Emergency health services : demand and service delivery models. Monograph 1: literature review and activity trends

Emergency Health Services (EHS), encompassing hospital-based Emergency Departments (ED) and pre-hospital ambulance services, are a significant and high profile component of Australia���s health care system and congestion of these, evidenced by physical overcrowding and prolonged waiting times, is causing considerable community and professional concern. This concern relates not only to Australia���s capacity to manage daily health emergencies but also the ability to respond to major incidents and disasters. EHS congestion is a result of the combined effects of increased demand for emergency care, increased complexity of acute health care, and blocked access to ongoing care (e.g. inpatient beds). Despite this conceptual understanding there is a lack of robust evidence to explain the factors driving increased demand, or how demand contributes to congestion, and therefore public policy responses have relied upon limited or unsound information. The Emergency Health Services Queensland (EHSQ) research program proposes to determine the factors influencing the growing demand for emergency health care and to establish options for alternative service provision that may safely meet patient���s needs. The EHSQ study is funded by the Australian Research Council (ARC) through its Linkage Program and is supported financially by the Queensland Ambulance Service (QAS). This monograph is part of a suite of publications based on the research findings that examines the existing literature, and current operational context. Literature was sourced using standard search approaches and a range of databases as well as a selection of articles cited in the reviewed literature. Public sources including the Australian Institute of Health and Welfare (AIHW), the Council of Ambulance Authorities (CAA) Annual Reports, Australian Bureau of Statistics (ABS) and Department of Health and Ageing (DoHA) were examined for trend data across Australia.

Prediction of structural integrity, robustness and service life using advanced finite element methods

Corrosion is a common phenomenon and critical aspects of steel structural application. It affects the daily design, inspection and maintenance in structural engineering, especially for the heavy and complex industrial applications, where the steel structures are subjected to hash corrosive environments in combination of high working stress condition and often in open field and/or under high temperature production environments. In the paper, it presents the actual engineering application of advanced finite element methods in the predication of the structural integrity and robustness at a designed service life for the furnaces of alumina production, which was operated in the high temperature, corrosive environments and rotating with high working stress condition.

Comparative study of DFSS in product and service innovation

Six sigma has proven itself as a major quality initiative in the last two decades. It is a philosophy which provides a systematic approach to applying numerous tools in the framework of several quality improvement methodologies. The most widely used six sigma methodology is DMAIC, which is best suited for improving existing processes. In order to build quality into the product or service, a proactive approach like Design for Six Sigma (DFSS) is required. This paper provides an overview of DFSS, product innovation, and service innovation. The emphasis is on comparing how DFSS is applied differently in product and service innovation. This paper contributes by analysing the existing literature on DFSS in product and service innovation. The major findings are that the DFSS approach in services and products can be differentiated along the following three dimensions: methodology, characteristics, and technology.

The Punitive Turn in Juvenile Justice: Cultures of Control and Rights of Compliance in Western Europe and the USA

Separate systems of justice for children and young people have always been beset by issues of contradiction and compromise. There is compelling evidence that such ambiguity is currently being `resolved' by a greater governmental resort to neo-conservative punitive and correctional interventions and a neo-liberal responsibilizing mentality in which the protection historically afforded to children is rapidly dissolving. This resurgent authoritarianism appears all the more anachronistic when it is set against the widely held commitment to act within the guidelines established by various children's rights conventions. Of note is the United Nations Convention on the Rights of the Child, frequently described as the most ratified human rights convention in the world, but lamentably also the most violated. Based on international research on juvenile custody rates and children's rights compliance in the USA and Western Europe, this article examines why and to what extent `American exceptionalism' might be permeating European nation states.

Health monitoring of buildings during construction and service stages using vibration characteristics

Columns and walls in buildings are subjected to a number of load increments during the construction and service stages. The combination of these load increments and poor quality construction can cause defects in these structural components. In addition, defects can also occur due to accidental or deliberate actions by users of the building during construction and service stages. Such defects should be detected early so that remedial measures can be taken to improve life time serviceability and performance of the building. This paper uses micro and macro model upgrading methods during construction and service stages of a building based on the mass and stiffness changes to develop a comprehensive procedure for locating and detecting defects in columns and walls of buildings. Capabilities of the procedure are illustrated through examples.

