Clinical sensemaking: a systematic approach to reduce the impact of normalised deviance in the medical profession

organisational culture, quality assurance, health care, state medicine, Great Britain, Health care reform, quality improvement

Do renal access coordinators make a difference? What is the evidence?

Background
Since the introduction of the renal access coordinator (RAC) role into Australia there have been only anecdotal examples of associated improvements in patient outcome and service delivery and scant published quantitative extant evidence exists.

Aim
To review the literature related to the impact of RACs on dialysis patient outcomes and associated service delivery, gauge the level of evidence available and identify gaps in the literature.

Method
A three stage Joanna Briggs Institute (JBI) systematic review process was used to collect and synthesise data. The review considered studies that explored and measured the RAC role in the adult haemodialysis context. All quantitative study designs were considered. Due to lack of homogeneity a narrative synthesis was undertaken.

Results
Five studies met the inclusion criteria for the review. All studies included multidisciplinary teams with variable emphasis on the RAC role. Four pre post intervention cohort studies measured incident and/or prevalent AVF, AVG and CVC rates in the haemodialysis population and the quality assurance report measured differences in patency rates between AVF and AVG and associated hospital length of stay. All discussed the role of central coordination as a contributor to the success of vascular access care.

Conclusion
The available reports do suggest an association between RACs and improved patient outcomes. These improved patient outcomes were apparent in an increase in incident and prevalent AVFs, and a decrease in the incidence and prevalence of CVCs. Both associations are correlated with a reduction in infection rates, length of hospital stay and healthcare costs
 

Effects of patient-, environment- and medication-related factors on high-alert medication incidents.

To measure the rate of medication incidents associated with the prescription and administration of high-alert medications and to identify patient-, environment- and medication-related factors associated with these incidents.

Are vitamins A and D important in the development of food allergy and how are they best measured?

Food allergy has a dramatic impact on a child's (and their family's) quality of life and places a major financial burden on the community. It has been hypothesized that the increase in food allergy may relate to the concordant rise in prevalence of vitamin D insufficiency. More recently a second hypothesis has implicated vitamin A sufficiency in the development of immune tolerance. Together, these hypotheses have prompted investigation into the circulating levels of vitamins A and D in relation to food allergy prevalence. This review aims to examine the relationship between vitamins A and D and food allergy. The first part of this review presents the available epidemiological data which proposes a dramatic increase of food allergy and related anaphylaxis during the last two decades. There is some indirect evidence that variation in food allergy prevalence within countries might be linked with ambient ultra violet radiation exposure and thus potentially with vitamin D levels. Only a few studies to date have directly examined the relationship between measured serum vitamin D levels and either food sensitization or allergy. The significance of vitamin A in food allergy prevalence is only provided through a hypothetical association due to its role in the immune system. The second part of this review discusses the relevant aspects of the analytical methods to assess vitamin A and D levels in children. The primary methods utilized relate to measuring the main circulating forms of vitamins A and D in blood i.e. retinol and 25-hydroxy-vitamin-D3 respectively. Chromatographic separation coupled with mass spectrometric detection is considered the gold standard method for both vitamins. These analytical methods should be fully validated for the use in pediatric populations to ensure they are fit for their clinical purpose.

TESOL professional standards in the "Asian century": dilemmas facing Australian TESOL teacher education

Australian teacher education programmes that prepare teachers of English to speakers of other languages (TESOL) are confronting the nexus of two facets of globalization: transformations in the Asian region, captured in the notion of the "Asian century", and shifting conceptions of professionalism in TESOL in non-compulsory education. In booming Asian economies, English language learning is integral to the demand for high-quality education. This has produced increases in TESOL Teacher Education Programme (TTEP) enrolments of both domestic Australian students and international students from Asia. Growth in demand for TTEPs has necessitated that they cater to student diversity, and the intended contexts of practice. This demand has coincided with a concurrent movement towards professional standards for TESOL that, we argue, confronts complexities around quality, accountability, and professional identity and achieving conceptual and contextual coherence. Drawing on discourses of managerialism and performativity, this paper explores tensions between increased student demands for TTEPs, professional standards discourses which are part of the global policy discourses on teacher quality, and the achievement of programmatic conceptual and contextual coherence from the perspective of Australian TTEPs.

Evidencing learning outcomes: a multi-level, multi-dimensional course alignment model

This conceptual framework proposes a multi-level, multi-dimensional course alignment model to implement a contextualised constructive alignment of rubric design that authentically evidences and assesses learning outcomes. By embedding quality control mechanisms at each level for each dimension, this model facilitates the development of an aligned curriculum. The use of rubrics is a crucial theme for many higher education institutions owing to the binding requirement by universities to provide evidence to quality assurance agencies. The success of evidencing learning outcomes through rubrics, however, is only one piece of the puzzle. The other is the contextualised constructive alignment of intertwined factors. Despite the significance of embedding these factors, there has been little, if any, systematic framework in this area. The two key instrumental forces underpinning the conception of this model are: seeking external accreditation and the implementation of programme enhancement thus realising the strategic agenda for an Australian university.

Understanding toxicities and complications of cancer treatment: a data mining approach

Cancer remains a major challenge in modern medicine. Increasing prevalence of cancer, particularly in developing countries, demands better understanding of the effectiveness and adverse consequences of different cancer treatment regimes in real patient population. Current understanding of cancer treatment toxicities is often derived from either “clean” patient cohorts or coarse population statistics. It is difficult to get up-to-date and local assessment of treatment toxicities for specific cancer centres. In this paper, we applied an Apriori-based method for discovering toxicity progression patterns in the form of temporal association rules. Our experiments show the effectiveness of the proposed method in discovering major toxicity patterns in comparison with the pairwise association analysis. Our method is applicable for most cancer centres with even rudimentary electronic medical records and has the potential to provide real-time surveillance and quality assurance in cancer care.

