Development and interrater reliability testing of a telephone interview training programme for Australian nurse interviewers

Summary Background The final phase of a three phase study analysing the implementation and impact of the nurse practitioner role in Australia (the Australian Nurse Practitioner Project or AUSPRAC) was undertaken in 2009, requiring nurse telephone interviewers to gather information about health outcomes directly from patients and their treating nurse practitioners. A team of several registered nurses was recruited and trained as telephone interviewers. The aim of this paper is to report on development and evaluation of the training process for telephone interviewers. Methods The training process involved planning the content and methods to be used in the training session; delivering the session; testing skills and understanding of interviewers post-training; collecting and analysing data to determine the degree to which the training process was successful in meeting objectives and post-training follow-up. All aspects of the training process were informed by established educational principles. Results Interrater reliability between interviewers was high for well-validated sections of the survey instrument resulting in 100% agreement between interviewers. Other sections with unvalidated questions showed lower agreement (between 75% and 90%). Overall the agreement between interviewers was 92%. Each interviewer was also measured against a specifically developed master script or gold standard and for this each interviewer achieved a percentage of correct answers of 94.7% or better. This equated to a Kappa value of 0.92 or better. Conclusion The telephone interviewer training process was very effective and achieved high interrater reliability. We argue that the high reliability was due to the use of well validated instruments and the carefully planned programme based on established educational principles. There is limited published literature on how to successfully operationalise educational principles and tailor them for specific research studies; this report addresses this knowledge gap.

Key priorities for Australian infection control : summary of findings from the launch of the Centre for Research Excellence in Reducing Healthcare Associated Infections

The launch of the Centre of Research Excellence in Reducing Healthcare Associated Infection (CRE-RHAI) took place in Sydney on Friday 12 October 2012. The mission of the CRE-RHAI is to generate new knowledge about strategies to reduce healthcare associated infections and to provide data on the cost-effectiveness of infection control programs. As well as launching the CRE-RHAI, an important part of this event was a stakeholder Consultation Workshop, which brought together several experts in the Australian infection control community. The aims of this workshop were to establish the research and clinical priorities in Australian infection control, assess the importance of various multi-resistant organisms, and to gather information about decision making in infection control. We present here a summary and discussion of the responses we received.

An integrated educational model for continuing nurse education

Aim This paper reports on the development and evaluation of an integrated clinical learning model to inform ongoing education for surgical nurses. The research aim was to evaluate the effectiveness of implementing a Respiratory Skills Update (ReSKU) education program, in the context of organisational utility, on improving surgical nurses' practice in the area of respiratory assessment. Background Continuous development and integration of technological innovations and research in the healthcare environment mandate the need for continuing education for nurses. Despite an increased worldwide emphasis on this, there is scant empirical evidence of program effectiveness. Methods A quasi experimental pre test, post test non–equivalent control group design evaluated the impact of the ReSKU program on surgical nurses' clinical practice. The 2008 study was conducted in a 400 bed regional referral public hospital and was consistent with contemporary educational approaches using multi-modal, interactive teaching strategies. Findings The study demonstrated statistically significant differences between groups regarding reported use of respiratory skills, three months after ReSKU program attendance. Between group data analysis indicated that the intervention group's reported beliefs and attitudes pertaining to subscale descriptors showed statistically significant differences in three of the six subscales. Conclusion The construct of critical thinking in the clinical context, combined with clinical reasoning and purposeful reflection, was a powerful educational strategy to enhance competency and capability in clinicians.

Applied Reliability of Transmission Substations

Reliability is an integral component of modern power system design, planning and management. This paper uses the Markov approach to substation reliability evaluation using dedicated reliability software. This technique was applied to yield reliability indices for an existing and important substation in the POWERLINK QUEENSLAND 275 kV transmission network. Reliability indices were also determined for several reinforcement alternatives for this substation with the aim of improving substation reliability. The economic feasibility of achieving higher levels of reliability was also taken into account.

Simulation of phosphine flow in vertical grain storage : a preliminary numerical study

To fumigate grain stored in a silo, phosphine gas is distributed by a combination of diffusion and fan-forced advection. This initial study of the problem mainly focuses on the advection, numerically modelled as fluid flow in a porous medium. We find satisfactory agreement between the flow predictions of two Computational Fluid Dynamics packages, Comsol and Fluent. The flow predictions demonstrate that the highest velocity (>0.1 m/s) occurs less than 0.2m from the inlet and reduces drastically over one metre of silo height, with the flow elsewhere less than 0.002 m/s or 1% of the velocity injection. The flow predictions are examined to identify silo regions where phosphine dosage levels are likely to be too low for effective grain fumigation.

