Production of biodegradable nano and micro particles via ultrasonic atomization for biopharmaceutical delivery

Biopharmaceuticals have been shown to have low delivery and transformation efficiencies. To over come this, larger doses are administered in order to obtain the desired response which may lead to toxicity and drug resistance. This paper reports upon a continuous particle production method utilizing surface acoustic wave atomization to reliably produce micro and nanoparticles with physical characteristics to facilitate the cellular uptake of biopharmaceuticals. By producing particles of an optimal size for cellular uptake, the efficacy and specificity of drug loaded nanoparticles will be increased. Better delivery methods will result in dosage reduction (hence lower costs per dose), reduced toxicity, and reduced problems associated with multidrug resistance due to over dosing.

Patient engagement: What and who is it good for?

A huge and diverse literature emphasises that patient engagement is a key factor in: effective health service delivery; quality and safety; responsive health services; patient satisfaction; improved health outcomes; and reduced health care costs. Yet there are also cautionary caveats regarding this discourse. Additionally, although contemporary recommendations regarding good practice and National Health Standards point to the importance of patient engagement and health service providers are striving to implement them in practice, on the ground patient engagement is ‘all things to all people’ with widespread confusion about what patient engagement is and how it could be facilitated. In terms of scholarship, there is a dearth of theoretical and critical examination of what patient engagement constitutes, its application and effects. This analysis aims to contribute to scholarly debate and increased understanding of the use of patient engagement in health policy and practice.

Hospital infection control units: Staffing, costs, and priorities

Background: This article describes infection prevention and control professionals’ (ICPs’) staffing levels, patient outcomes, and costs associated with the provision of infection prevention and control services in Australian hospitals. A secondary objective was to determine the priorities for infection control units. Methods: A cross-sectional study design was used. Infection control units in Australian public and private hospitals completed a Web-based anonymous survey. Data collected included details about the respondent; hospital demographics; details and services of the infection control unit; and a description of infection prevention and control-related outputs, patient outcomes, and infection control priorities. Results: Forty-nine surveys were undertaken, accounting for 152 Australian hospitals. The mean number of ICPs was 0.66 per 100 overnight beds (95% confidence interval, 0.55-0.77). Privately funded hospitals have significantly fewer ICPs per 100 overnight beds compared with publicly funded hospitals (P < .01). Staffing costs for nursing staff in infection control units in this study totaled $16,364,392 (mean, $380,566). Infection control units managing smaller hospitals (<270 beds) identified the need for increased access to infectious diseases or microbiology support. Conclusion: This study provides valuable information to support future decisions by funders, hospital administrators, and ICPs on service delivery models for infection prevention and control. Further, it is the first to provide estimates of the resourcing and cost of staffing infection control in hospitals at a national level. Copyright

An empirical analysis of the factors and measures of Enterprise Architecture Management success

Enterprise Architecture Management (EAM) is discussed in academia and industry as a vehicle to guide IT implementations, alignment, compliance assessment, or technology management. Still, a lack of knowledge prevails about how EAM can be successfully used, and how positive impact can be realized from EAM. To determine these factors, we identify EAM success factors and measures through literature reviews and exploratory interviews and propose a theoretical model that explains key factors and measures of EAM success. We test our model with data collected from a cross-sectional survey of 133 EAM practitioners. The results confirm the existence of an impact of four distinct EAM success factors, ‘EAM product quality’, ‘EAM infrastructure quality’, ‘EAM service delivery quality’, and ‘EAM organizational anchoring’, and two important EAM success measures, ‘intentions to use EAM’ and ‘Organizational and Project Benefits’ in a confirmatory analysis of the model. We found the construct ‘EAM organizational anchoring’ to be a core focal concept that mediated the effect of success factors such as ‘EAM infrastructure quality’ and ‘EAM service quality’ on the success measures. We also found that ‘EAM satisfaction’ was irrelevant to determining or measuring success. We discuss implications for theory and EAM practice.

A feasibility and pilot randomized controlled trial of the "Timing it Right Stroke Family Support Program"

