Differences in identifying healthcare associated infections using clinical vignettes and the influence of respondent characteristics: A cross-sectional survey of Australian infection prevention staff

Background Australia has commenced public reporting and benchmarking of healthcare associated infections (HAIs), despite not having a standardised national HAI surveillance program. Annual hospital Staphylococcus aureus bloodstream (SAB) infection rates are released online, with other HAIs likely to be reported in the future. Although there are known differences between hospitals in Australian HAI surveillance programs, the effect of these differences on reported HAI rates is not known. Objective To measure the agreement in HAI identification, classification, and calculation of HAI rates, and investigate the influence of differences amongst those undertaking surveillance on these outcomes. Methods A cross-sectional online survey exploring HAI surveillance practices was administered to infection prevention nurses who undertake HAI surveillance. Seven clinical vignettes describing HAI scenarios were included to measure agreement in HAI identification, classification, and calculation of HAI rates. Data on characteristics of respondents was also collected. Three of the vignettes were related to surgical site infection and four to bloodstream infection. Agreement levels for each of the vignettes were calculated. Using the Australian SAB definition, and the National Health and Safety Network definitions for other HAIs, we looked for an association between the proportion of correct answers and the respondents’ characteristics. Results Ninety-two infection prevention nurses responded to the vignettes. One vignette demonstrated 100 % agreement from responders, whilst agreement for the other vignettes varied from 53 to 75 %. Working in a hospital with more than 400 beds, working in a team, and State or Territory was associated with a correct response for two of the vignettes. Those trained in surveillance were more commonly associated with a correct response, whilst those working part-time were less likely to respond correctly. Conclusion These findings reveal the need for further HAI surveillance support for those working part-time and in smaller facilities. It also confirms the need to improve uniformity of HAI surveillance across Australian hospitals, and raises questions on the validity of the current comparing of national HAI SAB rates.

Let's do it: A framework to investigate the affordances of experimental learning environments

BACKGROUND Experimental learning, traditionally conducted in on-campus laboratory venues, is the cornerstone of science and engineering education. In order to ensure that engineering graduates are exposed to ‘real-world’ situations and attain the necessary professional skill-sets, as mandated by course accreditation bodies such as Engineers Australia, face-to-face laboratory experimentation with real equipment has been an integral component of traditional engineering education. The online delivery of engineering coursework endeavours to mimic this with remote and simulated laboratory experimentation. To satisfy student and accreditation requirements, the common practice has been to offer equivalent remote and/or simulated laboratory experiments in lieu of the ones delivered, face-to face, on campus. The current implementations of both remote and simulated laboratories tend to be specified with a focus on technical characteristics, instead of pedagogical requirements. This work attempts to redress this situation by developing a framework for the investigation of the suitability of different experimental educational environments to deliver quality teaching and learning. PURPOSE For the tertiary education sector involved with technical or scientific training, a research framework capable of assessing the affordances of laboratory venues is an important aid during the planning, designing and evaluating stages of face-to-face and online (or cyber) environments that facilitate student experimentation. Providing quality experimental learning venues has been identified as one of the distance-education providers’ greatest challenges. DESIGN/METHOD The investigation draws on the expertise of staff at three Australian universities: Swinburne University of Technology (SUT), Curtin University (Curtin) and Queensland University of Technology (QUT). The aim was to analyse video recorded data, in order to identify the occurrences of kikan-shido (a Japanese term meaning ‘between desks instruction’ and over-the-shoulder learning and teaching (OTST/L) events, thereby ascertaining the pedagogical affordances in face-to-face laboratories. RESULTS These will be disseminated at a Master Class presentation at this conference. DISCUSSION Kikan-shido occurrences did reflect on the affordances of the venue. Unlike with other data collection methods, video recorded data and its analysis is repeatable. Participant bias is minimised or even eradicated and researcher bias tempered by enabling re-coding by others. CONCLUSIONS Framework facilitates the identification of experiential face-to-face learning venue affordances. Investigation will continue with on-line venues.

