Queensland Emergency Medical System : a structural and organizational model for the emergency medical system in Australia

Objective: The emergency medical system (EMS) can be defined as a comprehensive, coordinated and integrated system of care for patients suffering acute illness and injury. The aim of the present paper is to describe the evolution of the Queensland Emergency Medical System (QEMS) and to recommend a strategic national approach to EMS development. Methods: Following the formation of the Queensland Ambulance Service in 1991, a state EMS committee was formed. This committee led the development and approval of the cross portfolio QEMS policy framework that has resulted in dynamic policy development, system monitoring and evaluation. This framework is led by the Queensland Emergency Medical Services Advisory Committee. Results: There has been considerable progress in the development of all aspects of the EMS in Queensland. These developments have derived from the improved coordination and leadership that QEMS provides and has resulted in widespread satisfaction by both patients and stakeholders. Conclusions: The strategic approach outlined in the present paper offers a model for EMS arrangements throughout Australia. We propose that the Council of Australian Governments should require each state and Territory to maintain an EMS committee. These state EMS committees should have a broad portfolio of responsibilities. They should provide leadership and direction to the development of the EMS and ensure coordination and quality of outcomes. A national EMS committee with broad representation and broad scope should be established to coordinate the national development of Australia's EMS.

Patterns of reporting to child protection services in Canada by healthcare and nonhealthcare professionals

Background: All Canadian jurisdictions require certain professionals to report suspected or observed child maltreatment. This study examined the types of maltreatment, level of harm and child functioning issues, controlling for family socioeconomic status, age and gender of the child reported by healthcare and non-healthcare professionals. Methods: We conducted chi-square analyses and logistic regression on a national child welfare sample from the 2003 Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003) and compared the differences in professional reporting with its previous cycle (CIS-1998) using Bonferroni-corrected confidence intervals. Results: Our analysis of CIS-2003 data revealed that the majority of substantiated child maltreatment is reported to service agencies by non-healthcare professionals (57%), followed by non-professionals (33%) and healthcare professionals (10%). The number of professional reports increased 2.5 times between CIS-1998 and CIS-2003, while non-professionals’ increased 1.7 times. Of the total investigations, professional reports represented 59% in CIS-1998 and 67% in CIS-2003 (p<0.001). Compared to non-healthcare professionals, healthcare professionals more often reported younger children, children who experienced neglect and emotional maltreatment and those assessed as suffering harm and child functioning issues, but less often exposure to domestic violence. Conclusion: The results indicate that healthcare professionals played an important role in identifying children in need of protection considering harm and other child functioning issues. The authors discuss the reasons why underreporting is likely to remain an issue.

Resistance training for obese, type 2 diabetic adults: A review of the evidence

In both developed and developing countries, increased prevalence of obesity has been strongly associated with increased incidence of type 2 diabetes mellitus (T2DM) in the adult population. Previous research has emphasized the importance of physical activity in the prevention and management of obesity and T2DM, and generic exercise guidelines originally developed for the wider population have been adapted for these specific populations. However, the guidelines traditionally focus on aerobic training without due consideration to other exercise modalities. Recent reviews on resistance training in the T2DM population have not compared this modality with others including aerobic training, or considered the implications of resistance training for individuals suffering from both obesity and T2DM. In short, the optimal mix of exercise modalities in the prescription of exercise has not been identified for it benefits to the metabolic, body composition and muscular health markers common in obesity and T2DM. Similarly, the underlying physical, social and psychological barriers to adopting and maintaining exercise, with the potential to undermine the efficacy of exercise interventions, have not been addressed in earlier reviews. Because it is well established that aerobic exercise has profound effects on obesity and T2DM risk, the purpose of this review was to address the importance of resistance training to obese adults with T2DM.

Dealing with Post-GFC stress disorder : Bwembya Chikolwa quoted by Christine Retschlag for Property Australia magazine 4th March 2010

Has the GFC really changed the thinking of the property industry? Or are investment managers suffering from post-GFC stress disorder fated to repeat the mistakes of the past? Christine Retschlag reports on the mindset of the market.

Somatoform and dissociative disorders

• The somatoform disorders are psychiatric illnesses that present as physical disorders. • The somatoform disorders are not to be confused with malingering, which is the intentional production of symptoms to avoid some responsibility or duty. • Somatisation is a method of expressing anxiety and distress and is found in all cultural groups. • The distress and suffering experienced by clients with a somatoform disorder are real, although the medical basis for their symptoms is not. • Clients with a somatoform disorder are most frequently encountered in primary health care settings. • The dissociative disorders are marked by an abrupt, temporary change in consciousness, cognition, memory, identity or behaviour.

