A prospective pilot study evaluating the ‘cardiac decompensation score’ in the setting of intraaortic balloon counterpulsation

The study objective was to determine whether the ‘cardiac decompensation score’ could identify cardiac decompensation in a patient with existing cardiac compromise managed with intraaortic balloon counterpulsation (IABP). A one-group, posttest-only design was utilised to collect observations in 2003 from IABP recipients treated in the intensive care unit of a 450 bed Australian, government funded, public, cardiothoracic, tertiary referral hospital. Twenty-three consecutive IABP recipients were enrolled, four of whom died in ICU (17.4%). All non-survivors exhibited primarily rising scores over the observation period (p < 0.001) and had final scores of 25 or higher. In contrast, the maximum score obtained by a survivor at any time was 15. Regardless of survival, scores for the 23 participants were generally decreasing immediately following therapy escalation (p = 0.016). Further reflecting these changes in patient support, there was also a trend for scores to move from rising to falling at such treatment escalations (p = 0.024). This pilot study indicates the ‘cardiac decompensation score’ to accurately represent changes in heart function specific to an individual patient. Use of the score in conjunction with IABP may lead to earlier identification of changes occurring in a patient's cardiac function and thus facilitate improved IABP outcomes.

Interventions for preventing and managing aggressive patients admitted to an acute hospital setting: A systematic review

Background: Violence in health care has been widely reported and health care workers, particularly nurses in acute care settings, are ill-equipped to manage patients who exhibit aggressive traits. Aim: The aim of this systematic review was to establish best practice in the prevention and management of aggressive behaviours in patients admitted to acute hospital settings. Data Sources: An extensive search of the major databases was conducted from 1990 to 2007. The search included published and unpublished studies and papers in English. Review Methods: This review considered any quantitative research study design that evaluated the effectiveness of interventions in the prevention and management of patients who exhibit aggressive behaviours in an acute hospital setting. Each included study was quality assessed by two independent reviewers and data were extracted using the relevant tools developed by the Joanna Briggs Institute. Results: Ten studies met the inclusion criteria and were included in the review. The evidence identified from the studies includes: the benefit of education and training of acute care nurses in aggression management techniques; use of “as required” medications is effective in minimising harm to patients and staff; and that specific interventions such as physical restraint may play a role in managing aggressive behaviours from patients in the acute care setting. Conclusions: This review makes several recommendations for the prevention and management of aggressive behaviours in acute hospital patients. However, due to the lack of high-quality studies conducted in the acute care setting there is huge scope for future research in this area.

Clinical outcomes in residential care : setting benchmarks for quality

Aim Australian residential aged care does not have a system of quality assessment related to clinical outcomes, or comprehensive quality benchmarking. The Residential Care Quality Assessment was developed to fill this gap; and this paper discusses the process by which preliminary benchmarks representing high and low quality were developed for it. Methods Data were collected from all residents (n = 498) of nine facilities. Numerator–denominator analysis of clinical outcomes occurred at a facility-level, with rank-ordered results circulated to an expert panel. The panel identified threshold scores to indicate excellent and questionable care quality, and refined these through Delphi process. Results Clinical outcomes varied both within and between facilities; agreed thresholds for excellent and poor outcomes were finalised after three Delphi rounds. Conclusion Use of the Residential Care Quality Assessment provides a concrete means of monitoring care quality and allows benchmarking across facilities; its regular use could contribute to improved care outcomes within residential aged care in Australia.

Seeking a life in the literary position : the writing of Charmian Clift

An examination of the published and unpublished writing of Charmian Clift.

Encryption schemes and key exchange protocols in the certificateless setting

The contributions of this thesis fall into three areas of certificateless cryptography. The first area is encryption, where we propose new constructions for both identity-based and certificateless cryptography. We construct an n-out-of- n group encryption scheme for identity-based cryptography that does not require any special means to generate the keys of the trusted authorities that are participating. We also introduce a new security definition for chosen ciphertext secure multi-key encryption. We prove that our construction is secure as long as at least one authority is uncompromised, and show that the existing constructions for chosen ciphertext security from identity-based encryption also hold in the group encryption case. We then consider certificateless encryption as the special case of 2-out-of-2 group encryption and give constructions for highly efficient certificateless schemes in the standard model. Among these is the first construction of a lattice-based certificateless encryption scheme. Our next contribution is a highly efficient certificateless key encapsulation mechanism (KEM), that we prove secure in the standard model. We introduce a new way of proving the security of certificateless schemes based that are based on identity-based schemes. We leave the identity-based part of the proof intact, and just extend it to cover the part that is introduced by the certificateless scheme. We show that our construction is more efficient than any instanciation of generic constructions for certificateless key encapsulation in the standard model. The third area where the thesis contributes to the advancement of certificateless cryptography is key agreement. Swanson showed that many certificateless key agreement schemes are insecure if considered in a reasonable security model. We propose the first provably secure certificateless key agreement schemes in the strongest model for certificateless key agreement. We extend Swanson's definition for certificateless key agreement and give more power to the adversary. Our new schemes are secure as long as each party has at least one uncompromised secret. Our first construction is in the random oracle model and gives the adversary slightly more capabilities than our second construction in the standard model. Interestingly, our standard model construction is as efficient as the random oracle model construction.

Flagging spaces : exploring representations of ownership on the Australian beach

The Australian beach is a significant element of our national identity. Since the majority of the population lives on the coastlines of the continent, the beach (rather than the Bush) plays an important role to many Australians. Yet the beach can also be a complex setting because of the often complicated concepts of ownership that surround it. ‘Flagging Spaces’ examines the layers of complexity surrounding textual representations of ownership of the beach space. In particular, this paper explores the Indigenous representation on the beach moving through to the role of multiculturalism on the beach space in the wake of the 2005 Cronulla riots, using specific textual examples such as Sacred Cows (Heiss 1996), Australia (dir. Baz Luhrmann 2008), Heaven (dir. Tracey Moffatt 1997), Radiance (dir. Rachel Perkins 1998), Butterfly Song (Jenkins 2005), and Bra Boys (dir. Sonny Abberton 2006).