A holistic, institution-wide approach to building sessional staff capacity

Sessional Academics enhance students’ learning experience by bringing a diverse range of perspectives and expertise into the classroom. As industry specialists, research students, and recent graduates who have excelled in their courses, they complement the discipline expertise of career academics. With increasing casualization of the academic workforce, Sessional Academics now deliver the majority of face-to-face undergraduate teaching in Australian Universities. To enable them to realize their full potential as effective contributors to student learning and course quality, universities need to offer effective training and access to advice and support and facilitate engagement in university life. However, in the face of complex and diverse contexts, overwhelming numbers, and the transitory nature of sessional cohorts, few universities have developed a comprehensive, systematic approach. During the past three years at QUT, we have set out to develop a multifaceted approach to Sessional Academic support and development. In this paper I will explain why and how we have done so, and describe the range of strategies and programs we have developed. They include a central academic development program, which is structured and scaffolded with learning objectives and outcomes, and aligned with a graduate certificate in Academic Practice; a Sessional Academic Success program, which deploys experienced, school-based sessional academic success advisors to provide local support, build a sense of community, and offer discipline focused academic development; an online, dialogic communication strategy; and opportunities to present and be acknowledged for good learning and teaching practices. Together, these strategies have impacted on sessional academics’ confidence, learning and teaching capacity, reflection and engagement.

The introduction of an Inter-professional learning unit: staff and student perspectives

Background The School of Clinical Sciences comprises a number of health disciplines including podiatry, paramedic science, pharmacy, medical imaging and radiation therapy. A new inter-professional unit was introduced in 2014, which covered key introductory learnings applicable for future health practitioners. This study examined teaching staff and student perspectives about their experience with the new unit for first year students. Methods Qualitative interviews with teaching staff (n=9) and focus group interviews with students (5 groups which ranged in size from 4-30) were conducted. Extensive notes were taken during the interviews Issues emerging from the interviews were identified and organised according to themes and subthemes. Results Four major themes were identified namely: Something new; To be or not to be that is the question; Advantages of the new unit; and Areas for improvement. Previous staff experience with inter-professional learning (IPL) had been ad-hoc, whereas the new unit brought together several disciplines in a planned and deliberate way. There was strong philosophical agreement about the value of IPL but some debate about the extent to which the unit provided IPL experience. The unit was seen as assisting students’ social and academic adjustment to university and provided opportunity for professional socialisation, exposure to macro and micro aspects of the Australian health care system and various types of communication. For podiatry students it was their first opportunity to formally meet and work with other podiatry students and moved their identity from ‘university student’ to ‘podiatry student’. Other positives included providing the opportunity for staff and students to interact at an early stage with the perceived benefit of reducing attrition. Areas for unit improvement included institutional arrangements, unit administration aspects and assessment. Conclusion The unit was seen as beneficial by staff and students however, students were more polarised in their views than staff. There was a tension between feeling apart of and learning about one's own profession and feeling apart of and learning about the roles of other health professionals in relation to patient care and the health care system.

“We have to work within the system!”: Staff perceptions of organizational barriers to decision making for older adults with dementia in Australian aged care facilities

The current study explored the perceptions of direct care staff working in Australian residential aged care facilities (RACFs) regarding the organizational barriers that they believe prevent them from facilitating decision making for individuals with dementia. Normalization process theory (NPT) was used to interpret the findings to understand these barriers in a broader context. The qualitative study involved semi-structured interviews (N = 41) and focus groups (N = 8) with 80 direct care staff members of all levels working in Australian RACFs. Data collection and analysis were conducted in parallel and followed a systematic, inductive approach in line with grounded theory. The perceptions of participants regarding the organizational barriers to facilitating decision making for individuals with dementia can be described by the core category, Working Within the System, and three sub-themes: (a) finding time, (b) competing rights, and (c)not knowing. Examining the views of direct care staff through the lens of NPT allows possible areas for improvement to be identified at an organizational level and the perceived barriers to be understood in the context of promoting normalization of decision making for individuals with dementia.

Who Participated in School-to-Work Programs in 1998? Technical Report

[Excerpt] This report is based on a survey of 7425 students attending high school during the 1998/99 academic year that asked about recent participation in school-to-work (STW) activities. The survey is the first wave of the National Longitudinal Survey of Youth begun in early 1997 (NLSY97). Ninety-three percent of the youth surveyed in the initial wave were interviewed in the second follow up that we are analyzing here. The statistics reported below are based on weighted data and so represent the population of 15 to 19 year olds attending school during the 1998/99 academic year. Youth who graduated from or dropped out of high school before fall 1998 were not asked questions about participation in school-to-work programs and so are not included in our analysis.