- Objective Examine feasibility of conducting a randomized controlled trial of the Timing it Right Stroke Family Support Program (TIRSFSP) and collect pilot data. - Design Multi-site mixed method randomized controlled trial. - Setting Acute and community care in three Canadian cities. - Subjects Caregivers were family members or friends providing care to individuals who experienced their first stroke. - Intervention The TIRSFSP offered in two formats, self-directed by the caregiver or stroke support person-directed over time, were compared to standard care. - Main Measures Caregivers completed baseline and follow-up measures 1, 3 and 6 months post-stroke including Centre for Epidemiological Studies Depression, Positive Affect, Social Support, and Mastery Scales. We completed in-depth qualitative interviews with caregivers and maintained intervention records describing support provided to each caregiver. - Results Thirty-one caregivers received standard care (n=10), self-directed (n=10), or stroke support person-directed (n=11) interventions. We retained 77% of the sample through 6-months. Key areas of support derived from intervention records (n=11) related to caregiver wellbeing, caregiving strategies, patient wellbeing, community re-integration, and service delivery. Compared to standard care, caregivers receiving the stroke support person-directed intervention reported improvements in perceived support (estimate 3.1, P=.04) and mastery (estimate .35, P=.06). Qualitative caregiver interviews (n=19) reflected the complex interaction between caregiver needs, preferences and available options when reporting on level of satisfaction. - Conclusions Preliminary findings suggest the research design is feasible, caregivers’ needs are complex, and the support intervention may enhance caregivers’ perceived support and mastery. The intervention will be tested further in a large scale trial.

Public use and perceptions of emergency departments: A population survey

Objectives To inform demand management strategies aimed at reducing congestion in EDs by: (i) identifying public use of EDs, decision-making and reasons; and (ii) measuring acceptance of alternative care models. Methods A cross-sectional telephone survey of a random sample of Queensland population aged 18 years or older residing in a dwelling unit in Queensland that could be contacted on a land-based telephone service was conducted. One person per household was selected according to a predetermined algorithm to ensure sex and regional balance were interviewed. The main outcome measures were: ED use, attitudes towards ED staff and services, and alternative models of care. Results The final sample included a total of 1256 respondents (response rate = 40.3%). Twenty-one per cent attended EDs in the preceding 12 months. The decision to attend was made by patients (51%), health and medical professionals (31%), and others (18%). The main reasons included perceived severity of the illness (47%), unavailability of alternative services (26%) and better care (11%). Most respondents agreed with more flexible care models of service delivery including incentives for general practitioners (90%), private health insurance coverage for ED use (89%), and enhanced roles for paramedics and nurses. Conclusions Main reason for attending ED is perceived severity of illness, followed by lack of alternative care. The majority of both consumers and the public are in favour of more flexible care models. However, further research is necessary to detail those alternatives and to test and validate their effectiveness.

Flexible learning design in curriculum delivery promotes student engagement and develops metacognitive learners: An integrated review

Historically, university students have been the passive recipients of face-to-face instructor designed and led classes (Hudson, 2014; Myers et al., 2011). Technological advancement, however, has provided an opportunity for greater flexibility around educational structure; students are starting to expectmore fromtertiary education providers, specifically around the delivery and provision of education (Myers et al., 2011). For universities to meet the ever-changing needs of the student they need to consider the integration of flexible learning designs into their curricula. The consequent willingness of the faculty to rethink the design and delivery of curricula has seen a recent shift in the design and delivery of education. As universities strive to promote student engagement, active learning, and communities of enquiry, they are moving progressively towards flexible learning models, virtual interaction and student centric curricula (Heise and Himes, 2010; Hsu and Hsieh, 2011). The challenge this shift creates is how to best engage students throughout their studies in order to produce graduates with the skills necessary for societal and professional sustainability (Castle and McGuire, 2010). Despite a wealth of literature addressing this topic, there is a paucity of substantive, conclusive outcomes as to the efficacy of its full implementation and potential for producing capable learners. This integrative review therefore aims to inform curriculum delivery that is flexible, student centric and scaffolds learning. It also aims to identify whether this approach assists in the development of metacognitive learners.

Frequent (flier) frustration and the dark side of word‐of‐web: exploring online dysfunctional behavior in online feedback forums

