The growing demand for emergency healthcare

Emergency health is a critical component of health systems; one increasingly congested from growing demand and blocked access to care. The Emergency Health Services Queensland (EHSQ) study aimed to identify the factors driving increased demand for emergency healthcare. This study examined data on patients treated by the ambulance service and Emergency Departments across Queensland. Data was derived from the Queensland Ambulance Service’s (QAS) Ambulance Information Management System and electronic Ambulance Report Form and from the Emergency Department Information System (EDIS). Data was obtained for the period 2001-02 through to 2009-10. A snapshot of users for the 2009-10 year was used to describe the characteristics of users and comparisons made with the year 2003-04 to identify trends. Per capita demand for EDs has increased by 2% per annum over the decade and for ambulance by 3.7% per annum. The growth in ED demand is most significant in more urgent triage categories with decline in less urgent patients. The growth is most prominent amongst patients suffering injuries and poisoning, amongst both men and women and across all age groups. Patients from lower socioeconomic areas appear to have higher utilisation rates and the utilisation rate for indigenous people exceeds those of other backgrounds. The utilisation rates for immigrant people is less than Australian born however it has not been possible to eliminate the confounding impact of age and socioeconomic profiles. These findings contribute to an understanding of the growth in demand for emergency health. It is evident that the growth is amongst patients in genuine need of emergency healthcare and public rhetoric that congested emergency health services is due to inappropriate attendees is unsustainable. The growth in demand over the last decade reflects not only on changing demographics of the Australian population but also changes in health status, standards of acute health care and other social factors.

Role salience and support as moderators of demand/conflict relationships in China

This study examined the effects of role demand on both work–family conflict and family–work conflict, and the moderating effects of role salience and support on these relationships. Based on 391 dual-career (managerial and blue-collar employees) couples from a Taiwanese company in China, the results of this survey study showed clear gender differences in the patterns of relationships observed. For men, the most important demands that negatively impacted on work–family conflict were frequency of overtime and frequency of socializing for work purposes (yingchou), and supervisory support buffered the negative impact of frequent overtime. For women however, strong supervisory support and low work role salience were more important for reducing work–family conflict, and there was no significant main effect found for any of the role demand factors. Furthermore, women with high work role salience were more likely to feel the impact of yingchou on work–family conflict. In the family domain, the most influential demand for men was hours spent on household tasks, but for women, it was the frequency of family-related leave. Interestingly, males reported higher family role salience than females and spouse support intensified rather than buffered the positive impact of hours spent on household tasks on family–work conflict for males.

Smart grid-demand side response model to mitigate prices and peak impact on the electrical system

The aims of this project is to develop demand side response model which assists electricity consumers who are exposed to the market price through aggregator to manage the air-conditioning peak electricity demand. The main contribution of this research is to show how consumers can optimise the energy cost caused by the air-conditioning load considering the electricity market price and network overload. The model is tested with selected characteristics of the room, Queensland electricity market data from Australian Energy Market Operator and data from the Bureau of Statistics on temperatures in Brisbane, during weekdays on hot days from 2011 - 2012.

Quality demand in vaccination and how to improve service quality under Total Quality Control [论全面质量管理模式下预防接种工作的质量要求与改进对策]

Under the concept of Total Quality Control, based on their experience, the authors discussed potential demand for quality of immunization services and possible solutions to these demands. Abstract in Chinese 全面质量管理(total quality control,TQC)是在20世纪60年代由美国人V,Feigonbaum和J.unan先后提出的新的质量管理观念,众所周知的ISO9000族标准即建立在TQC理念下的质量管理标准,该标准已成为当今世界全球一致、最具权威的质量管理和质量保证的国际规则[1-2].21世纪是质量世纪,推行TQC,不断改进产品和服务质量,目前已成为我国各行各业在不断激烈的市场竞争下完善自我、保证生存和发展的重要手段.实施预防接种是预防和控制传染病,保护人群健康的重要措施,预防接种工作中,产品即预防接种服务,需方(顾客)为接受预防接种服务的广大人群,是产品的消费者.随社会的迅速发展,人们对健康需求的不断提高,对预防接种工作也提出了更高的质量要求.本文对TQC模式下顾客对预防接种服务的质量要求进行了综合分析,并对如何改进服务质量进行了初步探讨.

