Discrepancy between expected and actual child support payments : predicting the health and health-related quality of life of children living in low-income, single-parent families

Objective Although the amount and frequency of child support payments received by single parents are often erratic and fluctuate, no study to date has quantitatively explored how the discrepancy between expected and actual payments relates to child health. This study aims to examine whether the discrepancy between expected and actual child support payments predicts a range of child health outcomes, including global health, health-related quality of life, involvement in activities and parental psychological distress.

Methods This study used results from the Longitudinal Study of Australian Children, which included a sample of parents of children aged 4–5 years (n = 4983). The questionnaire was completed by the parent who spent the most time with the child and knew the child best. From the 4983 families, 332 low-income single parents reliant on welfare with a formal or informal child support order in place were identified.

Results After controlling for income, the discrepancy between expected and actual child support predicted school functioning, conduct problems, total mental health problems and involvement in activities. Discrepancy between expected and actual child support payments did not predict the remaining health-related quality of life domains, mental health domains, global child health or parental psychosocial distress.

Conclusion This was the first study to examine how the discrepancy between expected and actual child support payments relates to child health, providing important data on the effectiveness of the child support system for children's well-being. These findings highlight the potential impact of the discrepancy on school functioning, conduct problems, total mental health problems and involvement in activities.

Exploring creativity support systems for the Ne"X"t generation

This paper explores the implementation of a creativity support system (CSS) for tertiary students studying Games Design and Development at Deakin University, Victoria, Australia. The students at the centre of this study are the ‘next’ generation of learners and are often called the Internet generation because of their pre-imposed for ‘online’ and being ‘connected’. The CSS for the games students is designed within a context that encompasses a ‘whole’ system, as focusing on only one component to augment a person’s creativity does not take into consideration the multitude of factors, for example social factors, that are pertinent on a person ability to grow their creative behaviours. This study will present a set of factors that each CSS should employ to facilitate creative abilities within people, with particular focus on how social activities help to enhance creativity.

Nurses' critical event risk assessments : a judgement analysis

Aims. To explore and explain nurses' use of readily available clinical information when deciding whether a patient is at risk of a critical event.

Background. Half of inpatients who suffer a cardiac arrest have documented but unacted upon clinical signs of deterioration in the 24 hours prior to the event. Nurses appear to be both misinterpreting and mismanaging the nursing-knowledge 'basics' such as heart rate, respiratory rate and oxygenation. Whilst many medical interventions originate from nurses, up to 26% of nurses' responses to abnormal signs result in delays of between one and three hours.

Methods. A double system judgement analysis using Brunswik's lens model of cognition was undertaken with 245 Dutch, UK, Canadian and Australian acute care nurses. Nurses were asked to judge the likelihood of a critical event, 'at-risk' status, and whether they would intervene in response to 50 computer-presented clinical scenarios in which data on heart rate, systolic blood pressure, urine output, oxygen saturation, conscious level and oxygenation support were varied. Nurses were also presented with a protocol recommendation and also placed under time pressure for some of the scenarios. The ecological criterion was the predicted level of risk from the Modified Early Warning Score assessments of 232 UK acute care inpatients.

Results. Despite receiving identical information, nurses varied considerably in their risk assessments. The differences can be partly explained by variability in weightings given to information. Time and protocol recommendations were given more weighting than clinical information for key dichotomous choices such as classifying a patient as 'at risk' and deciding to intervene. Nurses' weighting of cues did not mirror the same information's contribution to risk in real patients. Nurses synthesized information in non-linear ways that contributed little to decisional accuracy. The low-moderate achievement (Ra) statistics suggests that nurses' assessments of risk were largely inaccurate; these assessments were applied consistently among 'patients' (scenarios). Critical care experience was statistically associated with estimates of risk, but not with the decision to intervene.

Conclusion. Nurses overestimated the risk and the need to intervene in simulated paper patients at risk of a critical event. This average response masked considerable variation in risk predictions, the need for action and the weighting afforded to the information they had available to them. Nurses did not make use of the linear reasoning required for accurate risk predictions in this task. They also failed to employ any unique knowledge that could be shown to make them more accurate. The influence of time pressure and protocol recommendations depended on the kind of judgement faced suggesting then that knowing more about the types of decisions nurses face may influence information use.

Relevance to clinical practice. Practice developers and educators need to pay attention to the quality of nurses' clinical experience as well as the quantity when developing judgement expertise in nurses. Intuitive unaided decision making in the assessment of risk may not be as accurate as supported decision making. Practice developers and educators should consider teaching nurses normative rules for revising probabilities (even subjective ones) such as Bayes' rule for diagnostic or assessment judgements and also that linear ways of thinking, in which decision support may help, may be useful for many choices that nurses face. Nursing needs to separate the rhetoric of 'holism' and 'expertise' from the science of predictive validity, accuracy and competence in judgement and decision making.