Bushfire responsive design : real life responses to energy ratings, bushfire standards and biodiverse sites.

Many of the more extreme bushfire prone landscapes in Australia are located in colder climate regions. For such sites, the National Construction Code regulates that houses satisfy both the Australian Standard for Bushfire (AS 3959:2009) and achieve a 6 Star energy rating. When combined these requirements present a considerable challenge to the construction of affordable housing - a problem which is often exacerbated by the complex topography of bushifre prone landscapes. Dr Weir presents a series of case studies from his architetcural practice which highlight the need for further design-led research into affordable housing - a ground up holistic approach to design which recolciles energy performance, human behaviourm, bushland conservation and bushfire safety.

Optimal distribution network reinforcement considering load growth, line loss, and reliability

In this paper, a new comprehensive planning methodology is proposed for implementing distribution network reinforcement. The load growth, voltage profile, distribution line loss, and reliability are considered in this procedure. A time-segmentation technique is employed to reduce the computational load. Options considered range from supporting the load growth using the traditional approach of upgrading the conventional equipment in the distribution network, through to the use of dispatchable distributed generators (DDG). The objective function is composed of the construction cost, loss cost and reliability cost. As constraints, the bus voltages and the feeder currents should be maintained within the standard level. The DDG output power should not be less than a ratio of its rated power because of efficiency. A hybrid optimization method, called modified discrete particle swarm optimization, is employed to solve this nonlinear and discrete optimization problem. A comparison is performed between the optimized solution based on planning of capacitors along with tap-changing transformer and line upgrading and when DDGs are included in the optimization.

A randomized controlled pilot study comparing aqueous cream with a beeswax and herbal oil cream in the provision of relief from postburn pruritis

Postburn itch is reported to affect up to 87% of the burn population. Although treatments for postburn itch are multimodal, they remain consistently ineffective. However, recent anecdotal evidence from several outpatients at a tertiary referral hospital suggests that a cream combining beeswax and several herbal oils may be effective in the minimization of postburn itch. The aim of this study was to test the efficacy of beeswax and herbal oil cream against the standard treatment of aqueous cream in the provision of relief from the symptoms of postburn itch. A randomized controlled trial compared two groups using a visual analog scale, frequency of cream application, itch recurrence after cream application, use of antipruritic medications, and sleep disturbance to determine the effect of itch severity and duration. Fifty-two participants were enrolled in the study (84% male) with a mean age of 35 years (SD = 16) and mean burn TBSA of 7.2% (SD = 7.7). Study results found that the beeswax and herbal oil cream reduce itch after application more frequently than aqueous cream (P = .001). In addition, when managed with beeswax and herbal oil cream, participants found that their itch recurred later (P ≤ .001) and their use of antipruritic medications was lower (P = .023). Findings of this study suggest beeswax and herbal oil cream to be more effective in the minimization of postburn itch than aqueous cream. Given this, a larger study examining the efficacy of beeswax and herbal oil cream appears warranted.

Development of clinical competencies for emergency nurse practitioners : a pilot study

Background: Nurse practitioner education and practice has been guided by generic competency standards in Australia since 2006. Development of specialist competencies has been less structured and there are no formal standards to guide education and continuing professional development for specialty fields. There is limited international research and no Australian research into development of specialist nurse practitioner competencies. This pilot study aimed to test data collection methods, tools and processes in preparation for a larger national study to investigate specialist competency standards for emergency nurse practitioners. Research into specialist emergency nurse practitioner competencies has not been conducted in Australia. Methods: Mixed methods research was conducted with a sample of experienced emergency nurse practitioners. Deductive analysis of data from a focus group workshop informed development of a draft specialty competency framework. The framework was subsequently subjected to systematic scrutiny for consensus validation through a two round Delphi Study. Results: The Delphi study first round had a 100% response rate; the second round 75% response rate. The scoring for all items in both rounds was above the 80% cut off mark with the lowest mean score being 4.1 (82%) from the first round. Conclusion: The authors collaborated with emergency nurse practitioners to produce preliminary data on the formation of specialty competencies as a first step in developing an Australian framework.

