A protocol for a pragmatic randomized controlled trial evaluating outcomes of emergency nurse practitioner service

Aim To evaluate emergency nurse practitioner service effectiveness on outcomes related to quality of care and service responsiveness. Background Increasing service pressures in the emergency setting have resulted in the adoption of service innovation models; the most common and rapidly expanding of these is the emergency nurse practitioner. The delivery of high quality patient care in the emergency department is one of the most important service indicators to be measured in health services today. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this model in outcomes related to safety and quality of patient care. Design Pragmatic randomized controlled trial at one site with 260 participants. Methods This protocol describes a definitive prospective randomized controlled trial, which will examine the impact of emergency nurse practitioner service on key patient care and service indicators. The study control will be standard emergency department care. The intervention will be emergency nurse practitioner service. The primary outcome measure is pain score reduction and time to analgesia. Secondary outcome measures are waiting time, number of patients who did not wait, length of stay in the emergency department and representations within 48 hours. Discussion Scant research enquiry evaluating emergency nurse practitioner service on patient effectiveness and service responsiveness exists currently. This study is a unique trial that will test the effectiveness of the emergency nurse practitioner service on patients who present to the emergency department with pain. The research will provide an opportunity to further evaluate emergency nurse practitioner models of care and build research capacity into the workforce.

Numerical investigation into the buckling behavior of advanced grid stiffened composite cylindrical shell

Advanced grid stiffened composite cylindrical shell is widely adopted in advanced structures due to its exceptional mechanical properties. Buckling is a main failure mode of advanced grid stiffened structures in engineering, which calls for increasing attention. In this paper, the buckling response of advanced grid stiffened structure is investigated by three different means including equivalent stiffness model, finite element model and a hybrid model (H-model) that combines equivalent stiffness model with finite element model. Buckling experiment is carried out on an advanced grid stiffened structure to validate the efficiency of different modeling methods. Based on the comparison, the characteristics of different methods are independently evaluated. It is arguable that, by considering the defects of material, finite element model is a suitable numerical tool for the buckling analysis of advanced grid stiffened structures.

A preliminary decision model for shared services : insights from an Australian university context

Shared Services involves the convergence and streamlining of an organisation’s functions to ensure timely service delivery as effectively and efficiently as possible. This would result in lower cost, improved service delivery and economies of scale. The conventional wisdom of today is that the potential for Shared Services is increasing due to the increasing costs of changing systems and business requirements and also in implementing and running information systems (IS). However many organizations opt instead for an outsourcing arrangement as the alternative towards cost savings, due in essence to a lack of realization of this potential for Shared Services. This paper rationales turning from outsourcing (to looking within organisations) to leverage on Shared Services for similar cost savings and reaping other potential benefits. The paper’s objectives and contributions are three-fold: (1) distinguish between Shared Services and Outsourcing, (2) report on insights from a single Australian university case study through a transaction cost lens, and to demonstrate the potential for Shared Services and (3) develop a decision model to gauge the potential of implementing Shared Services across similar organisations.

Conceptual framework for understanding the demand for emergency health services

Background & Objectives Emergency health services (EHS) throughout the world are increasingly congested. As more people use EHS, factors such as population growth and aging cannot fully explain this increase. Also, focus on patients’ clinical characteristics ignores the role that attitudinal and perceptual factors and motivations play in directing their decisions and actions. The aim of this study is to review and synthesize an integrated conceptual framework for understanding social psychological factors underpinning demand for EHS. Methodology A comprehensive search and review of empirical and theoretical studies about the utilization of EHS was conducted using major medical, health, social and behavioral sciences databases. Results A small number of studies used a relevant conceptual framework (e.g. Health Services Utilization Model or Health Belief Model) or their components to analyze patients’ decision to use EHS. The studies evidenced that demand was affected by perceived severity of the condition; perceived costs and benefits (e.g. availability, accessibility and affordability of alternative services); experience, preference and knowledge; perceived and actual social support; and demographic characteristics (e.g. age, sex, socioeconomic status, ethnicity, marital and living circumstances, place of residence). Conclusions Conceptual models that are commonly used in areas like social and behavioral sciences have rarely been applied in the EHS utilization field. Understanding patients’ decision-making and associated factors will lay the groundwork for identification of the evidence to inform improved policy responses and the development of demand management strategies. An integrated conceptual framework will be introduced as part of this study.