Burnout in physicians : a case for peer-support

Background: It is well documented that doctors experience a high level of stress in their profession, and that this can lead to physical, psychological, and emotional harm, in particular, burnout. Overseas (especially in the UK and USA), research investigating the levels of stress, burnout, and associated psychiatric morbidity in health professionals, across many specialities, has been carried out with a view to prevention of these adverse outcomes.

Aims: To assess the level of burnout in a sample of New Zealand physicians, the associated work and personal characteristics, and the need for development of a support peer supervision or support system.

Methods: Questionnaires that measured a number of work and personal characteristics, including the Maslach Burnout Inventory, the General Health Questionnaire, and additional questions regarding mistakes, and need for support, were sent to 83 physicians in the Waikato and Bay of Plenty areas. Analysis involved descriptive statistics, with t-tests for comparison with other studies, Pearson Product-Moment correlations between variables and analysis of variance where appropriate.

Results: Of the 50 respondents, 28% experienced high levels of two or three aspects of burnout (emotional exhaustion, depersonalization, low personal accomplishment). Emotional exhaustion correlated with a greater need for support. Most respondents favoured a one-to-one support system.

Conclusion: This study highlights the presence of significant workplace difficulties for physicians and the need to develop a preventative support system for the protection of physicians and the patients in their care.

How information technology can support family law and mediation

In Australia, before a divorcing couple can have their case heard by the Family Court, they must undertake mediation. Thus it is useful to develop information technology tools to support negotiation and mediation in family law. Most negotiation support systems focus upon integrative bargaining. In doing so, they tend to ignore issues of fairness. In Australian Family Law, the interests of the children, as opposed to those of their parents/guardians, are paramount. We investigate the use of providing BATNAs and integrative bargaining in providing family mediation decision support. The discussion is highlighted with examples taken from the domain of Australian Family Law

Strategic facilities management system in relation with building performance; the significance and relationship

Healthcare design frequently involves complex concepts that are difficult to measure and evaluate because the building require a modern, quality, functional and therapeutic environment. For this specific reason, facilities management has become a very important support system to ensure smoothness in healthcare business. Facilities management in healthcare building is a complicated system involving multiple layers of administrative division and sub-divisions. Building performance such as building impact, function and quality prove to have significant impact on strategic facilities management. This paper will do an extensive review of strategic healthcare business management as a holistic approach and examine how facilities management can effectively manage their division with consideration and understanding of building performance. The correlation between strategic facilities management and building performance will be identified and a framework for strategic FM system with regards to building performance will be developed.

Anaesthesia monitoring using fuzzy logic

Objective. Humans have a limited ability to accurately and continuously analyse large amount of data. In recent times, there has been a rapid growth in patient monitoring and medical data analysis using smart monitoring systems. Fuzzy logic-based expert systems, which can mimic human thought processes in complex circumstances, have indicated potential to improve clinicians' performance and accurately execute repetitive tasks to which humans are ill-suited. The main goal of this study is to develop a clinically useful diagnostic alarm system based on fuzzy logic for detecting critical events during anaesthesia administration. Method. The proposed diagnostic alarm system called fuzzy logic monitoring system (FLMS) is presented. New diagnostic rules and membership functions (MFs) are developed. In addition, fuzzy inference system (FIS), adaptive neuro fuzzy inference system (ANFIS), and clustering techniques are explored for developing the FLMS' diagnostic modules. The performance of FLMS which is based on fuzzy logic expert diagnostic systems is validated through a series of offline tests. The training and testing data set are selected randomly from 30 sets of patients' data. Results. The accuracy of diagnoses generated by the FLMS was validated by comparing the diagnostic information with the one provided by an anaesthetist for each patient. Kappa-analysis was used for measuring the level of agreement between the anaesthetist's and FLMS's diagnoses. When detecting hypovolaemia, a substantial level of agreement was observed between FLMS and the human expert (the anaesthetist) during surgical procedures. Conclusion. The diagnostic alarm system FLMS demonstrated that evidence-based expert diagnostic systems can diagnose hypovolaemia, with a substantial degree of accuracy, in anaesthetized patients and could be useful in delivering decision support to anaesthetists.

Prediction of Drug Dissolution Profiles Using Artificial Neural Networks

This paper investigates the efficacy and reliability of Artificial Neural Networks (ANNs) as an intelligent decision support tool for pharmaceutical product formulation. Two case studies have been employed to evaluate capabilities of the Multilayer Perceptron network in predicting drug dissolution/release profiles. Performances of the network were evaluated using similarity factor (&fnof[sub 2]) — an index recommended by the United States Food and Drug Administration for profile comparison in pharmaceutical research. In addition, the bootstrap method was applied to assess the network prediction reliability by estimating confidence intervals associated with the results. The Multilayer Perceptron network also demonstrated a superior performance in comparison with multiple regression models. The results reveal that the ANN system has potentials to be a decision support tool for profile prediction in pharmaceutical experimentation, and the bootstrap method could be used as a means to assess reliability of the network prediction. [ABSTRACT FROM AUTHOR].

