Queensland Emergency Medical System : a structural and organizational model for the emergency medical system in Australia

Objective: The emergency medical system (EMS) can be defined as a comprehensive, coordinated and integrated system of care for patients suffering acute illness and injury. The aim of the present paper is to describe the evolution of the Queensland Emergency Medical System (QEMS) and to recommend a strategic national approach to EMS development. Methods: Following the formation of the Queensland Ambulance Service in 1991, a state EMS committee was formed. This committee led the development and approval of the cross portfolio QEMS policy framework that has resulted in dynamic policy development, system monitoring and evaluation. This framework is led by the Queensland Emergency Medical Services Advisory Committee. Results: There has been considerable progress in the development of all aspects of the EMS in Queensland. These developments have derived from the improved coordination and leadership that QEMS provides and has resulted in widespread satisfaction by both patients and stakeholders. Conclusions: The strategic approach outlined in the present paper offers a model for EMS arrangements throughout Australia. We propose that the Council of Australian Governments should require each state and Territory to maintain an EMS committee. These state EMS committees should have a broad portfolio of responsibilities. They should provide leadership and direction to the development of the EMS and ensure coordination and quality of outcomes. A national EMS committee with broad representation and broad scope should be established to coordinate the national development of Australia's EMS.

Environmental rights, justice and climate change

The human rights implications of climate change are increasingly gaining attention, with wider international acknowledgement that climate change poses a real threat to human rights. This paper considers the impact of climate change on human rights, looking particularly at the experiences of Torres Strait Islanders in northern Australia. It argues that human rights law offers a guiding set of principles which can help in developing appropriate strategies to combat climate change. In particular, the normative principles embodied in environmental rights can be useful in setting priorities and evaluating policies in response to climate change. The paper also argues that a human rights perspective can help address the underlying injustice of climate change: that it is the people who have contributed least to the problem who will bear the heaviest burden of its effects.

Sustainable water provision : alternative strategy and sources in the era of climate change

As a result of rapid urbanisation, population growth, change in lifestyles, pollution and the impacts of climate change, water provision has become a critical challenge for planners and policy-makers. In the wake of increasingly difficult water provision and drought, the notion that freshwater is a finite and vulnerable resources is increasingly being realised. Many city administrations around the World are struggling to provide water security for their residents to maintain lifestyle and economic grouth. This paper review the glocalalternatives to current water sources, including that of desalination, water transfers, recycling, and integrated water management. A comparative study on alternative resources is undertaken and the results are discussed.

Diffuse reflectance near infrared spectroscopy can distinguish normal from enzymatically digested cartilage

A non-destructive, diffuse reflectance near infrared spectroscopy (DR-NIRS)approach is considered as a potential tool for determining the component-level structural properties of articular cartilage. To this end, DR-NIRS was applied in vitro to detect structural changes, using principal component analysis as the statistical basis for characterization. The results show that this technique, particularly with first-derivative pretreatment, can distinguish normal, intact cartilage from enzymatically digested cartilage. Further, this paper establishes that the use of DR-NIRS enables the probing of the full depth of the uncalcified cartilage matrix, potentially allowing the assessment of degenerative changes in joint tissue, independent of the site of initiation of the osteoarthritic process.

Metal oxide nanofibres membranes assembled by spin-coating method

Ceramic membranes are of particular interest in many industrial processes due to their ability to function under extreme conditions while maintaining their chemical and thermal stability. Major structural deficiencies under conventional fabrication approach are pin-holes and cracks, and the dramatic losses of flux when pore sizes are reduced to enhance selectivity. We overcome these structural deficiencies by constructing hierarchically structured separation layer on a porous substrate using larger titanate nanofibres and smaller boehmite nanofibres. This yields a radical change in membrane texture. The differences in the porous supports have no substantial influences on the texture of resulting membranes. The membranes with top layer of nanofibres coated on different porous supports by spin-coating method have similar size of the filtration pores, which is in a range of 10–100 nm. These membranes are able to effectively filter out species larger than 60 nm at flow rates orders of magnitude greater than conventional membranes. The retention can attain more than 95%, while maintaining a high flux rate about 900 L m-2 h. The calcination after spin-coating creates solid linkages between the fibres and between fibres and substrate, in addition to convert boehmite into -alumina nanofibres. This reveals a new direction in membrane fabrication.

