Improved rural health through a collaborative model of care – qualitative findings

INTRODUCTION Health disparity between urban and rural regions in Australia is well-documented. In the Wheatbelt catchments of Western Australia there is higher incidence and rate of avoidable hospitalisation for chronic diseases. Structured care approach to chronic illnesses is not new but the focus has been on single disease state. A recent ARC Discovery Project on general practice nurse-led chronic disease management of diabetes, hypertension and stable ischaemic heart disease reported improved communication and better medical administration.[1] In our study we investigated the sustainability of such a multi-morbidities general practice –led collaborative model of care in rural Australia. METHODS A QUAN(qual) design was utilised. Eight pairs of rural general practices were matched. Inclusion criteria used were >18 years and capable of giving informed consent, at least one identified risk factor or diagnosed with chronic conditions. Patients were excluded if deemed medically unsuitable. A comprehensive care plan was formulated by the respective general practice nurse in consultation with the treating General Practitioner (GP) and patient based on the individual’s readiness to change, and was informed by available local resource. A case management approach was utilised. Shediaz-Rizkallah and Lee’s conceptual framework on sustainability informed our evaluation.[2] Our primary outcome on measures of sustainability was reduction in avoidable hospitalisation. Secondary outcomes were patients and practitioners acceptance and satisfaction, and changes to pre-determined interim clinical and process outcomes. RESULTS The qualitative interviews highlighted the community preference for a ‘sustainable’ local hospital in addition to general practice. Costs, ease of access, low prioritisation of self chronic care, workforce turnover and perception of losing another local resource if underutilised influenced the respondents’ decision to present at local hospital for avoidable chronic diseases regardless. CONCLUSIONS Despite the pragmatic nature of rural general practice in Australia, the sustainability of chronic multi-morbidities management in general practice require efficient integration of primary-secondary health care and consideration of other social determinants of health. What this study adds: What is already known on this subject: Structured approach to chronic disease management is not new and has been shown to be effective for reducing hospitalisation. However, the focus has been on single disease state. What does this study add: Sustainability of collaborative model of multi-morbidities care require better primary-secondary integration and consideration of social determinants of health.

Professional conversations : a collaborative approach to support policy implementation, professional learning and practice change in ECEC

In 2012, Australia introduced a new National Quality Framework, comprising enhanced quality expectations for early childhood education and care services, two national learning frameworks and a new Assessment and Rating System spanning child care centres, kindergartens and preschools, family day care and outside school hours care. This is the linchpin in a series of education reforms designed to support increased access to higher quality early childhood education and care (ECEC) and successful transition to school. As with any policy change, success in real terms relies upon building shared understanding and the capacity of educators to apply new knowledge and to support change and improved practice within their service. With this in mind, a collaborative research project investigated the efficacy of a new approach to professional learning in ECEC: the professional conversation. This paper reports on the trial and evaluation of a series of professional conversations to support implementation of one element of the NQF, the Early Years Learning Framework (DEEWR,2009), and their capacity to promote collaborative reflective practice, shared understanding, and improved practice in ECEC. Set against the backdrop of the NQF, this paper details the professional conversation approach, key challenges and critical success factors, and the learning outcomes for conversation participants. Findings support the efficacy of this approach to professional learning in ECEC, and its capacity to support policy reform and practice change in ECEC.

Treating the whole not the hole : necessary coupling of technologies for diabetic foot ulcer treatment

Highlights • Diabetic foot ulcers (DFUs) are a major complication of diabetes. • We describe the development of next-generation technologies for DFU repair. • We highlight the modest success of growth factor-, scaffold-, and cell-based DFU therapies. • We rationalize that combination therapies will be necessary to enable effective and reliable DFU repair.