The role of social support in families coping with childhood brain tumor

Previous studies suggest that support from social networks is a protective factor buffering the negative effects of stressful events, such as having a child with a chronic illness. The literature highlights the need for more systematic examination of parents’ social support networks across the disease trajectory, to obtain a more complete understanding of how a family's support system affects adjustment over time. This was attempted in this study of 88 parents of children with brain tumors, recruited from hospitals in Australia, Singapore, and New Zealand. It employed a longitudinal design, tracking families for 2 years postdiagnosis to examine the relationship between social support and coping. As in previous research this study showed that different types of support are needed at different stages in the illness trajectory. The study also identified the use of various coping strategies by families, directed at the maintenance and enhancement of existing supports and the securing of new supports. The study failed to establish a statistically significant relationship between level of coping and social support, however, suggesting that parents were using primarily “internal” familial modes of coping, including preexisting patterns of coping, with external social support being an adjunct to their coping rather than being a major contributor.

Creative geeks? Investigating creativity support systems for information technology students

This study investigated creativity and what factors can be conducive to a creative educational milieu. The results of this study highlighted the diverse nature of creativity, and substantiated the need for an audience specific ‘Creativity Support System’. An outcome was a model of creative needs specific for an educational setting

Principal led school improvement and teacher capacity building in the Barwon South Network : final report, May 2013

The period of interest for this report is the beginning of 2011 to the end of 2012. The period commenced when the Regional Network Leader of the Barwon South Network of schools in the Barwon South Region of the Department of Education and Early Childhood contacted the School of Education at Deakin University, Waurn Ponds Campus Geelong. The Regional Network Leader outlined a desire to engage with Deakin University to research a short-term-cycle model of school improvement to be implemented in the region. While the model was expected to be taken on by all schools in the region the research was limited to the 23 schools in the Barwon South Network with four schools to be investigated more closely for each of two years (2001 & 2012) – eight focus schools in total.

Many positive outcomes flowed from the implementation of short-term-cycle school improvement plans and their associated practices but there was wide variation in the nature and degrees of success and of the perception of the process. The research team asked the following questions of the data:

1. What aspects of the School Improvement Plan (SIP) approach were important for initiating and supporting worthwhile change?
2. What might we take from this, to provide guidance on how best to support change in teaching and learning processes in schools?

The School Improvement Plan (SIP) worked in a range of ways. At one level it was strongly focused on school leadership, and a need to improve principals’ capacity to initiate worthwhile teaching and learning processes in their schools. Underlying this intent, one might think an assumption is operation is that the leadership process involves top down decision-making and a willingness to hold staff accountable for the quality of their practice.

The second strong focus was on the translation into practice and the consequent effect on student learning, involving an emphasis on data and evidence led practice. Hence, along with the leadership focus there was a demand for the process of school improvement to reach down into students and classrooms. Thus, the SIP process inevitably involved a chain of decision-making by which student learning quality drove the intervention, and teachers responsible for this had a common view. The model therefore should not be seen as an intervention only on the principal, but rather on the school decision-making system and focus. Even though it was the principal receiving the SIP planning template, and reporting to the network, the reporting was required to include description of the operation of the school processes, of classroom processes, and of student learning. This of course placed significant constraints on principals, which may help explain the variation in responses and outcomes described above.

The findings from this study are based on multiple data sources: analysis of both open and closed survey questions which all teachers in the 23 schools in the network were invited to complete; interviews with principals, teachers and leaders in the eight case study schools; some interviews with students in the case study schools; and interviews with leaders who worked in the regional network office; and field notes from network meetings including the celebrations days. Celebrations days occurred each school term when groups of principals came together to share and celebrate the improvements and processes happening in their schools. Many of the themes emerging from the analysis of the different data sources were similar or overlapping, providing some confidence in the evidence-base for the findings.

The study, conducted over two years of data collection and analysis, has demonstrated a range of positive outcomes in at the case study schools relating to school communication and collaboration processes, professional learning of principals, leadership teams and classroom teachers. There was evidence in the survey responses and field notes from ‘celebration days’ that these outcomes were also represented in other schools in the network. The key points of change concerned the leadership processes of planning for improvement, and the rigorous attention to student data in framing teaching and learning processes. This latter point of change had the effect of basing SIP processes on a platform of evidence-based change. The research uncovered considerable anecdotal and observational evidence of improvements in student learning, in teacher accounts in interview, and presentations of student work. Interviews with students, although not as representative as the team would have liked, showed evidence of student awareness of learning goals, a key driver in the SIP improvement model. It was, however, not possible over this timescale to collect objective comparative evidence of enhanced learning outcomes.