Settings for mental health care

The quality of the environment is important to client recovery and rehabilitation. • The preferred environment for the care of the mentally ill over time has been the home. • Environmental strategies in the care of the mentally ill became more important in the eighteenth century, when it was noticed that patients were more manageable in a pleasant environment. • Confinement of the mentally ill in large public asylums was largely an innovation of the nineteenth century. • The therapeutic milieu is a consciously organised environment. • Maxwell Jones in the United States and Thomas Main in the United Kingdom pioneered the concept of the hospital and environment as treatment tools. • The goals of the therapeutic milieu are containment, structure, support, involvement, validation, symptom management, and maintaining links with family and the community. • The principles on which the therapeutic milieu is based include: open communication, democratisation, reality confrontation, permissiveness, group cohesion and the multidisciplinary team. • The principle guiding the care of clients in the community is that of the least-restrictive alternative. • The therapeutic community residence is an environment that encourages the development of the client as a person in interaction with others, rather than as someone suffering from a health problem or disability. • The preferred contemporary setting for the provision of mental health care is the community. • The predominant form of service delivery in the community is case management, which has been found to be most effective for people with severe mental illnesses. • The principles of caring in the community are self-determination, normalisation, a focus on client strengths, and the community as a resource

The Sociology of Cosmopolitanism:Globalization, Identity, Culture and Government

The dream of a cosmopolitical utopia has been around for thousands of years. Yet the promise of being locally situated and at the same time globally connected and mobile has never seemed more possible than it is today. The question remains as to whether it is positive and realistic for us to have multiple loyalties. Can we sustain community and solidarity with our neighbours while we look beyond our nation? And if we can't - or won't – consider distant strangers as part of our own world, are there increasingly dire consequences? This book reconnects classical sociological theory and contemporary ideas on mobility, otherness, material assemblages, consumption and surveillance to render the idea of a global cosmopolitan utopia amenable to sociological investigation. The book takes a realistic approach to the development of cosmopolitical arrangements. It embraces the imaginative impulses the cosmopolitan dream provides, but takes into account the political, ethical and cultural dimensions of such cosmopolitan developments. In revisiting the relevance of classical sociological approaches in the context of contemporary theoretical challenges, the distinctive approach this book takes to understanding cosmopolitanism will be of use to scholars and students alike.

Sex trafficking : the global market in women and children

This book is one of a series on contemporary social issues. It provides a painstakingly researched analysis of the contemporary phenomenon of sex trafficking. As the author Kathryn Farr points out, the phenomenon is not all that contemporary, as women and children have historically been trafficked and enslaved for the purposes of prostitution, particularly during war: in World War II on the southern islands of Okinawa, the Philippines, Hawaii, Liberia, Japan, the Korean war, the Vietnam war, and more recently in Bosnia and Rwanda. Farr links the phenomenon to military socialization, especially to its patriarchal culture which celebrates hyper-masculinity, eroticizes violence, desensitizes soldiers to suffering and brutality and treats women as sex objects.

Does research into sensitive areas do harm? Experiences of research participation after a child’s diagnosis with Ewing’s Sarcoma

Objective: To investigate family members’ experiences of involvement in a previous study (conducted August 1995 to June 1997) following their child’s diagnosis with Ewing’s sarcoma. Design: Retrospective survey, conducted between 1 November and 30 November 1997, using a postal questionnaire. Participants: Eighty-one of 97 families who had previously completed an in-depth interview as part of a national case–control study of Ewing’s sarcoma. Main outcome measures: Participants’ views on how participation in the previous study had affected them and what motivated them to participate. Results: Most study participants indicated that taking part in the previous study had been a positive experience. Most (n = 79 [97.5%]) believed their involvement would benefit others and were glad to have participated, despite expecting and finding some parts of the interview to be painful. Parents whose child was still alive at the time of the interview recalled participation as more painful than those whose child had died before the interview. Parents who had completed the interview less than a year before our study recalled it as being more painful than those who had completed it more than a year before. Conclusions: That people suffering bereavement are generally eager to participate in research and may indeed find it a positive experience is useful information for members of ethics review boards and other “gatekeepers”, who frequently need to determine whether studies into sensitive areas should be approved. Such information may also help members of the community to make an informed decision regarding participation in such research.