Purpose Following the perspective of frustration theory customer frustration incidents lead to frustration behavior such as protest (negative word‐of‐mouth). On the internet customers can express their emotions verbally and non‐verbally in numerous web‐based review platforms. The purpose of this study is to investigate online dysfunctional customer behavior, in particular negative “word‐of‐web” (WOW) in online feedback forums, among customers who participate in frequent‐flier programs in the airline industry. Design/methodology/approach The study employs a variation of the critical incident technique (CIT) referred to as the critical internet feedback technique (CIFT). Qualitative data of customer reviews of 13 different frequent‐flier programs posted on the internet were collected and analyzed with regard to frustration incidents, verbal and non‐verbal emotional effects and types of dysfunctional word‐of‐web customer behavior. The sample includes 141 negative customer reviews based on non‐recommendations and low program ratings. Findings Problems with loyalty programs evoke negative emotions that are expressed in a spectrum of verbal and non‐verbal negative electronic word‐of‐mouth. Online dysfunctional behavior can vary widely from low ratings and non‐recommendations to voicing switching intentions to even stronger forms such as manipulation of others and revenge intentions. Research limitations/implications Results have to be viewed carefully due to methodological challenges with regard to the measurement of emotions, in particular the accuracy of self‐report techniques and the quality of online data. Generalization of the results is limited because the study utilizes data from only one industry. Further research is needed with regard to the exact differentiation of frustration from related constructs. In addition, large‐scale quantitative studies are necessary to specify and test the relationships between frustration incidents and subsequent dysfunctional customer behavior expressed in negative word‐of‐web. Practical implications The study yields important implications for the monitoring of the perceived quality of loyalty programs. Management can obtain valuable information about program‐related and/or relationship‐related frustration incidents that lead to online dysfunctional customer behavior. A proactive response strategy should be developed to deal with severe cases, such as sabotage plans. Originality/value This study contributes to knowledge regarding the limited research of online dysfunctional customer behavior as well as frustration incidents of loyalty programs. Also, the article presents a theoretical “customer frustration‐defection” framework that describes different levels of online dysfunctional behavior in relation to the level of frustration sensation that customers have experienced. The framework extends the existing perspective of the “customer satisfaction‐loyalty” framework developed by Heskett et al.

Perceived quality of e‐health services: A conceptual scale development of e‐health service quality based on the C‐OAR‐SE approach

Purpose Health service quality is an important determinant for health service satisfaction and behavioral intentions. The purpose of this paper is to investigate requirements of e‐health services and to develop a measurement model to analyze the construct of “perceived e‐health service quality.” Design/methodology/approach The paper adapts the C‐OAR‐SE procedure for scale development by Rossiter. The focal aspect is the “physician‐patient relationship” which forms the core dyad in the healthcare service provision. Several in‐depth interviews were conducted in Switzerland; first with six patients (as raters), followed by two experts of the healthcare system (as judges). Based on the results and an extensive literature research, the classification of object and attributes is developed for this model. Findings The construct e‐health service quality can be described as an abstract formative object and is operationalized with 13 items: accessibility, competence, information, usability/user friendliness, security, system integration, trust, individualization, empathy, ethical conduct, degree of performance, reliability, and ability to respond. Research limitations/implications Limitations include the number of interviews with patients and experts as well as critical issues associated with C‐OAR‐SE. More empirical research is needed to confirm the quality indicators of e‐health services. Practical implications Health care providers can utilize the results for the evaluation of their service quality. Practitioners can use the hierarchical structure to measure service quality at different levels. The model provides a diagnostic tool to identify poor and/or excellent performance with regard to the e‐service delivery. Originality/value The paper contributes to knowledge with regard to the measurement of e‐health quality and improves the understanding of how customers evaluate the quality of e‐health services.

Beyond social justice agendas: Indigenous knowledges in pre-service teacher education and practice in Australia

The space and positioning of Indigenous knowledges (IK) within Australian curricula and pedagogy are often contentious, informed by the broader Australian socio-cultural, political and economic landscape. Against changing educational policy, historically based on the myth of terra nullius, we discuss the shifting priorities for embedding Indigenous knowledges in educational practice in university and school curricula and pedagogy. In this chapter, we argue that personal and professional commitment to social justice is an important starting point for embedding Indigenous knowledges in the Australian school curricula and pedagogy. Developing teacher knowledge around embedding IK is required to enable teachers’ preparedness to navigate a contested historical/colonising space in curriculum decision-making, teaching and learning. We draw one mpirical data from a recent research project on supporting pre-service teachers as future curriculum leaders; the project was funded by the Office of Learning and Teaching (OLT). This project aimed to support future curriculum leaders to develop their knowledge of embedding IK at one Australian university. We propose supporting the embedding of IK in situ with pre-service teachers and their supervising teachers on practicum in real, sustained and affirming ways that shifts the recognition of IK from personal commitment to social justice in education, to one that values Indigenous knowledges as content to educate (Connell, 1993). We argue that sustained engagement with and appreciation of IKhas the potential to decolonise Australian curricula, shift policy directions and enhance race relations between Indigenous and non-Indigenous Australians .

Street-level perceptions of procedural rights for young unemployed people - a comparative study between Sweden and Australia

Two types of welfare states are compared in this article. Differences in procedural rights for young unemployed at the level of service delivery are analyzed. In Australia, rights are regulated through a rigid procedural justice system. The young unemployed within the social assistance system in Sweden encounter staff with high discretionary powers, which makes the legal status weak for the unemployed but, on the other hand, the system is more flexible. Despite the differences, there is striking convergence in how the young unemployed describe how discretionary power among street-level staff affects their procedural rights. This result can be understood as a result of similar professional norms, work customs and occupational cultures of street-level staff, and that there is a basic logic of conditionality in all developed welfare states where procedural rights are tightly coupled with responsibilities.