Design and Simulation of a Solar Powered UAV for Remote Sensing Tasks Technical Report

This research deals with the development of a Solar-Powered UAV designed for remote sensing, in particular to the development of the autopilot sub-system and path planning. The design of the Solar-Powered UAS followed a systems engineering methodology, by first defining system architecture, and selecting each subsystem. Validation tests and integration of autopilot is performed, in order to evaluate the performances of each subsystem and to obtain a global operational system for data collection missions. The flight tests planning and simulation results are also explored in order to verify the mission capabilities using an autopilot on a UAS. The important aspect of this research is to develop a Solar-Powered UAS for the purpose of data collection and video monitoring, especially data and images from the ground; transmit to the GS (Ground Station), segment the collected data, and afterwards analyze it with a Matlab code.

Technical highlights: Invasive plant and animal research 2009-10

Technical highlights 2009–10, with detailed progress reports on the latest invasive plant and animal research undertaken by Biosecurity Queensland, a service unit of the Department of Employment, Economic Development and Innovation.

Technical highlights: Invasive plant and animal research 2008-09

Technical highlights 2008–09, with detailed progress reports on the latest invasive plant and animal research undertaken by Biosecurity Queensland, a service unit of the Department of Employment, Economic Development and Innovation.

Technical highlights: Invasive plant and animal research 2007-08

Technical highlights 2007–08, with detailed progress reports on the latest invasive plant and animal research undertaken by Biosecurity Queensland, a service unit of the Department of Primary Industries and Fisheries.

Tree growth relationships and silvicultural tools to assist stand management in private native spotted gum dominant forests in Queensland and northern New South Wales.

Spotted gum dominant forests occur from Cooktown in northern Queensland (Qld) to Orbost in Victoria (Boland et al. 2006) and these forests are commercially very important with spotted gum the most commonly harvested hardwood timber in Qld and one of the most important in New South Wales (NSW). Spotted gum has a wide range of end uses from solid wood products through to power transmission poles and generally has excellent sawing and timber qualities (Hopewell 2004). The private native forest resource in southern Qld and northern NSW is a critical component of the hardwood timber industry (Anon 2005, Timber Qld 2006) and currently half or more of the native forest timber resource harvested in northern NSW and Qld is sourced from private land. However, in many cases productivity on private lands is well below what could be achieved with appropriate silvicultural management. This project provides silvicultural management tools to assist extension staff, land owners and managers in the south east Qld and north eastern NSW regions. The intent was that this would lead to improvement of the productivity of the private estate through implementation of appropriate management. The other intention of this project was to implement a number of silvicultural experiments and demonstration sites to provide data on growth rates of managed and unmanaged forests so that landholders can make informed decisions on the future management of their forests. To assist forest managers and improve the ability to predict forest productivity in the private resource, the project has developed: • A set of spotted gum specific silvicultural guidelines for timber production on private land that cover both silvicultural treatment and harvesting. The guidelines were developed for extension officers and property owners. • A simple decision support tool, referred to as the spotted gum productivity assessment tool (SPAT), that allows an estimation of: 1. Tree growth productivity on specific sites. Estimation is based on the analysis of site and growth data collected from a large number of yield and experimental plots on Crown land across a wide range of spotted gum forest types. Growth algorithms were developed using tree growth and site data and the algorithms were used to formulate basic economic predictors. 2. Pasture development under a range of tree stockings and the expected livestock carrying capacity at nominated tree stockings for a particular area. 3. Above-ground tree biomass and carbon stored in trees. •A series of experiments in spotted gum forests on private lands across the study area to quantify growth and to provide measures of the effect of silvicultural thinning and different agro-forestry regimes. The adoption and use of these tools by farm forestry extension officers and private land holders in both field operations and in training exercises will, over time, improve the commercial management of spotted gum forests for both timber and grazing. Future measurement of the experimental sites at ages five, 10 and 15 years will provide longer term data on the effects of various stocking rates and thinning regimes and facilitate modification and improvement of these silvicultural prescriptions.