A sustainable tourism development in Alacati, Turkey: (Re) invention of public space with clean energy

Although there is an increasing recognition of the impacts of climate change on communities, residents often resist changing their lifestyle to reduce the effects of the problem. By using a landscape architectural design medium, this paper argues that public space, when designed as an ecological system, has the capacity to create social and environmental change and to increase the quality of the human environment. At the same time, this ecological system can engage residents, enrich the local economy, and increase the social network. Through methods of design, research and case study analysis, an alternative master plan is proposed for a sustainable tourism development in Alacati, Turkey. Our master plan uses local geographical, economic and social information within a sustainable landscape architectural design scheme that addresses the key issues of ecology, employment, public space and community cohesion. A preliminary community empowerment model (CEM) is proposed to manage the designs. The designs address: the coexistence of local agricultural and sustainable energy generation; state of the art water management; and the functional and sustainable social and economic interrelationship of inhabitants, NGOs, and local government.

Spreading peak demand for urban rail transit through differential fare policy : a review of empirical evidence

More evenly spread demand for public transport throughout a day can reduce transit service provider‟s total asset and labour costs. A plausible peak spreading strategy is to increase peak fare and/or to reduce off-peak fare. This paper reviews relevant empirical studies for urban rail systems, as rail transit plays a key role in Australian urban passenger transport and experiences severe peak loading variability. The literature is categorised into four groups: a) passenger opinions on willingness to change time for travel, b) valuations of displacement time using stated preference technique, c) simulations of peak spreading based on trip scheduling models, and: d) real-world cases of peak spreading using differential fare. Policy prescription is advised to take into account impacts of traveller‟s time flexibility and joint effects of mode shifting and peak spreading. Although focusing on urban rail, arguments in this paper are relevant to public transport in general with values to researchers and practitioners.

Emergency Health Services (EHS) : demand and service delivery models. monograph 3 : patients’ reasons and perceptions

Executive Summary Emergency health is a critical component of Australia’s health system and emergency departments (EDs) are increasingly congested from growing demand and blocked access to inpatient beds. The Emergency Health Services Queensland (EHSQ) study aims to identify the factors driving increased demand for emergency health and to evaluate strategies which may safely reduce the future demand growth. This monograph addresses the perspectives of users of both ambulance services and EDs. The research reported here aimed to identify the perspectives of users of emergency health services, both ambulance services and public hospital Emergency Departments and to identify the factors that they took into consideration when exercising their choice of location for acute health care. A cross-sectional survey design was used involving a survey of patients or their carers presenting to the EDs of a stratified sample of eight hospitals. A specific purpose questionnaire was developed based on a novel theoretical model which had been derived from analysis of the literature (Monograph 1). Two survey versions were developed: one for adult patients (self-complete); and one for children (to be completed by parents/guardians). The questionnaires measured perceptions of social support, health status, illness severity, self-efficacy; beliefs and attitudes towards ED and ambulance services; reasons for using these services, and actions taken prior to the service request. The survey was conducted at a stratified sample of eight hospitals representing major cities (four), inner regional (two) and outer regional and remote (two). Due to practical limitations, data were collected for ambulance and ED users within hospital EDs, while patients were waiting for or under treatment. A sample size quota was determined for each ED based on their 2009/10 presentation volumes. The data collection was conducted by four members of the research team and a group of eight interviewers between March and May 2011 (corresponding to autumn season). Of the total of 1608 patients in all eight emergency departments the interviewers were able to approach 1361 (85%) patients and seek their consent to participate in the study. In total, 911 valid surveys were available for analysis (response rate= 67%). These studies demonstrate that patients elected to attend hospital EDs in a considered fashion after weighing up alternatives and there is no evidence of deliberate or ill-informed misuse. • Patients attending ED have high levels of social support and self-efficacy that speak to the considered and purposeful nature of the exercise of choice. • About one third of patients have new conditions while two thirds have chronic illnesses • More than half the attendees (53.1%) had consulted a healthcare professional prior to making the decision. • The decision to seek urgent care at an ED was mostly constructed around the patient’s perception of the urgency and severity of their illness, reinforced by a strong perception that the hospital ED was the correct location for them (better specialised staff, better care for my condition, other options not as suitable). • 33% of the respondent held private hospital insurance but nevertheless attended a public hospital ED. Similarly patients exercised considered and rational judgements in their choice to seek help from the ambulance service. • The decision to call for ambulance assistance was based on a strong perception about the severity of the illness (too severe to use other means of transport) and that other options were not considered appropriate. • The decision also appeared influenced by a perception that the ambulance provided appropriate access to the ED which was considered most appropriate for their particular condition (too severe to go elsewhere, all facilities in one spot, better specialised and better care). • In 43.8% of cases a health care professional advised use of the ambulance. • Only a small number of people perceived that ambulance should be freely available regardless of severity or appropriateness. These findings confirm a growing understanding that the choice of professional emergency health care services is not made lightly but rather made by reasonable people exercising a judgement which is influenced by public awareness of the risks of acute health and which is most often informed by health professionals. It is also made on the basis of a rational weighing up of alternatives and a deliberate and considered choice to seek assistance from a service which the patient perceived was most appropriate to their needs at that time. These findings add weight to dispensing with public perceptions that ED and ambulance congestion is a result of inappropriate choice by patients. The challenge for health services is to better understand the patient’s needs and to design and validate services that meet those needs. The failure of our health system to do so should not be grounds for blaming the patient, claiming inappropriate patient choices.