Nature and genesis of clay minerals of the Rustler Formation in the vicinity of the Waste Isolation Pilot Plant in Souteastern New Mexico

Detailed mineralogical studies of the matrix and fracture-fill materials of a large number of samples from the Rustler Formation have been carried out using x-ray diffraction, high-resolution transmission electron microscopy, electron microprobe analysis, x-ray fluorescence, and atomic absorption spectrophotometry. These analyses indicate the presence of four clay minerals: interstratified chlorite/saponite, illite, chlorite, and serpentine. Corrensite (regularly stratified chlorite/saponite) is the dominant clay mineral in samples from the Culebra dolomite and two shale layers of the lower unnamed member of the Rustler Formation. Within other layers of the Rustler Formation, disordered mixed chlorite/saponite is usually the most abundant clay mineral. Studies of the morphology and composition of clay crystallites suggest that the corrensite was formed by the alteration of detrital dioctahedral smectite in magnesium-rich pore fluids during early diagenesis of the Rustler Formation. This study provides initial estimates of the abundance and nature of the clay minerals in the Culebra dolomite in the vicinity of the Waste Isolation Pilot Plant.

Advanced practice nursing role development : factor analysis of a modified role delineation tool

Aim his study reports the use of exploratory factor analysis to determine construct validity of a modified advanced practice role delineation tool. Background Little research exists on specific activities and domains of practice within advanced practice nursing roles, making it difficult to define service parameters of this level of nursing practice. A valid and reliable tool would assist those responsible for employing or deploying advanced practice nurses by identifying and defining their service profile. This is the third paper from a multi-phase Australian study aimed at assigning advanced practice roles. Methods A postal survey was conducted of a random sample of state government employed Registered nurses and midwives, across various levels and grades of practice in the state of Queensland, Australia, using the modified Advanced Practice Role Delineation tool. Exploratory factor analysis, using principal axis factoring was undertaken to examine factors in the modified tool. Cronbach’s alpha coefficient determined reliability of the overall scale and identified factors. Results There were 658 responses (42% response rate). The five factors found with loadings of ≥.400 for 40 of the 41 APN activities were similar to the five domains in the Strong model. Cronbach’s alpha coefficient was .94 overall and for the factors ranged from 0.83 to 0.95. Conclusion Exploratory factor analysis of the modified tool supports validity of the five domains of the original tool. Further investigation will identify use of the tool in a broader healthcare environment.

The emerging role of the Board of Directors in enterprise business technology governance

In an increasingly business technology (BT) dependent world, the impact of the extraordinary changes brought about by the nexus of mobile and cloud technologies, social media and big data is increasingly being felt in the board room. As leaders of enterprises of every type and size, board directors can no longer afford to ignore, delegate or avoid BT-related decisions. Competitive, financial and reputational risk is increased if boards fail to recognize their role in governing technology as an asset and in removing barriers to improving enterprise business technology governance (EBTG). Directors’ awareness of the need for EBTG is increasing. However, industry research shows that board level willingness to rectify the gap between awareness and action is very low or non-existent. This literature review-based research identifies barriers to EBTG effectiveness. It provides a practical starting point for board analysis. We offer four outcomes that boards might focus on to ensure the organizations they govern are not left behind by those led by the upcoming new breed of technology-savvy leaders. Most extant research looks backward for examples, examining data pre-2010, the time when a tipping point in the personal and business use of multimedia and mobile-internet devices significantly deepened the impacts of the identified nexus technology forces, and began rapidly changing the way many businesses engage with their customers, employees and stakeholders. We situate our work amidst these nexus forces, discuss the board’s role in EBTG in this context, and modernize current definitions of enterprise technology governance. The primary limitation faced is the lack of scholarly research relating to EBTG in the rapidly changing digital economy. Although we have used recent (2011 - 2013) industry surveys, the volume of these surveys and congruence across them is significant in terms of levels of increased awareness and calls for increased board attention and competency in EBTG and strategic information use. Where possible we have used scholarly research to illustrate or discuss industry findings.

Water microbiology

Microbiology is the science devoted lo the study of organisms that are too small to be seen by the naked eye. These microorganisms are a large and diverse group of free-living forms that exist as single cells or cell clusters. Being free-living, microbial cells are distinct from the cells of animals and plants as the latter are not able to live alone in nature but only in characteristic groups. A single microbial cell, generally, is able to carry out its life processes of growth, respiration and reproduction independently of other cells, either of the same kind or of different kinds. There are five subdisciplines of microbiology: (a) the study of bacteria (bacteriology); (b) the study of viruses (virology); (c) the study of algae (phycology); (d) the study of fungi (mycology); and (e) the study of protozoa (protozoology). In the examination of the environment, all five areas of microbiology are studied. This becomes obvious when discussing the significance of each of these groups of organisms in relation to human health.