Small acts of resistance : the role of intergenerational collaborative drawing in early childhood teaching and learning

This chapter focuses on ‘intergenerational collaborative drawing’, a particular process of drawing whereby adults and children draw at the same time on a blank paper space. Such drawings can be produced for a range of purposes, and based on different curriculum or stimulus subjects. Children of all ages, and with a range of physical and intellectual abilities are able to draw with parents, carers and teachers. Intergenerational collaborative drawing is a highly potent method for drawing in early childhood contexts because it brings adults and children together in the process of thinking and theorizing in order to create visual imagery and this exposes in deep ways to adults and children, the ideas and concepts being learned about. For adults, this exposure to a child’s thinking is a far more effective assessment tool than when they are presented with a finished drawing they know little about. This chapter focuses on drawings to examine wider issues of learning independence and how in drawing, preferred schema in the form of hand-out worksheets, the suggestive drawings provided by adults, and visual material seen in everyday life all serve to co-opt a young child into making particular schematic choices. I suggest that intergenerational collaborative drawing therefore serves to work as a small act of resistance to that co-opting, in that it helps adults and children to collectively challenge popular creativity and learning discourses.

Working knowledge for collaborative water planning in Australia’s Wet Tropics region

Cooperation between multiple environmental decision-makers and activities is necessary to address the impacts of diffuse sources of agricultural pollution on the water quality entering Australia’s Great Barrier Reef (GBR). Water planning efforts requires available knowledge to inform this co-operative water program implementation and reform. This paper uses knowledge sharing, translation and feedback features of collaboration as a way to assess knowledge work practices during key phases of the water planning process. This enabled a systematic review of knowledge work practices in partnership with collaborative water planning groups established to inform water quality program investment decisions in the GBR’s Wet Tropics region. This research builds on the growing academic and policy interest in the conditions required to enable different types of knowledge to be successfully used for policy-making by focusing on when, how and why knowledge work to meet these conditions is required.

Creative practices in the design studio culture : collaboration and communication

For the purpose of developing collaborative support in design studio environments, we have carried out ethnographic fieldwork in professional and academic product design studios. Our intention was to understand design practices beyond the productivity point of view and take into account the experiential, inspirational and aesthetical aspects of design practices. Using examples from our fieldwork, we develop our results around three broad themes by which design professionals support communication and collaboration: (1) use of artefacts, (2) use of space and (3) designerly practices. We use the results of our fieldwork for drawing implications for designing technologies for the design studio culture.

CAM : a collaborative object memory system

Physical design objects such as sketches, drawings, collages, storyboards and models play an important role in supporting communication and coordination in design studios. CAM (Cooperative Artefact Memory) is a mobile-tagging based messaging system that allows designers to collaboratively store relevant information onto their design objects in the form of messages, annotations and external web links. We studied the use of CAM in a Product Design studio over three weeks, involving three different design teams. In this paper, we briefly describe CAM and show how it serves as 'object memory'.

"Show me, how does it look now" : remote help-giving in collaborative design

This paper examines the role of visual information in a remote help-giving situation involving the collaborative physical task of designing a prototype remote control. We analyze a set of video recordings captured within an experimental setting. Our analysis shows that using gestures and relevant artefacts and by projecting activities on the camera, participants were able to discuss several design-related issues. The results indicate that with a limited camera view (mainly faces and shoulders), participants' conversations were centered at the physical prototype that they were designing. The socially organized use of our experimental setting provides some key implications for designing future remote collaborative systems.

Designing awareness support for distributed cooperative design teams

Motivation Awareness is an integral part of remote collaborative work and has been an important theme within the CSCW research. Our project aims at understanding and mediating non-verbal cues between remote participants involved in a design project. Research approach Within the AMIDA project we focus on distributed 'cooperative design' teams. We especially focus on the 'material' signals - signals in which people communicate through material artefacts, locations and their embodied actions. We apply an ethnographic approach to understand the role of physical artefacts in co-located naturalistic design setting. Based on the results we will generate important implications to support remote design work. We plan to develop a mixed-reality interface supported by a shared awareness display. This awareness display will provide information about the activities happening in the design room to remotely located participants. Findings/Design Our preliminary investigation with real-world design teams suggests that both the materiality of designers' work settings and their social practices play an important role in understanding these material signals that are at play. Originality/Value Most research supporting computer mediated communication have focused on either face-to-face or linguistically oriented communication paradigms. Our research focuses on mediating the non-verbal, material cues for supporting collaborative activities without impoverishing what designers do in their day to day working lives. Take away message An ethnographic approach allows us to understand the naturalistic practices of design teams, which can lead to designing effective technologies to support group work. In that respect, the findings of our research will have a generic value beyond the application domain chosen (design teams).