Re-Presenting/Representing Melbourne: A literary and cultural analysis of Melbourne’s inner city and outer suburbs in contemporary fiction

This article provides an overview of a research project investigating contemporary literary representations of Melbourne’s inner and outer suburban spaces. It will argue that the city represented by local writers is an often more complex way of envisioning the city than the one presented in public policy and cultural discourses. In this view, the writer’s vision of a city does not necessarily override or provide a “truer’ account but it is in the fictional city where the complexity of the everyday life of a city is most accurately portrayed. The article will also provide an overview of the theoretical framework for reading the fictional texts in this way, examining how Soja’s concept of Thirdspace (2006) provides a place to engage “critically with theoretical issues, while simultaneously being that space where the debate occurs” (Mole 2008: 3).

Factors contributing to nurse job satisfaction in the acute hospital setting : a review of recent literature

Aim  To explore and discuss from recent literature the common factors contributing to nurse job satisfaction in the acute hospital setting. Background  Nursing dissatisfaction is linked to high rates of nurses leaving the profession, poor morale, poor patient outcomes and increased financial expenditure. Understanding factors that contribute to job satisfaction could increase nurse retention. Evaluation  A literature search from January 2004 to March 2009 was conducted using the keywords nursing, (dis)satisfaction, job (dis)satisfaction to identify factors contributing to satisfaction for nurses working in acute hospital settings. Key issues  This review identified 44 factors in three clusters (intra-, inter- and extra-personal). Job satisfaction for nurses in acute hospitals can be influenced by a combination of any or all of these factors. Important factors included coping strategies, autonomy, co-worker interaction, direct patient care, organizational policies, resource adequacy and educational opportunities. Conclusions  Research suggests that job satisfaction is a complex and multifactorial phenomenon. Collaboration between individual nurses, their managers and others is crucial to increase nursing satisfaction with their job. Implications for nursing management  Recognition and regular reviewing by nurse managers of factors that contribute to job satisfaction for nurses working in acute care areas is pivotal to the retention of valued staff.

Setting a new agenda: Developing an Aboriginal and Torres Strait Islander women's health strategy

The Australian National Aboriginal and Torres Strait Islander Women’s Health Strategy was developed to reflect the health priorities of Aboriginal and Torres Strait Islander women, as identified by Aboriginal and Torres Strait Islander women themselves. This article describes the process used by the Australian Women’s Health Network to develop the strategy. The women involved in the research used the talking circle method and engaged with Aboriginal and Torres Strait Islander women through a process referred to as ‘talkin’ up’, where women ‘talk back’ to one another about issues that matter to them. In this article, we describe the power of the talkin’ up process, as a way for Aboriginal and Torres Strait Islander women to identify their own issues, discuss them in context and talk in a culturally safe environment. The strategy which emerged from this process is an accurate reflection of the issues that are important to Australian Indigenous women and highlights the improvements needed in Aboriginal and Torres Strait Islander women’s health to strengthen and underpin women’s health, Indigeneity and their sense of well-being as Aboriginal and Torres Strait Islander women.

Re/presenting readings of the indigenous literary terrain

In this study I investigate the spectrum of authoring, publishing and everyday reading of three texts - My Place (Morgan 1987), Jandamarra and the Bunuba Resistance (Pedersen and Woorunmurra 1995) and Carpentaria (Wright 2006). I have addressed this study within the field of production and consumption, utilising amongst others the work of Edward Said (1978, 1983) and Stanley Fish (1980). I locate this work within the holism of Kombu-merri philosopher, Mary Graham's 'Aboriginal Inquiry' (2008), which promotes self-reflexivity and a concern for others as central tenets of such inquiry. I also locate this work within a postcolonial framework and in recognition of the dynamic nature of that phenomenon I use Aileen MoretonRobinson's (2003) adoption of the active verb, "postcolonising"(38). In apprehending selected texts through the people who make them and who make meaning from them - authors, publishers and everyday readers, I interviewed members of each cohort within a framework that recognises the exercise of agency in their respective practices as well as the socio-historical contexts to such textual practices. Although my research design can be applied to other critical arrangements of texts, my interest here lies principally in texts that incorporate the subjects of Indigenous worldview and Indigenous experience; and in texts that are Indigenous authored or Indigenous co-authored.

The relationship between lower intelligence, crime and custodial outcomes : a brief literary review of a vulnerable group

The relationship between intellectual functioning and criminal offending has received considerable focus within the literature. While there remains debate regarding the existence (and strength) of this relationship, there is a wider consensus that individuals with below average functioning (in particular cognitive impairments) are disproportionately represented within the prison population. This paper focuses on research that has implications for the effective management of lower functioning individuals within correctional environments as well as the successful rehabilitation and release of such individuals back into the community. This includes a review of the literature regarding the link between lower intelligence and offending and the identification of possible factors that either facilitate (or confound) this relationship. The main themes to emerge from this review are that individuals with lower intellectual functioning continue to be disproportionately represented in custodial settings and that there is a need to increase the provision of specialised programs to cater for their needs. Further research is also needed into a range of areas including: (1) the reason for this over-representation in custodial settings, (2) the existence and effectiveness of rehabilitation and release programs that cater for lower IQ offenders, (3) the effectiveness of custodial alternatives for this group (e.g. intensive corrections orders) and (4) what post-custodial release services are needed to reduce the risk of recidivism.