Improving US airport taxicab services through governance arrangements

Most airports internationally have implemented customer satisfaction programs into their operations to increase non-aeronautical revenues. In the US, taxicabs are an essential airport transport mode given the limited public transport options available. Effective airport taxicab planning can increase airport customer satisfaction levels, as well as facilitate handling increased airport passenger volumes. However, little is known on how US airports have adapted their governance practices from a traditional hierarchical to a network approach in their efforts to undertake airport taxicab planning initiatives since the deregulation of the transportation industry. Data acquired from 51 US hub airports is used to examine their existing taxicab planning practices. The findings offer how US airports can modify governance processes in their airport taxicab planning processes to better support increases in the customer satisfaction levels of airport taxicab patrons.

From prototype to exploitation : mobile services for patients with chronic lower back pain

Many research and development projects that are carried out by firms and research institutes are technology-oriented. There is a large gap between research results, for instance in the form of prototypes, and the actual service offerings to customers. This becomes problematic when an organization wants to bring the results from such a project to the market, which will be particularly troublesome when the research results do not readily fit traditional offerings, roles and capabilities in the industry, nor the financial arrangements. In this chapter, we discuss the design of a business model for a mobile health service, starting with a research prototype that was developed for patients with chronic lower back pain, using the STOF model and method. In a number of design sessions, an initial business model was developed that identifies critical design issues that play a role in moving from prototype toward market deployment. The business model serves as a starting-point to identify and commit relevant stakeholders, and to draw up a business plan and case. This chapter is structured as follows. We begin by discussing the need for mobile health business models. Next, the research and development project on mobile health and the prototype for chronic lower back pain patients are introduced, after which the approach used to develop the business model is described, followed by a discussion of the developed mobile health business model for each of the STOF domains. We conclude with a discussion regarding the lessons that were learned with respect to the development of a business model on the basis of a prototype.

Advanced in-vehicle applications to mitigate driver aggression

Aggressive behavior at the steering wheel has been indicated as a contributing factor in a majority of crashes and anger has been compared to alcohol impairment in terms of probability to cause a crash. It has been shown that being in a state of anger or excitement while driving can decrease the drivers’ performances. . This paper reports the evaluation of 6 novel design alternatives of In-Vehicle Information Systems (IVIS) aimed at mitigating driver aggression. Each application presented was designed to tackle the following contributing factors to driver aggression: competitiveness, anonymity, territoriality, stress as well as social and emotional isolation. The 6 applications were simulated using computer vision algorithm to automatically overlay the real traffic conditions with ‘Head-Up Display’ visualizations. Two applications emerged over the others from participant’s evaluation: shared music combined the known calming effect of music with the sense of sympathy and intimacy caused by hearing other drivers’ music. The Shared Snapshot application provided an immediate gratification and was evaluated as a potential prevention of roadside quarrels. The paper presents Theoretical foundation, participant’s evaluations, implications and limitations of the study.

Gratuitous services - Civil Liability Act 2003 s59

The article considers the decision of the Queensland Court of Appeal in Kritz v King [2006] QCA 351, which examined for the first time s59 of the Civil Liability Act 2003 (Qld) in relation to claims for damages for gratuitous services.

On governance structures for the cloud computing services and assessing their effectiveness

This research suggests information technology (IT) governance structures to manage the cloud computing services. The interest in acquiring IT resources as a utility from the cloud computing environment is gaining momentum. The cloud computing services present organizations with opportunities to manage their IT expenditure on an ongoing basis, and access to modern IT resources to innovate and manage their continuity. However, the cloud computing services are no silver bullet. Organizations would need to have appropriate governance structures and policies in place to manage the cloud computing services. The subsequent decisions from these governance structures will ensure the effective management of the cloud computing services. This management will facilitate a better fit of the cloud computing services into organizations’ existing processes to achieve the business (process-level) and the financial (firm-level) objectives. Using a triangulation approach, we suggest four governance structures for managing the cloud computing services. These structures are a chief cloud officer, a cloud management committee, a cloud service facilitation centre, and a cloud relationship centre. We also propose that these governance structures would relate directly to organizations cloud computing services-related business objectives, and indirectly to cloud computing services-related financial objectives. Perceptive field survey data from actual and prospective cloud computing service adopters suggest that the suggested governance structures would contribute directly to cloud computing-related business objectives and indirectly to cloud computing-related financial objectives.