Public Economics and the Assessment of Tourism Developments and Policies

Public economics covers both topics in welfare economic of social (as opposed to private) interest and aspects of public finance. This chapter considers the application of two methods of social economic evaluation of tourist developments, namely, social cost-benefit analysis and economic impact analysis. The role of social cost-benefit analysis in the assessment of tourism is illustrated by its application to the evaluation of inbound tourism. This is followed by a discussion of taxes on tourism and subsidies to promote it. The principle focus is on hotel room taxes. The analysis of taxes on tourism involves both public finance and welfare economics issues. The scope for and desirability of applying the user-pays principle to tourism is then examined.

Inside the pleasure dome : cultural tourism on Australia’s Gold Coast

In 2018 the City of the Gold Coast in south-east Queensland, Australia, will host the next Commonwealth Games. The City is made up a 57 km stretch of coastline and hinterland divided by a major highway. The famous surfing beaches are framed by high-rise development while the hinterland is marketed as a green, unspoilt environment. The winning bid for the Games, and discussion about future infrastructure and marketing of the region’s attributes, has focussed attention on the way City residents and policy makers think about their region in broad terms. Whereas in the past tourism marketing has been directed towards the pleasures of sun and surf by day and bright lights by night, various regional tourist stakeholders are beginning to reorient their programs. This paper considers some of the competing aims of the various stakeholders in this region and the interaction of existing ‘cultures’ with new technology and the demands of permanent residents, using data from a case study of e-literary trails developed in Brisbane, the capital city of Queensland. The importance of tourist imaginaries as a basis for using rich accounts of the past for future planning is emphasized.

A novel real time pricing scheme for demand response in residential distribution systems

Price based technique is one way to handle increase in peak demand and deal with voltage violations in residential distribution systems. This paper proposes an improved real time pricing scheme for residential customers with demand response option. Smart meters and in-home display units are used to broadcast the price and appropriate load adjustment signals. Customers are given an opportunity to respond to the signals and adjust the loads. This scheme helps distribution companies to deal with overloading problems and voltage issues in a more efficient way. Also, variations in wholesale electricity prices are passed on to electricity customers to take collective measure to reduce network peak demand. It is ensured that both customers and utility are benefitted by this scheme.

A critical analysis of business process management education and alignment with industry demand : an Australian perspective

Business Process Management (BPM) is accepted globally as an organizational approach to enhance productivity and drive cost efficiencies. Studies confirm a shortage of BPM skilled professionals with limited opportunities to develop the required BPM expertise. This study investigates this gap starting from a critical analysis of BPM courses offered by Australian universities and training institutions. These courses were analyzed and mapped against a leading BPM capability framework to determine how well current BPM education and training offerings in Australia address the core capabilities required by BPM professionals globally. To determine the BPM skill-sets sought by industry, online recruitment advertisements were collated, analyzed, and mapped against this BPM capability framework. The outcomes provide a detailed overview on the alignment of available BPM education/training and industry demand. These insights are useful for BPM professionals and their employers to build awareness of the BPM capabilities required for a BPM mature organization. Universities and other training institutions will benefit from these results by understanding where demand is, where the gaps are, and what other BPM education providers are supplying. This structured comparison method could continue to provide a common ground for future discussion across university-industry boundaries and continuous alignment of their respective practices.