Emergency Health Services (EHS) : demand and service delivery models. [Monograph 2 : Queensland EHS users��� profile]

Emergency health is a critical component of Australia���s health system and one which is 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 characteristics of users of emergency health services with an aim to identify those that appear to contribute to demand growth. This study utilises data on patients treated by Emergency Departments (ED) and Queensland Ambulance Service (QAS) across Queensland. ED data was derived from the Emergency Department Information System (EDIS) for the period 2001-02 through to 2010-11. Ambulance data was extracted from the QAS��� Ambulance Information Management System (AIMS) and electronic Ambulance Report Form (eARF) for the period 2001-02 through to 2009-10. Due to discrepancies and comparability issues for ED data, this monograph compares data from the 2003-04 time period with 2010-11 data for 21 of the reporting EDs. Also a snapshot of users for the 2010-11 financial year for 31 reporting EDs is used to describe the characteristics of users and to compare those characteristics with population demographics. For QAS data, the 2002-03 and 2009-10 time periods were selected for detailed analyses to identify trends. ��� Demand for emergency health care services is increasing, representing both increased population and increased relative utilisation. Per capita demand for ED attention has increased by 2% per annum over the last decade and for ambulance attention by 3.7% per annum. ��� The growth in ED demand is prominent in more urgent triage categories with actual decline in less urgent patients. An estimated 55% of patients attend hospital EDs outside of normal working hours. There is no evidence that patients presenting out of hours are significantly different to those presenting within working hours; they have similar triage assessments and outcomes. ��� Patients suffering from injuries and poisoning comprise 28% of the ED workload (an increase of 65% in the study period), whilst declines of 32% in cardiovascular and circulatory conditions, and musculoskeletal problems have been observed. ��� 25.6% of patients attending EDs are admitted to hospital. 19% of admitted patients and 7% of patients who die in the ED are triage category 4 or 5 on arrival. ��� The average age of ED patients is 35.6 years. Demand has grown in all age groups and amongst both men and women. Men have higher utilisation rates for ED in all age groups. The only group where the growth rate in women has exceeded men is in the 20-29 age group; this growth is particularly in the injury and poisoning categories. ��� Considerable attention has been paid publicly to ED performance criteria. It is worth noting that 50% of all patients were treated within 33 minutes of arrival. ��� Patients from lower socioeconomic areas appear to have higher utilisation rates and the utilisation rate for indigenous people appears to exceed those of European and other backgrounds. The utilisation rates for immigrant people is generally less than that of Australian born however it has not been possible to eliminate the confounding impact of different age and socioeconomic profiles. ��� Demand for ambulance service is also increasing at a rate that exceeds population growth. Utilisation rates have increased by an average of 5% per annum in Queensland compared to 3.6% nationally, and the utilisation rate in Queensland is 27% higher than the national average. ��� The growth in ambulance utilisation has also been amongst the more urgent categories of dispatch and utilisation rates are higher in rural and regional areas than in the metropolitan area. The demand for ambulance increases with age but the growth in demand for ambulance service has been more prominent in younger age groups. These findings contribute significantly to an understanding of the growth in demand for emergency health. It shows that the growth is amongst patients in genuine need of emergency healthcare and public rhetoric that the congestion of emergency health services is due to inappropriate attendees is unable to be substantiated. The consistency of the growth in demand over the last decade reflects not only the changing demographics of the Australian population but also the changes in health status, standards of acute health care and other social factors. The growth is also amongst patients with acute injury and poisoning which is inconsistent with rates of chronic disease as a fundamental driver. We have also interviewed patients in regard to their decision making choices for acute health care and the factors that influence these decisions and this will be the subject of a third Monograph and publications.

Narcissistic and service-oriented leadership : contrasting perspectives

Leadership writing has tended to present a positive picture about leadership practice yet, in recent times, researchers have highlighted the ���dark side��� of leadership. In this exploratory conceptual paper, we juxtapose two contrasting forms of leadership: narcissistic leadership and service-oriented leadership (that draws heavily upon servant leadership) in order to provide a better understanding of both of these forms. In particular, we explore four core constructs of leadership: service, power, role of followers, and morality, to provide a constrast. Given that little empirical works exists on narcissistic and servant leadership in educational contexts, the paper concludes by arguing for further research in the field.

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.

���We���re not like these weird feather boa-covered AIDS-spreading monsters��� : How LGBT young people and service providers think riskiness informs LGBT youth���police interactions

Research has suggested that lesbian, gay, bisexual and transgender (LGBT) young people are ���at-risk��� of victimization and/or legally ���risky.��� Relatively few studies have examined the social construction of risk in ���risk factor��� research and whether risk as a concept influences the everyday lives of LGBT young people. This article reports how 35 LGBT young people and seven service provider staff in Brisbane, Queensland, Australia perceived LGBT youth���police interactions as reflecting discourses about LGBT riskiness and danger. The participants specifically note how they thought looking at-risk and/or looking risky informed their policing experiences. The article concludes with recommendations for improving future policing practice.