New technologies for assessing the contact lens wearing eye

New technologies for examination of the anterior eye in contact lens practice don’t appear to have taken a huge leap in the past decade however there a several novel adaptations of existing technology worthy of note. In other areas of health we have self-diagnosis via smartphone or other gadgets adapted as medical devices. In practice and research in vitro and in vivo new adaptive technologies have expanded our capabilities in assessing the anterior eye, in particular corneal and conjunctival confocal microscopy.

Bug reproduction : a collaborative practice within software maintenance activities

Software development settings provide a great opportunity for CSCW researchers to study collaborative work. In this paper, we explore a specific work practice called bug reproduction that is a part of the software bug-fixing process. Bug re-production is a highly collaborative process by which software developers attempt to locally replicate the ‘environment’ within which a bug was originally encountered. Customers, who encounter bugs in their everyday use of systems, play an important role in bug reproduction as they provide useful information to developers, in the form of steps for reproduction, software screenshots, trace logs, and other ways to describe a problem. Bug reproduction, however, poses major hurdles in software maintenance as it is often challenging to replicate the contextual aspects that are at play at the customers’ end. To study the bug reproduction process from a human-centered perspective, we carried out an ethnographic study at a multinational engineering company. Using semi-structured interviews, a questionnaire and half-a-day observation of sixteen software developers working on different software maintenance projects, we studied bug reproduction. In this pa-per, we present a holistic view of bug reproduction practices from a real-world set-ting and discuss implications for designing tools to address the challenges developers face during bug reproduction.

Literacy in the Middle Years : Learning from Collaborative Classroom Research

Literacy in the Middle Years: Learning from Collaborative Classroom Research, showcases teachers' innovative literacy work across the curriculum. Classroom practice, teacher thinking and collaborative research are highlighted in ways of working with new curricula and rapidly changing literacy modes and platforms. Connections with place, critical engagement with digital literacies, using polymedia with EAL/D learners, and subject-specific literacies are detailed in teachers' stories of practice. Teacher wellbeing, for a sustainable workforce, underpins the case studies, aimed at equipping 'change ready' teachers with positive examples of literacy approaches and inquiry in practice.

Workplace surfaces as resource for social interactions

Space and spatial arrangements play an important role in our everyday social interactions. The way we use and manage our surrounding space is not coincidental, on the contrary, it reflects the way we think, plan and act. Within collaborative contexts, its ability to support social activities makes space an important component of human cognition in the post-cognitive era. As technology designers, we can learn a lot by rigorously understanding the role of space for the purpose of designing collaborative systems. In this paper, we describe an ethnographic study on the use of workplace surfaces in design studios. We introduce the idea of artful surfaces. Artful surfaces are full of informative, inspirational and creative artefacts that help designers accomplish their everyday design practices. The way these surfaces are created and used could provide information about how designers work. Using examples from our fieldwork, we show that artful surfaces have both functional and inspirational characteristics. We indentify four types of artful surfaces: personal, shared, project-specific and live surfaces. We believe that a greater insight into how these artful surfaces are created and used could lead to better design of novel display technologies to support designers’ everyday work.