Contradictions : Genre, causal layered analysis and analysis of institutional change

In what follows, I put forward an argument for an analytical method for social science that operates at the level of genre. I argue that generic convergence, generic hybridity, and generic instability provide us with a powerful perspectives on changes in political, cultural, and economic relationships, most specifically at the level of institutions. Such a perspective can help us identify the transitional elements, relationships, and trajectories that define the place of our current system in history, thereby grounding our understanding of possible futures.1 In historically contextualising our present with this method, my concern is to indicate possibilities for the future. Systemic contradictions indicate possibility spaces within which systemic change must and will emerge. We live in a system currently dominated by many fully-expressed contradictions, and so in the presence of many possible futures. The contradictions of the current age are expressed most overtly in the public genres of power politics. Contemporary public policy—indeed politics in general-is an excellent focus for any investigation of possible futures, precisely because of its future-oriented function. It is overtly hortatory; it is designed ‘to get people to do things’ (Muntigl in press: 147). There is no point in trying to get people to do things in the past. Consequently, policy discourse is inherently oriented towards creating some future state of affairs (Graham in press), along with concomitant ways of being, knowing, representing, and acting (Fairclough 2000).

Context change archetypes : understanding the impact of context change on business processes

The emergence of Enterprise Resource Planning systems and Business Process Management have led to improvements in the design, implementation, and overall management of business processes. However, the typical focus of these initiatives has been on internal business operations, assuming a defined and stable context in which the processes are designed to operate. Yet, a lack of context-awareness for external change leads to processes and supporting information systems that are unable to react appropriately and timely enough to change. To increase the alignment of processes with environmental change, we propose a conceptual framework that facilitates the identification of context change. Based on a secondary data analysis of published case studies about process adaptation, we exemplify the framework and identify four general archetypes of context-awareness. The framework, in combination with the learning from the case analysis, provides a first understanding of what, where, how, and when processes are subjected to change.

Creating cultural change in education : A proposal for a continuum for evaluating the effectiveness of sustainable schools implementation strategies in Australia

Networks are increasingly recognised as advantageous when creating and embedding cultural change within organisations. This paper explores andproblematises ideas around networks for education for sustainability (EfS), Australian Sustainable Schools Initiative (AuSSI), a national, whole-school approach to EfS. In three Australian states - New South Wales, Victoria and Queensland – AuSSI has been implemented in different ways. In examining the use of products, facilitators and networks to embed initiatives such as AuSSI in Australian schools, we propose a “continuum of cultural change strategies” as a framework for thinking about each of these approaches to creating organisational and cultural change for sustainability. We anticipate that such a framework may assist where choices need to be made in relation to the kinds of capacity building processes that might best achieve “deep and wide” change within schools hoping to engender significant cultural change.

HABITAT : a longitudinal multilevel study of physical acitvity change in mid-aged adults

Purpose. To explore the role of the neighborhood environment in supporting walking Design. Cross sectional study of 10,286 residents of 200 neighborhoods. Participants were selected using a stratified two-stage cluster design. Data were collected by mail survey (68.5% response rate). Setting. The Brisbane City Local Government Area, Australia, 2007. Subjects. Brisbane residents aged 40 to 65 years. Measures. Environmental: street connectivity, residential density, hilliness, tree coverage, bikeways, and street lights within a one kilometer circular buffer from each resident’s home; and network distance to nearest river or coast, public transport, shop, and park. Walking: minutes in the previous week categorized as < 30 minutes, ≥ 30 < 90 minutes, ≥ 90 < 150 minutes, ≥ 150 < 300 minutes, and ≥ 300 minutes. Analysis. The association between each neighborhood characteristic and walking was examined using multilevel multinomial logistic regression and the model parameters were estimated using Markov chain Monte Carlo simulation. Results. After adjustment for individual factors, the likelihood of walking for more than 300 minutes (relative to <30 minutes) was highest in areas with the most connectivity (OR=1.93, 99% CI 1.32-2.80), the greatest residential density (OR=1.47, 99% CI 1.02-2.12), the least tree coverage (OR=1.69, 99% CI 1.13-2.51), the most bikeways (OR=1.60, 99% CI 1.16-2.21), and the most street lights (OR=1.50, 99% CI 1.07-2.11). The likelihood of walking for more than 300 minutes was also higher among those who lived closest to a river or the coast (OR=2.06, 99% CI 1.41-3.02). Conclusion. The likelihood of meeting (and exceeding) physical activity recommendations on the basis of walking was higher in neighborhoods with greater street connectivity and residential density, more street lights and bikeways, closer proximity to waterways, and less tree coverage. Interventions targeting these neighborhood characteristics may lead to improved environmental quality as well as lower rates of overweight and obesity and associated chromic disease.