Grand tours in the glare of the sun : harnessing digital media to develop cultural tourism in Queensland, Australia

It has been well established that highlighting the cultural attributes of a region through stories of place, local histories, and the creative arts boosts tourism income to a region. Cultural tourism also serves to promote the creative industries to visitors and residents alike and, by enhancing a region’s cultural identity, fosters new opportunities for the arts. It can therefore offer considerable potential benefit to the creative economy in Australia. However, in comparison with Europe, where cultural tourism can rely upon an established historical, artistic and literary cultural identity that stretches back to Grand Tours of the seventeenth century, in Queensland, Australia the relatively new enterprise of cultural tourism must compete with visitor expectations of sun, surf and the natural landscapes, which have become the mainstay of tourism advertising. Moreover, in Queensland, it is essential to connect vast distances, diverse communities and a variety of cultural experiences. We must also take account of the expectations of contemporary tourists, who anticipate a digitally mediated travel experience and increasingly seek to connect with local communities in authentic ways. In this paper we consider the unique considerations that must be taken into account in the Queensland context and propose approaches to developing an integrated identity that embraces both the ‘great outdoors’ and the region’s cultural attributes. We make recommendations for providing the types of digitally mediated ‘local’ experiences that cultural tourists now expect, and illustrate the design principles we propose through early, tentative approaches to smart phones, locative media and augmented reality applications for cultural tourism in the region. We conclude by proposing additional ways to formulate a digital strategy in line with the recommendations we make.

Internet-enabled tourism entrepreneurs. International entrepreneurial values elicited through repertory test and laddering analysis

Although the tourism industry has been dramatically altered due to the Internet, there has been limited research published about international entrepreneurial values and Internet use in tourism firms. The findings of this study point to a relationship between the values of Internet-enabled international entrepreneurs in small-sized to medium-sized enterprises and the inclination of the firm to develop and initiate international activity. The findings of this study suggest that Internet-enabled tourism entrepreneurs share similar construct values. Two effective but underutilized qualitative methods were used in this study. The first method, repertory test, is an efficient technique for exploring constructs in decision making; the second method, laddering analysis, facilitates understanding of the perceived consequences and personal values guiding behaviour.

A demand-responsive decision support system for coal transportation

In this paper, a demand-responsive decision support system is proposed by integrating the operations of coal shipment, coal stockpiles and coal railing within a whole system. A generic and flexible scheduling optimisation methodology is developed to identify, represent, model, solve and analyse the coal transport problem in a standard and convenient way. As a result, the integrated train-stockpile-ship timetable is created and optimised for improving overall efficiency of coal transport system. A comprehensive sensitivity analysis based on extensive computational experiments is conducted to validate the proposed methodology. The mathematical proposition and proof are concluded as technical and insightful advices for industry practice. The proposed methodology provides better decision making on how to assign rail rolling-stocks and upgrade infrastructure in order to significantly improve capacity utilisation with the best resource-effectiveness ratio. The proposed decision support system with train-stockpile-ship scheduling optimisation techniques is promising to be applied in railway or mining industry, especially as a useful quantitative decision making tool on how to use more current rolling-stocks or whether to buy additional rolling-stocks for mining transportation.

Demand response for residential appliances via Customer Reward Scheme

This paper proposes a reward based demand response algorithm for residential customers to shave network peaks. Customer survey information is used to calculate various criteria indices reflecting their priority and flexibility. Criteria indices and sensitivity based house ranking is used for appropriate load selection in the feeder for demand response. Customer Rewards (CR) are paid based on load shift and voltage improvement due to load adjustment. The proposed algorithm can be deployed in residential distribution networks using a two-level hierarchical control scheme. Realistic residential load model consisting of non-controllable and controllable appliances is considered in this study. The effectiveness of the proposed demand response scheme on the annual load growth of the feeder is also investigated. Simulation results show that reduced peak demand, improved network voltage performance, and customer satisfaction can be achieved.