Disease prevention and control

Globally, the main contributors to morbidity and mortality are chronic diseases, including cardiovascular disease and diabetes. Chronic diseases are costly and partially avoidable, with around sixty percent of deaths and nearly fifty percent of the global disease burden attributable to these conditions. By 2020, chronic illnesses will likely be the leading cause of disability worldwide. Existing health care systems, both national and international, that focus on acute episodic health conditions, cannot address the worldwide transition to chronic illness; nor are they appropriate for the ongoing care and management of those already afflicted with chronic diseases. International and Australian strategic planning documents articulate similar elements to manage chronic disease; including the need for aligning sectoral policies for health, forming partnerships and engaging communities in decision-making. The Australian National Chronic Disease Strategy focuses on four core areas for managing chronic disease; prevention across the continuum, early detection and treatment, integrated and coordinated care, and self-management. Such a comprehensive approach incorporates the entire population continuum, from the ‘healthy’, to those with risk factors, through to people suffering from chronic conditions and their sequelae. This chapter examines comprehensive approach to the prevention, management and care of the population with non-communicable, chronic diseases and communicable diseases. It analyses models of care in the context of need, service delivery options and the potential to prevent or manage early intervention for chronic and communicable diseases. Approaches to chronic diseases require integrated approaches that incorporate interventions targeted at both individuals and populations, and emphasise the shared risk factors of different conditions. Communicable diseases are a common and significant contributor to ill health throughout the world. In many countries, this impact has been minimised by the combined efforts of preventative health measures and improved treatment of infectious diseases. However in underdeveloped nations, communicable diseases continue to contribute significantly to the burden of disease. The aim of this chapter is to outline the impact that chronic and communicable diseases have on the health of the community, the public health strategies that are used to reduce the burden of those diseases and the old and emerging risks to public health from infectious diseases.

Anxiety among high school students in India : comparisons across gender, school type, social strata, and perceptions of quality time with parents

The broad objective of the study was to better understand anxiety among adolescents in Kolkata city, India. Specifically, the study compared anxiety across gender, school type, socio-economic background and mothers’ employment status. The study also examined adolescents’ perceptions of quality time with their parents. A group of 460 adolescents (220 boys and 240 girls), aged 13-17 years were recruited to participate in the study via a multi-stage sampling technique. The data were collected using a self-report semi-structured questionnaire and a standardized psychological test, the State-Trait Anxiety Inventory. Results show that anxiety was prevalent in the sample with 20.1% of boys and 17.9% of girls found to be suffering from high anxiety. More boys were anxious than girls (p<0.01). Adolescents from Bengali medium schools were more anxious than adolescents from English medium schools (p<0.01). Adolescents belonging to the middle class (middle socio-economic group) suffered more anxiety than those from both high and low socio-economic groups (p<0.01). Adolescents with working mothers were found to be more anxious (p<0.01). Results also show that a substantial proportion of the adolescents perceived they did not receive quality time from fathers (32.1%) and mothers (21.3%). A large number of them also did not feel comfortable to share their personal issues with their parents (60.0% for fathers and 40.0% for mothers).

Pollutant characteristics on roof surfaces for evaluation as a stormwater harvesting catchment

This paper presents the outcomes of a study which focused on evaluating roof surfaces as stormwater harvesting catchments. Build-up and wash-off samples were collected from model roof surfaces. The collected build-up samples were separated into five different particle size ranges prior to the analysis of physico-chemical parameters. Study outcomes showed that roof surfaces are efficient catchment surfaces for the deposition of fine particles which travel over long distances. Roof surfaces contribute relatively high pollutant loads to the runoff and hence significantly influence the quality of the harvested rainwater. Pollutants associated with solids build-up on roof surfaces can vary with time, even with minimal changes to total solids load and particle size distribution. It is postulated that this variability is due to changes in distant atmospheric pollutant sources and wind patterns. The study highlighted the requirement for first flush devices to divert the highly polluted initial portion of roof runoff. Furthermore, it is highly recommended to not to harvest runoff from small intensity rainfall events since there is a high possibility that the runoff would contain a significant amount of pollutants even after the initial runoff fraction.