Leveraging of software as a service by small and medium enterprises: Information systems capabilities and organisational complementarities

This research explored how small and medium enterprises can achieve success with software as a service (SaaS) applications from cloud. Based upon an empirical investigation of six growth oriented and early technology adopting small and medium enterprises, this study proposes a SaaS for small and medium enterprise success model with two approaches: one for basic and one for advanced benefits. The basic model explains the effective use of SaaS for achieving informational and transactional benefits. The advanced model explains the enhanced use of software as a service for achieving strategic and transformational benefits. Both models explicate the information systems capabilities and organizational complementarities needed for achieving success with SaaS.

Factors influencing sustainability of health service innovation: Emergency nurse practitioner services

Introduction: Emergency department nurse practitioner services are one of the most frequently implemented service delivery models in Australian hospitals. This research examined factors influencing sustainability of this innovative service delivery model and offers some recommendations for future service integration. Background Many health service innovations have been implemented in an attempt to meet the growing demand for efficient, cost effective health care however, sustainability of many of these innovations has not been evaluated and is poorly understood. Aim The aim of the research was to identify factors that influence sustainability of emergency department nurse practitioner services and to operationalise a theoretical framework for evaluating innovation sustainability. Methodology The research used case study methodology. The case was emergency nurse practitioner services, and units of analysis were emergency department staff, emergency nurse practitioners and documents relating to nurse practitioner services. The data collection methods included, survey, one-on-one interviews, document analysis and telephone survey. Results This research shows that emergency nurse practitioner services partially comply with the factors of sustainability as described in the Sustainability of Innovation theoretical framework: Political, Organisational, Workforce, Financial and Innovation specific factors. Where services do not entirely meet the factors the existing benefits of the service may outweigh the barriers and other means of working around shortfalls are also implemented by staff to ensure patient safety. Conclusion The rapidly expanding emergency nurse practitioner service has been examined using case study methodology to find that certain factors may be threatening the sustainability of this health service innovation. Potentially an innovation may be sustained when only some factors are met in the short term, however, long term sustainability may be challenged if factors are not addressed and supported.

Assessment of transit quality of service with occupancy load factor and passenger travel time measures

This paper investigates quality of service (QoS) and resource productivity implications of transit route passenger loading and travel time. It highlights the value of occupancy load factor as a direct passenger comfort QoS measure. Automatic Fare Collection data for a premium radial bus route in Brisbane, Australia, is used to investigate time series correlation between occupancy load factor and passenger average travel time. Correlation is strong across the entire span of service in both directions. Passengers tend to be making longer, peak direction commuter trips under significantly less comfortable conditions than off-peak. The Transit Capacity and Quality of Service Manual uses segment based load factor as a measure of onboard loading comfort QoS. This paper provides additional insight into QoS by relating the two route based dimensions of occupancy load factor and passenger average travel time together in a two dimensional format, both from the passenger’s and operator’s perspectives. Future research will apply Value of Time to QoS measurement, reflecting perceived passenger comfort through crowding and average time spent onboard. This would also assist in transit service quality econometric modeling. The methodology can be readily applied in a practical setting where AFC data for fixed scheduled routes is available. The study outcomes also provide valuable research and development directions.

Developing a best practice pathway to support improvements in Indigenous Australians' mental health and well-being: A qualitative study

Objective: There is a need to adapt pathways to care to promote access to mental health services for Indigenous people in Australia. This study explored Indigenous community and service provider perspectives of well-being and ways to promote access to care for Indigenous people at risk of depressive illness. Design: A participatory action research framework was used to inform the development of an agreed early intervention pathway; thematic analysis Setting: 2 remote communities in the Northern Territory. Participants: Using snowball and purposive sampling, 27 service providers and community members with knowledge of the local context and the diverse needs of those at risk of depression were interviewed. 30% of participants were Indigenous. The proposed pathway to care was adapted in response to participant feedback. Results: The study found that Indigenous mental health and well-being is perceived as multifaceted and strongly linked to cultural identity. It also confirms that there is broad support for promotion of a clear pathway to early intervention. Key identified components of this pathway were the health centre, visiting and community-based services, and local community resources including elders, cultural activities and families. Enablers to early intervention were reported. Significant barriers to the detection and treatment of those at risk of depression were identified, including insufficient resources, negative attitudes and stigma, and limited awareness of support options. Conclusions: Successful early intervention for wellbeing concerns requires improved understanding of Indigenous well-being perspectives and a systematic change in service delivery that promotes integration, flexibility and collaboration between services and the community, and recognises the importance of social determinants in health promotion and the healing process. Such changes require policy support, targeted training and education, and ongoing promotion.