal Charts and show how it can bring out the interweaving of different themes and settings in a film. We also extract color events that filmmakers use to draw/force a viewer's attention to a shot/scene. This is done by first extracting a set of colors used rarely in film, and then building a probabilistic model for color event detection. We demonstrate with experimental results from ten movies that our algorithms are effective in the extraction of both scene-cluster temporal charts and color events.

Heritage of war

The Heritage of War is an interdisciplinary study of the ways in which heritage is mobilized in remembering war, and in reconstructing landscapes, political systems and identities after conflict. It examines the deeply contested nature of war heritage in a series of places and contexts, highlighting the modes by which governments, communities, and individuals claim validity for their own experiences of war, and the meanings they attach to them.

From colonizing violence in South America to the United States’ Civil War, the Second World War on three continents, genocide in Rwanda and continuing divisions in Europe and the Middle East, these studies bring us closer to the very processes of heritage production. The Heritage of War uncovers the histories of heritage: it charts the constant social and political construction of heritage sites over time, by a series of different agents, and explores the continuous reworking of meaning into the present.

What are the forces of contingency, agency and political power that produce, define and sustain the heritage of war? How do particular versions of the past and particular identities gain legitimacy, while others are marginalised? In this book contributors explore the active work by which heritage is produced and reproduced in a series of case studies of memorialization, battlefield preservation, tourism development, private remembering and urban reconstruction. These are the acts of making sense of war; they are acts that continue long after violent conflict itself has ended.