Bargara Pasturage Reserve : Future Visions

Bargara Pasturage Reserve: Future Visions This exhibition showcases the work of Postgraduate Landscape Architecture and final year Undergraduate Civil and Environmental Engineering students in response to issues of sustainability in a coastal wetland known as the Bargara Pasturage Reserve; an exemplar of the many issues facing sensitive coastal places in Queensland today. The 312ha Pasturage Reserve at Bargara is the only biofilter between the pressures of Bargara’s urban and tourism expansion, surrounding sugarcane farming, and the Great Sandy Marine Park, including the largest concentration of nesting marine turtles on the eastern Australian mainland. This ephemeral wetland, while struggling to fulfil its coastal biofiltration function, is also in high demand for passive recreation, and the project partners’ priorities were to meet both of these challenges. The students were required to plan and design for the best balance possible amongst, but not limited to: wetland and coastal ecological health, enhancement of cultural heritage and values, sustainable urban development, and local economic health. To understand these challenges, QUT staff and students met with partners, visited and analysed the Pasturage Reserve, spent time in and around Bargara talking to locals and inviting dialogue with Indigenous representatives and the South Sea Islander community. We then went home to Brisbane to undertake theoretical and technical research, and then worked to produce 11 Strategic Plans, 2 Environmental Management Plans and 33 Detailed Designs. One group of students analysed the Bargara coastal landscape as an historical and ongoing series of conversations between ecological systems, cultural heritage, community and stakeholders. Another group identified the landscape as neither ‘urban,’ ‘rural,’ nor ‘natural,’ instead identifying it metaphorically as a series of layered thematic ‘fields’ such as water, conservation, reconciliation, and educational fields. These landscape analyses became the organising mechanisms for strategic planning. An outstanding Strategic Plan was produced by Zhang, Lemberg and Jensen, entitled Metanoia, which means to ‘make a change as the result of reflection on values’. Three implementation phases of “flow”, “flux”, and “flex” span twenty-five years, and present a vision a coastal and marine research and conservation hub, with a focus on coastal wetland function, turtle habitat and coral reef conservation. An Environmental Management Plan by Brand and Stickland focuses on protecting and improving wetland biodiversity and habitat quality, and increasing hydrological and water quality function; vital in a coastal area of such high conservation value. After the planning phase, students individually developed detailed design proposals responsive to their plans. From Metanoia, Zhang concentrated on wetland access and interpretation, proposing four focal places to form the nucleus of a wider pattern of connectivity, and to encourage community engagement with coastal environmental management and education. Jensen tackled the thorny issue of coastal urban development, proposing a sensitive staged eco-village model which maintains both ecological and recreational connectivity between the wetland and the marine environment. This project offered QUT’s partners many innovative options to inform their future planning. BSC, BMRG and Oceanwatch Australia are currently engaged in the investigation of on-ground opportunities drawing on these options.

Age-related changes in cardiac adenosine receptor expression

Adenosine is an important cardioprotective agent that works via several adenosine receptor (ADOR) subtypes to regulate cardiovascular activity. It is well established that functional responses to adenosine decline with age. What is unclear, though, is whether these changes occur at the receptor, second messenger or translational level. In this study we determined the effect of age on cardiac adenosine receptor expression using the housekeeping gene 18S rRNA versus the adenosine A2B receptor gene as internal controls. Absolute quantification showed that no age-related changes occurred in the expression of 18S rRNA or adenosine A2B receptor internal control genes. Subsequently, relative analysis of the adenosine receptor subtypes using 18S rRNA found a significant age-related reduction in the expression of the adenosine A1 receptor (5.5-fold), with no changes in the expression of the adenosine A2A, A2B and A3 receptors. When using the expression of the adenosine A2B receptor as the internal control gene, a significant down regulation of both the adenosine A1 (5.4-fold) and A2A (2.2-fold) receptors with no change in the expression of adenosine A3 receptor was found. Therefore, the high level of expression of the 18S rRNA housekeeping gene was found to mask a significant change in expression of the adenosine A2A receptor with age. Ultimately, these findings show an age-related reduction in adenosine A1 and A2A receptor expression in rat heart.