Speech recognition using ad-hoc microphone arrays

While close talking microphones give the best signal quality and produce the highest accuracy from current Automatic Speech Recognition (ASR) systems, the speech signal enhanced by microphone array has been shown to be an effective alternative in a noisy environment. The use of microphone arrays in contrast to close talking microphones alleviates the feeling of discomfort and distraction to the user. For this reason, microphone arrays are popular and have been used in a wide range of applications such as teleconferencing, hearing aids, speaker tracking, and as the front-end to speech recognition systems. With advances in sensor and sensor network technology, there is considerable potential for applications that employ ad-hoc networks of microphone-equipped devices collaboratively as a virtual microphone array. By allowing such devices to be distributed throughout the users’ environment, the microphone positions are no longer constrained to traditional fixed geometrical arrangements. This flexibility in the means of data acquisition allows different audio scenes to be captured to give a complete picture of the working environment. In such ad-hoc deployment of microphone sensors, however, the lack of information about the location of devices and active speakers poses technical challenges for array signal processing algorithms which must be addressed to allow deployment in real-world applications. While not an ad-hoc sensor network, conditions approaching this have in effect been imposed in recent National Institute of Standards and Technology (NIST) ASR evaluations on distant microphone recordings of meetings. The NIST evaluation data comes from multiple sites, each with different and often loosely specified distant microphone configurations. This research investigates how microphone array methods can be applied for ad-hoc microphone arrays. A particular focus is on devising methods that are robust to unknown microphone placements in order to improve the overall speech quality and recognition performance provided by the beamforming algorithms. In ad-hoc situations, microphone positions and likely source locations are not known and beamforming must be achieved blindly. There are two general approaches that can be employed to blindly estimate the steering vector for beamforming. The first is direct estimation without regard to the microphone and source locations. An alternative approach is instead to first determine the unknown microphone positions through array calibration methods and then to use the traditional geometrical formulation for the steering vector. Following these two major approaches investigated in this thesis, a novel clustered approach which includes clustering the microphones and selecting the clusters based on their proximity to the speaker is proposed. Novel experiments are conducted to demonstrate that the proposed method to automatically select clusters of microphones (ie, a subarray), closely located both to each other and to the desired speech source, may in fact provide a more robust speech enhancement and recognition than the full array could.

Re-thinking home economics : from modern to postmodern accounts of pedagogical bodies

Two perceptions of the marginality of home economics are widespread across educational and other contexts. One is that home economics and those who engage in its pedagogy are inevitably marginalised within patriarchal relations in education and culture. This is because home economics is characterised as women's knowledge, for the private domain of the home. The other perception is that only orthodox epistemological frameworks of inquiry should be used to interrogate this state of affairs. These perceptions have prompted leading theorists in the field to call for non-essentialist approaches to research in order to re-think the thinking that has produced this cul-de-sac positioning of home economics as a body of knowledge and a site of teacher practice. This thesis takes up the challenge of working to locate a space outside the frame of modernist research theory and methods, recognising that this shift in epistemology is necessary to unsettle the idea that home economics is inevitably marginalised. The purpose of the study is to reconfigure how we have come to think about home economics teachers and the profession of home economics as a site of cultural practice, in order to think it otherwise (Lather, 1991). This is done by exploring how the culture of home economics is being contested from within. To do so, the thesis uses a 'posthumanist' approach, which rejects the conception of the individual as a unitary and fixed entity, but instead as a subject in process, shaped by desires and language which are not necessarily consciously determined. This posthumanist project focuses attention on pedagogical body subjects as the 'unsaid' of home economics research. It works to transcend the modernist dualism of mind/body, and other binaries central to modernist work, including private/public, male/female,paid/unpaid, and valued/unvalued. In so doing, it refuses the simple margin/centre geometry so characteristic of current perceptions of home economics itself. Three studies make up this work. Studies one and two serve to document the disciplined body of home economics knowledge, the governance of which works towards normalisation of the 'proper' home economics teacher. The analysis of these accounts of home economics teachers by home economics teachers, reveals that home economics teachers are 'skilled' yet they 'suffer' for their profession. Further,home economics knowledge is seen to be complicit in reinforcing the traditional roles of masculinity and femininity, thereby reinforcing heterosexual normativity which is central to patriarchal society. The third study looks to four 'atypical'subjects who defy the category of 'proper' and 'normal' home economics teacher. These 'atypical' bodies are 'skilled' but fiercely reject the label of 'suffering'. The discussion of the studies is a feminist poststructural account, using Russo's (1994) notion of the grotesque body, which is emergent from Bakhtin's (1968) theory of the carnivalesque. It draws on the 'shreds' of home economics pedagogy,scrutinising them for their subversive, transformative potential. In this analysis, the giving and taking of pleasure and fun in the home economics classroom presents moments of surprise and of carnival. Foucault's notion of the construction of the ethical individual shows these 'atypical' bodies to be 'immoderate' yet striving hard to be 'continent' body subjects. This research captures moments of transgression which suggest that transformative moments are already embodied in the pedagogical practices of home economics teachers, and these can be 'seen' when re-looking through postmodemist lenses. Hence, the cultural practices ofhome economics as inevitably marginalised are being contested from within. Until now, home economics as a lived culture has failed to recognise possibilities for reconstructing its own field beyond the confines of modernity. This research is an example of how to think about home economics teachers and the profession as a reconfigured cultural practice. Future research about home economics as a body of knowledge and a site of teacher practice need not retell a simple story of oppression. Using postmodemist epistemologies is one way to provide opportunities for new ways of looking.