Self-organized Au nanoarrays on vertical graphenes : an advanced three-dimensional sensing platform

A three-dimensional surface enhanced Raman scattering (SERS)/plasmonic sensing platform based on plasma-enabled, catalyst-free, few-layer vertical graphenes decorated with self-organized Au nanoparticle arrays is demonstrated. This platform is viable for multiple species detection and overcomes several limitations of two-dimensional sensors.

A QUM partnership approach to regulating biosimilars in Australia

Despite the realisation of the potential implications from biosimilars is relatively recent, much has already been written about raising the awareness of differences between biosimilars and originating/ reference listed (innovator) pharmaceuticals. The European Medicines Agency has led the global charge in regulating biosimilars. Regardless of sufficient similarities across international regulations, differences do exist across jurisdictions. The consideration of regulating biosimilars demands a congruent approach across all stages: pre-registration (Australian copyright protection, patent, international obligations), registration (confidential information, international regulators, safety and efficacy), post-registration (Pharmaceutical Benefit Scheme, prescriber and dispenser awareness). Our National Medicines Policy could provide the necessary congruent framework and function for national and international regulation of biosimilars. The Policy concedes that pharmaceuticals will be affected by financial policies and trade considerations, international treaty obligations, industrial policies, education policies and the need for public-private partnerships.

Advanced mass spectrometry-based multi-omics technologies for exploring the pathogenesis of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the primary hepatic malignancies and is the third most common cause of cancer related death worldwide. Although a wealth of knowledge has been gained concerning the initiation and progression of HCC over the last half century, efforts to improve our understanding of its pathogenesis at a molecular level are still greatly needed, to enable clinicians to enhance the standards of the current diagnosis and treatment of HCC. In the post-genome era, advanced mass spectrometry driven multi-omics technologies (e.g., profiling of DNA damage adducts, RNA modification profiling, proteomics, and metabolomics) stand at the interface between chemistry and biology, and have yielded valuable outcomes from the study of a diversity of complicated diseases. Particularly, these technologies are being broadly used to dissect various biological aspects of HCC with the purpose of biomarker discovery, interrogating pathogenesis as well as for therapeutic discovery. This proof of knowledge-based critical review aims at exploring the selected applications of those defined omics technologies in the HCC niche with an emphasis on translational applications driven by advanced mass spectrometry, toward the specific clinical use for HCC patients. This approach will enable the biomedical community, through both basic research and the clinical sciences, to enhance the applicability of mass spectrometry-based omics technologies in dissecting the pathogenesis of HCC and could lead to novel therapeutic discoveries for HCC.

The impact of nurse practitioner services on cost, quality of care, satisfaction and wait times in the emergency department: A systematic review

Aims To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. Background The delivery of quality care in the emergency department is one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. Data A comprehensive search of four electronic databases from 2006-­‐2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. Methods A three step approach was used. Following a comprehensive search, two reviewers assessed identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data extracted using standardised tools. Results Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-­‐analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding impact on costs. Conclusion Synthesis of the available research attempts to provide an evidence base for emergency nurse practitioner service to guide healthcare leaders, policy makers and clinicians in reforming emergency department service provision. The findings suggest that further quality research is required for comparative measures of clinical and service effectiveness of emergency nurse practitioner service. In the context of increased health service demand and the need to provide timely and effective care to patients, such measures will assist in delivering quality patient care.

Transforming the future of treatment for ovarian cancer

As for many other cancers, metastasis is the leading cause of death of patients with ovarian cancer. Vigorous basic and clinical research is being performed to initiate more efficacious treatment strategies to improve the poor outcome of women with this cancer. Current treatment for ovarian cancer includes advanced cyto-reductive surgery and traditional platinum and taxane combined chemotherapy. Clinical trials using novel cytotoxic reagents and tyrosine kinase inhibitors have also been progressing. In parallel, the application of robust unbiased high throughput research platforms using transcriptomic and proteomic approaches has identified that not only individual cell signalling pathways, but a network of molecular pathways, play an important role in the biology of ovarian cancer. Furthermore, intensive genomic and epigenetic analyses have also revealed single nucleotide polymorphisms associated with risk and/or aetiology of this cancer including patient response to treatment. Taken together, these approaches, that are advancing our understanding, will have an impact on the generation of new therapeutic approaches and strategies for improving the outcome and quality of life of patients with ovarian cancer in the near future.

Department of Social Services Options Paper : Options for Replacement Arrangements Following the Abolition of the Australian Charities and Not-for-profits Commission : Response

Submission in response to government options paper regarding arrangements for regulation of charities following abolition of the Australian Charities and Not-for-profits Commission.