Active awareness : supporting the intentional disclosure of awareness information in collaborative systems

This thesis opens up the design space for awareness research in CSCW and HCI. By challenging the prevalent understanding of roles in awareness processes and exploring different mechanisms for actively engaging users in the awareness process, this thesis provides a better understanding of the complexity of these processes and suggests practical solutions for designing and implementing systems that support active awareness. Mutual awareness, a prominent research topic in the fields of Computer-Supported Cooperative Work (CSCW) and Human-Computer Interaction (HCI) refers to a fundamental aspect of a person’s work: their ability to gain a better understanding of a situation by perceiving and interpreting their co-workers actions. Technologically-mediated awareness, used to support co-workers across distributed settings, distinguishes between the roles of the actor, whose actions are often limited to being the target of an automated data gathering processes, and the receiver, who wants to be made aware of the actors’ actions. This receiver-centric view of awareness, focusing on helping receivers to deal with complex sets of awareness information, stands in stark contrast to our understanding of awareness as social process involving complex interactions between both actors and receivers. It fails to take into account an actors’ intimate understanding of their own activities and the contribution that this subjective understanding could make in providing richer awareness information. In this thesis I challenge the prevalent receiver-centric notion of awareness, and explore the conceptual foundations, design, implementation and evaluation of an alternative active awareness approach by making the following five contributions. Firstly, I identify the limitations of existing awareness research and solicit further evidence to support the notion of active awareness. I analyse ethnographic workplace studies that demonstrate how actors engage in an intricate interplay involving the monitoring of their co-workers progress and displaying aspects of their activities that may be of relevance to others. The examination of a large body of awareness research reveals that while disclosing information is a common practice in face-to-face collaborative settings it has been neglected in implementations of technically mediated awareness. Based on these considerations, I introduce the notion of intentional disclosure to describe the action of users actively and deliberately contributing awareness information. I consider challenges and potential solutions for the design of active awareness. I compare a range of systems, each allowing users to share information about their activities at various levels of detail. I discuss one of the main challenges to active awareness: that disclosing information about activities requires some degree of effort. I discuss various representations of effort in collaborative work. These considerations reveal that there is a trade-off between the richness of awareness information and the effort required to provide this information. I propose a framework for active awareness, aimed to help designers to understand the scope and limitations of different types of intentional disclosure. I draw on the identified richness/effort trade-off to develop two types of intentional disclosure, both of which aim to facilitate the disclosure of information while reducing the effort required to do so. For both of these approaches, direct and indirect disclosure, I delineate how they differ from related approaches and define a set of design criteria that is intended to guide their implementation. I demonstrate how the framework of active awareness can be practically applied by building two proof-of-concept prototypes that implement direct and indirect disclosure respectively. AnyBiff, implementing direct disclosure, allows users to create, share and use shared representations of activities in order to express their current actions and intentions. SphereX, implementing indirect disclosure, represents shared areas of interests or working context, and links sets of activities to these representations. Lastly, I present the results of the qualitative evaluation of the two prototypes and analyse the results with regard to the extent to which they implemented their respective disclosure mechanisms and supported active awareness. Both systems were deployed and tested in real world environments. The results for AnyBiff showed that users developed a wide range of activity representations, some unanticipated, and actively used the system to disclose information. The results further highlighted a number of design considerations relating to the relationship between awareness and communication, and the role of ambiguity. The evaluation of SphereX validated the feasibility of the indirect disclosure approach. However, the study highlighted the challenges of implementing cross-application awareness support and translating the concept to users. The study resulted in design recommendations aimed to improve the implementation of future systems.

In-vehicle extremity injuries from improvised explosive devices : current and future foci

The conflicts in Iraq and Afghanistan have been epitomized by the insurgents’ use of the improvised explosive device against vehicle-borne security forces. These weapons, capable of causing multiple severely injured casualties in a single incident, pose the most prevalent single threat to Coalition troops operating in the region. Improvements in personal protection and medical care have resulted in increasing numbers of casualties surviving with complex lower limb injuries, often leading to long-term disability. Thus, there exists an urgent requirement to investigate and mitigate against the mechanism of extremity injury caused by these devices. This will necessitate an ontological approach, linking molecular, cellular and tissue interaction to physiological dysfunction. This can only be achieved via a collaborative approach between clinicians, natural scientists and engineers, combining physical and numerical modelling tools with clinical data from the battlefield. In this article, we compile existing knowledge on the effects of explosions on skeletal injury, review and critique relevant experimental and computational research related to lower limb injury and damage and propose research foci required to drive the development of future mitigation technologies.