Sustainable Grazing in the Channel Country Floodplains (phase 2) : A technical report on findings between March 2003 and June 2006

‘Sustainable Grazing in the Channel Country Floodplains’ was initiated by industry to redress the lack of objective information for sustainable management in the floodplains of Cooper Creek and the Diamantina and Georgina Rivers. The project has maintained links with the grazing community and has extensively drawn upon expert local experience and knowledge. The project has provided tools for managers to better anticipate the size of beneficial flooding arising from rains in the upper catchment and to more objectively assess the value of the pasture resulting from flooding. The latest information from the project has enabled customisation of the EDGENetwork™ Grazing Land Management training package for the Channel Country. In combination, these tools will assist in making earlier cattle stocking decisions, including when cattle may need to be mustered out of floodplain paddocks, how many additional cattle will be required to take advantage of the flood–grown pasture, and the timing of cattle turnoff. These will reduce costs by providing a greater lead time to plan cattle movements and purchases, and may enhance the sustainability of the resource base by better matching cattle numbers with the feed on offer.

Technical efficiency of blood component preparation in blood centres of 10 European countries

Various reasons, such as ethical issues in maintaining blood resources, growing costs, and strict requirements for safe blood, have increased the pressure for efficient use of resources in blood banking. The competence of blood establishments can be characterized by their ability to predict the volume of blood collection to be able to provide cellular blood components in a timely manner as dictated by hospital demand. The stochastically varying clinical need for platelets (PLTs) sets a specific challenge for balancing supply with requests. Labour has been proven a primary cost-driver and should be managed efficiently. International comparisons of blood banking could recognize inefficiencies and allow reallocation of resources. Seventeen blood centres from 10 countries in continental Europe, Great Britain, and Scandinavia participated in this study. The centres were national institutes (5), parts of the local Red Cross organisation (5), or integrated into university hospitals (7). This study focused on the departments of blood component preparation of the centres. The data were obtained retrospectively by computerized questionnaires completed via Internet for the years 2000-2002. The data were used in four original articles (numbered I through IV) that form the basis of this thesis. Non-parametric data envelopment analysis (DEA, II-IV) was applied to evaluate and compare the relative efficiency of blood component preparation. Several models were created using different input and output combinations. The focus of comparisons was on the technical efficiency (II-III) and the labour efficiency (I, IV). An empirical cost model was tested to evaluate the cost efficiency (IV). Purchasing power parities (PPP, IV) were used to adjust the costs of the working hours and to make the costs comparable among countries. The total annual number of whole blood (WB) collections varied from 8,880 to 290,352 in the centres (I). Significant variation was also observed in the annual volume of produced red blood cells (RBCs) and PLTs. The annual number of PLTs produced by any method varied from 2,788 to 104,622 units. In 2002, 73% of all PLTs were produced by the buffy coat (BC) method, 23% by aphaeresis and 4% by the platelet-rich plasma (PRP) method. The annual discard rate of PLTs varied from 3.9% to 31%. The mean discard rate (13%) remained in the same range throughout the study period and demonstrated similar levels and variation in 2003-2004 according to a specific follow-up question (14%, range 3.8%-24%). The annual PLT discard rates were, to some extent, associated with production volumes. The mean RBC discard rate was 4.5% (range 0.2%-7.7%). Technical efficiency showed marked variation (median 60%, range 41%-100%) among the centres (II). Compared to the efficient departments, the inefficient departments used excess labour resources (and probably) production equipment to produce RBCs and PLTs. Technical efficiency tended to be higher when the (theoretical) proportion of lost WB collections (total RBC+PLT loss) from all collections was low (III). The labour efficiency varied remarkably, from 25% to 100% (median 47%) when working hours were the only input (IV). Using the estimated total costs as the input (cost efficiency) revealed an even greater variation (13%-100%) and overall lower efficiency level compared to labour only as the input. In cost efficiency only, the savings potential (observed inefficiency) was more than 50% in 10 departments, whereas labour and cost savings potentials were both more than 50% in six departments. The association between department size and efficiency (scale efficiency) could not be verified statistically in the small sample. In conclusion, international evaluation of the technical efficiency in component preparation departments revealed remarkable variation. A suboptimal combination of manpower and production output levels was the major cause of inefficiency, and the efficiency did not directly relate to production volume. Evaluation of the reasons for discarding components may offer a novel approach to study efficiency. DEA was proven applicable in analyses including various factors as inputs and outputs. This study suggests that analytical models can be developed to serve as indicators of technical efficiency and promote improvements in the management of limited resources. The work also demonstrates the importance of integrating efficiency analysis into international comparisons of blood banking.

Group portrait at the farewell banquet for Dr. William Antopol from the laboratory staff of Mount Sinai Hospital; Ken's Chop House, New York city Portraits Groups

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Value chain technical development

Short-term research projects on insect pest management in processed food.