A number of features of the short-term-cycle SIP were identified that supported positive change across the network. These were: 1) the support structures represented by the network leader and support personnel within schools, 2) the nature of the SIP model – focusing strongly on change leadership but within a collaborative structure that combined top-down and bottom-up elements, 3) the focus on data-led planning and implementation that helped drill down to explicit elements of classroom practice, and 4) the accountability regimes represented by network leader presence, and the celebration days in which principals became effectively accountable to their peers. We found that in the second year of the project, momentum was lost in the case study schools, as the network was dismantled. This raised issues also for the conduct of research in situations of systemic change.

Alongside the finding of evidence of positive outcomes in the case study schools overall, was the finding that the SIP processes and outcomes varied considerably across schools. A number of contextual factors were identified that led to this variation, including school histories of reform, principal management style, and school size and structure that made the short-term-cycle model unmanageable. In some cases there was overt resistance to the SIP model, at least in some part, and this led to an element of performativity in which the language of the SIP was conscripted to other purposes. The study found that even with functioning schools the SIP was understood differently and the processes performed differently, raising the question of whether in the study we are dealing with one SIP or many. The final take home message from the research is that schools are complex institutions, and models of school improvement need to involve both strong principled features, and flexibility in local application, if all schools’ interests in improving teaching and learning processes and outcomes are to be served.

Shared decision making: what do clinicians need to know and why should they bother?

Shared decision making enables a clinician and patient to participate jointly in making a health decision, having discussed the options and their benefits and harms, and having considered the patient's values, preferences and circumstances. It is not a single step to be added into a consultation, but a process that can be used to guide decisions about screening, investigations and treatments. The benefits of shared decision making include enabling evidence and patients' preferences to be incorporated into a consultation; improving patient knowledge, risk perception accuracy and patient-clinician communication; and reducing decisional conflict, feeling uninformed and inappropriate use of tests and treatments. Various approaches can be used to guide clinicians through the process. We elaborate on five simple questions that can be used: What will happen if the patient waits and watches? What are the test or treatment options? What are the benefits and harms of each option? How do the benefits and harms weigh up for the patient? Does the patient have enough information to make a choice? Although shared decision making can occur without tools, various types of decision support tools now exist to facilitate it. Misconceptions about shared decision making are hampering its implementation. We address the barriers, as perceived by clinicians. Despite numerous international initiatives to advance shared decision making, very little has occurred in Australia. Consequently, we are lagging behind many other countries and should act urgently.

Analysis of operating environments: A diagnostic model for linking science, society and policy for sustainability

Through analysis of the dynamics between science and decision-making, we argue that diagnosing fit-for purpose approaches to linking science and decision-making may be possible. Such diagnosis should enable identification of appropriate processes, institutions, objects (e.g. tools, information products) and relationships that can facilitate outcomes. We begin the paper by unsettling the traditional constructions that science must distance itself from debates about values and what is at stake, and so from policy making. Then, drawing from mixed methods case studies in coastal South-eastern Australia, we describe how scientific research has had a bearing on decisions affecting society and the environment. These analyses suggest that the willingness and capacity of research organisations, programmes or projects to actively reflect on and participate in the evolution of the 'operating environment' for their research is integral to their ability to inform outcomes through science. © 2014 Elsevier Ltd.

A hybrid FAM–CART model and its application to medical data classification

In this paper, a hybrid model consisting of the fuzzy ARTMAP (FAM) neural network and the classification and regression tree (CART) is formulated. FAM is useful for tackling the stability–plasticity dilemma pertaining to data-based learning systems, while CART is useful for depicting its learned knowledge explicitly in a tree structure. By combining the benefits of both models, FAM–CART is capable of learning data samples stably and, at the same time, explaining its predictions with a set of decision rules. In other words, FAM–CART possesses two important properties of an intelligent system, i.e., learning in a stable manner (by overcoming the stability–plasticity dilemma) and extracting useful explanatory rules (by overcoming the opaqueness issue). To evaluate the usefulness of FAM–CART, six benchmark medical data sets from the UCI repository of machine learning and a real-world medical data classification problem are used for evaluation. For performance comparison, a number of performance metrics which include accuracy, specificity, sensitivity, and the area under the receiver operation characteristic curve are computed. The results are quantified with statistical indicators and compared with those reported in the literature. The outcomes positively indicate that FAM–CART is effective for undertaking data classification tasks. In addition to producing good results, it provides justifications of the predictions in the form of a decision tree so that domain users can easily understand the predictions, therefore making it a useful decision support tool.