Temporal verification for scientific cloud workflows: State-of-the-art and research challenges

Cloud computing is establishing itself as the latest computing paradigm in recent years. As doing science in the cloud is becoming a reality, scientists are now able to access public cloud centers and employ high-performance computing resources to run scientific applications. However, due to the dynamic nature of the cloud environment, the usability of scientific cloud workflow systems can be significantly deteriorated if without effective service quality assurance strategies. Specifically, workflow temporal verification as the major approach for workflow temporal QoS (Quality of Service) assurance plays a critical role in the on-time completion of large-scale scientific workflows. Great efforts have been dedicated to the area of workflow temporal verification in recent years and it is high time that we should define the key research issues for scientific cloud workflows in order to keep our research on the right track. In this paper, we systematically investigate this problem and present four key research issues based on the introduction of a generic temporal verification framework. Meanwhile, state-of-the-art solutions for each research issue and open challenges are also presented. Finally, SwinDeW-V, an ongoing research project on temporal verification as part of our SwinDeW-C cloud workflow system, is also demonstrated.

International students in the private VET sector in Melbourne, Australia: rethinking their characteristics and aspirations outside the deficit model

The reconstruction of the Australian Vocational Education and Training (VET) sector into a competitive training market, which led to the participation of international students and commercial for-profit private VET providers, has until
recently focused on the importance of international students to the national economy whilst ignoring the students ’important educational characteristics and the other benefits that accrue to Australia. Drawing on views and perspectives of students, teachers, training managers and quality assurance auditors, this article presents an analysis of the VET provider-level processes, which have contributed tolimited discursive constructions of the identities of international students in private VET providers in Melbourne. It argues that there is an urgent need for a rethinking of the way international students are conceptualised and represented in the competitive training market environment.

Sensory and Marketing - Partners for life

Sensory and marketing groups co-exist in many medium to large food companies. The roles of sensory departments vary from an integrated group fully embedded in new product development to those who are mainly involved in quality assurance. The idea that sensory groups should just support, rather than lead new product development by providing their services to marketing and product developers is becoming a highly challenged view. During the meeting delegates including academics, market research agencies as well as company sensory scientists discussed ways to facilitate the marriage between marketing and sensory - a relationship in which both partners are equal will result in great offspring, or products in this case

Ellipsoidal neighbourhood outlier factor for distributed anomaly detection in resource constrained networks

Anomaly detection in resource constrained wireless networks is an important challenge for tasks such as intrusion detection, quality assurance and event monitoring applications. The challenge is to detect these interesting events or anomalies in a timely manner, while minimising energy consumption in the network. We propose a distributed anomaly detection architecture, which uses multiple hyperellipsoidal clusters to model the data at each sensor node, and identify global and local anomalies in the network. In particular, a novel anomaly scoring method is proposed to provide a score for each hyperellipsoidal model, based on how remote the ellipsoid is relative to their neighbours. We demonstrate using several synthetic and real datasets that our proposed scheme achieves a higher detection performance with a significant reduction in communication overhead in the network compared to centralised and existing schemes. © 2014 Elsevier Ltd.

International student mobility and its impact on the Australian private VET sector

In recent years governments have legitimated neoliberal educational policy reforms such as the internationalization and commercialization of education through mobilising the discourses of globalization and the knowledge economy. In Australia for instance, a raft of policy initiatives over the last two and a half decades (beginning in the early 1990s) targeted full-fee paying international students prompting a surge in international student enrolments and a burgeoning private vocational education and training (VET) sector for international students. Drawing on a study of situated realities influencing international students in private VET providers in Melbourne Australia, this chapter analyses, from training managers’ and quality assurance auditors’ perspectives, the impact of international student mobility on the private VET sector. The chapter also utilises the notion of social structure as systems of human relations amongst social positions to examine how international student mobility has led to shifts in VET manager and quality assurance auditors’ perceptions and practices outside the boundaries of the education sector, particularly how private VET providers and international students are represented. In this instance by reforming the VET sector, governments change conventional characteristics through which people relate and the relationships that bind them with intended and unintended consequences. The findings suggest that whilst VET policy posits an easy and ready association between the needs of capital and the development of the workforce, this association is highly contestable and problematic as it can lead to negative student learning outcomes.

The reality of quality systems software : working for the machine, or smart people around the machine?

This case study-based research examines the outcomes of using quality system software (QSS) in terms of the support it provides to, and the constraints it imposes on, its users. The results indicate that QSS can help facilitate knowledge access and sharing, and to a lesser extent, facilitate communication. It can be an effective mechanism for initiating and managing changes to work processes. Although some writers have opined that information technology (IT) is another way of controlling workers, this was not evidenced in this study. Technical shortcomings did hamper performance of some tasks, and for some managers, extra work was involved.

Key success factors in real-time industrial system assurance

The thesis analyses the issues of implementing real-time software systems in industrial applications. The benefit is the development of the Integrated Mega Project Development Model, to improve the effectiveness of planning and timely delivery of software, the quality of the delivered software and reducing problems associated with integrating software systems.

What will affect software reuse: a causal model analysis

Software reuse is an important topic due to its potential benefits in increasing product quality and decreasing cost. Although more and more people are aware that not only technical issues, but also nontechnical issues are important to the success of software reuse, people are still not certain which factors will have direct effect on the success of reuse. In this paper, we applied a causal discovery algorithm to the software reuse survey data [2]. Ensemble strategy is incorporated to locate a probable causal model structure for software reuse, and find all those factors which have direct effect on the success of reuse. Our discovery results reinforced some conclusions of Morisio et al. and found some new conclusions which might significantly improve the odds of a reuse project succeeding.