Specialist versus generic models of psychiatry training and service provision for people with intellectual disabilities

Background��� Models of service provision and professional training differ between countries. This study aims to investigate a specialist intellectual disabilities model and a generic mental health model, specifically comparing psychiatrists��� knowledge and competencies, and service quality and accessibility in meeting the mental health needs of people with intellectual disabilities. Method��� Data were collected from consultant and trainee psychiatrists within a specialist intellectual disabilities model (UK) and a generic mental health model (Australia). Results��� The sample sizes were 294 (UK) and 205 (Australia). Statistically significant differences were found, with UK participants having positive views about the specialist intellectual disabilities service model they worked within, demonstrating flexible and accessible working practices and service provision, responsive to the range of mental health needs of the population with intellectual disabilities, and providing a wide range of treatments and supports. The UK participants were knowledgeable, well trained and confident in their work. They wanted to work with people with intellectual disabilities. In all of these areas, the converse was found from the Australian generic mental health service model. Conclusions��� The specialist intellectual disabilities model of service provision and training has advantages over the generic mental health model.

Recreational needs and service performance expectations

The theoretical contribution of this study lies with its focus on subjective experiencing, that is, the emotional convergence between feeling states, and perceptions of servicescapes and holiday activities. An empirical study models the impact of recreational needs on the perceived importance of destination attributes and intentions to participate in activities. A sample of prospective tourists was asked to indicate how important they considered servicescape elements to be in their general holiday planning. They were also asked to report on their emotional state (orientation) as a proxy for their needs for recreation, and to state their intention and likely involvement with holiday activities. Results suggest that those with high recreational needs (self-reflexive and inward-looking) regard elements of tourism servicescapes as significantly more important than those without (who are outward-looking and energetic), as well as show significant variations in their inclinations to be active and explorative at destinations. Rather, those with higher recreational needs as measured by combinations of lack of energy, self-confidence, and physiological well-being look for creature comfort, coziness, and familiarity, in other words, for things they already know and have experienced before. Subjective experiencing and service performance evaluations are thereby suggested to be influenced by emotional states. These states may also impact tourists' recognition of destination uniqueness as a major component of a destination's competitive advantage that cannot easily be copied. As a consequence, it may be worth reconsidering the role of recreation in tourism service design. Turning an inwardlooking focus bent on recreation to an outward-looking one interested in discovery would enable more tourists to more fully experience the destination before they leave.

Field and Service Robotics: Results of the 9th International Conference

The Field and Service Robotics (FSR) conference is a single track conference with a specific focus on field and service applications of robotics technology. The goal of FSR is to report and encourage the development of field and service robotics. These are non-factory robots, typically mobile, that must operate in complex and dynamic environments. Typical field robotics applications include mining, agriculture, building and construction, forestry, cargo handling and so on. Field robots may operate on the ground (of Earth or planets), under the ground, underwater, in the air or in space. Service robots are those that work closely with humans, importantly the elderly and sick, to help them with their lives. The first FSR conference was held in Canberra, Australia, in 1997. Since then the meeting has been held every 2 years in Asia, America, Europe and Australia. It has been held in Canberra, Australia (1997), Pittsburgh, USA (1999), Helsinki, Finland (2001), Mount Fuji, Japan (2003), Port Douglas, Australia (2005), Chamonix, France (2007), Cambridge, USA (2009), Sendai, Japan (2012) and most recently in Brisbane, Australia (2013). This year we had 54 submissions of which 36 were selected for oral presentation. The organisers would like to thank the international committee for their invaluable contribution in the review process ensuring the overall quality of contributions. The organising committee would also like to thank Ben Upcroft, Felipe Gonzalez and Aaron McFadyen for helping with the organisation and proceedings. and proceedings. The conference was sponsored by the Australian Robotics and Automation Association (ARAA), CSIRO, Queensland University of Technology (QUT), Defence Science and Technology Organisation Australia (DSTO) and the Rio Tinto Centre for Mine Automation, University of Sydney.

Candidatus Phytoplasma australiense is associated with pumpkin yellow leaf curl disease in Queensland, Western Australia and the Northern Territory

Pumpkin plants (Cucurbita maxima and C. moschata) with pumpkin yellow leaf curl (PYLC) disease were observed at production fields in Queensland, Western Australia and the Northern Territory. Diseased samples were positive for a phytoplasma indistinguishable from Candidatus Phytoplasma australiense, the phytoplasma associated with papaya dieback and strawberry lethal yellows. This is the first time Candidatus Phytoplasma australiense has been detected in pumpkin.