Structural health monitoring of bridges using acoustic emission technology

Bridges are an important part of society's infrastructure and reliable methods are necessary to monitor them and ensure their safety and efficiency. Bridges deteriorate with age and early detection of damage helps in prolonging the lives and prevent catastrophic failures. Most bridges still in used today were built decades ago and are now subjected to changes in load patterns, which can cause localized distress and if not corrected can result in bridge failure. In the past, monitoring of structures was usually done by means of visual inspection and tapping of the structures using a small hammer. Recent advancements of sensors and information technologies have resulted in new ways of monitoring the performance of structures. This paper briefly describes the current technologies used in bridge structures condition monitoring with its prime focus in the application of acoustic emission (AE) technology in the monitoring of bridge structures and its challenges.

Anterior vertebral stapling for the fusionless correction of scoliosis

Fusionless scoliosis surgery is an emerging treatment for idiopathic scoliosis as it offers theoretical advantages over current forms of treatment. Currently the treatment options for idiopathic scoliosis are observation, bracing and fusion. While brace treatment is non-invasive, and preserves the growth, motion, and function of the spine, it does not correct deformity and is only modestly successful in preventing curve progression. In adolescents who fail brace treatment, surgical treatment with an instrumented spinal fusion usually results in better deformity correction but is associated with substantially greater risk. Furthermore in younger patients requiring surgical treatment, fusion procedures are known to adversely effect the future growth of the chest and spine. Fusionless treatments have been developed to allow effective surgical treatment of patients with idiopathic scoliosis who are too young for fusion procedures. Anterior vertebral stapling is one such fusionless treatment which aims to modulate the growth of vertebra to allow correction of scoliosis whilst maintaining normal spinal motion The Mater Misericordiae Hospital in Brisbane has begun to use anterior vertebral stapling to treat patients with idiopathic scoliosis who are too young for fusion procedures. Currently the only staple approved for clinical use is manufactured by Medtronic Sofamor Danek (Memphis, TN). This thesis explains the biomechanical and anatomical changes that occur following anterior vertebral staple insertion using in vitro experiments performed on an immature bovine model. Currently there is a paucity of published information about anterior vertebral stapling so it is hoped that this project will provide information that will aid in our understanding of the clinical effects of staple insertion. The aims of this experimental study were threefold. The first phase was designed to determine the changes in the bending stiffness of the spine following staple insertion. The second phase was designed to measure the forces experienced by the staple during spinal movements. The third and final phase of testing was designed to describe the structural changes that occur to a vertebra as a consequence of staple insertion. The first phase of testing utilised a displacement controlled testing robot to compare the change in stiffness of a single spinal motion segment following staple insertion for the three basic spinal motions of flexion-extension, lateral bending, and axial rotation. For the second phase of testing strain gauges were attached to staples and used to measure staple forces during spinal movement. In the third and final phase the staples were removed and a testing specimen underwent micro-computed tomography (CT) scanning to describe the anatomical changes that occur following staple insertion. The displacement controlled testing showed that there was a significant decrease in bending stiffness in flexion, extension, lateral bending away from the staple, and axial rotation away from the staple following staple insertion. The strain gauge measurements showed that the greatest staple forces occurred in flexion and the least in extension. In addition, a reduction in the baseline staple compressive force was seen with successive loading cycles. Micro-CT scanning demonstrated that significant damage to the vertebral body and endplate occurred as a consequence of staple insertion. The clinical implications of this study are significant. Based on the findings of this project it is likely that the clinical effect of the anterior vertebral staple evaluated in this project is a consequence of growth plate damage (also called hemiepiphysiodesis) causing a partial growth arrest of the vertebra rather than simply compression of the growth plate. The surgical creation of a unilateral growth arrest is a well established treatment used in the management of congenital scoliosis but has not previously been considered for use in idiopathic scoliosis.

Change in colour appearance of small defocused lights

Small long wavelength lights (≤ 1’ arc) change colour appearance with positive defocus, appearing yellow or white. I investigated influences of longitudinal chromatic aberration and monochromatic aberrations on colour appearance of small narrow band lights. Seven cyclopleged participants viewed a small light (1’ arc diameter, λmax range 510 - 628 nm) centred within a 4.6’ black annulus and surrounded by a uniform white field under photopic light levels. An optical trombone varied focus. Participants were required to vary the focus by moving the optical trombone in either positive or negative direction and report when they noticed a change in appearance of the defocused narrow band light. Longitudinal chromatic aberration was controlled using a Powell achromatizing lens and its doublet and triplet components that neutralized, doubled and reversed the eye’s chromatic aberration, respectively. Changes in colour appearance for a 628 nm light occurred without any lens at +0.5 ± 0.2D defocus and with the doublet at +0.6 ± 0.2 D. The achromatizing lens did not affect appearance and the phenomenon was evident with the triplet for negative defocus (-0.5 ± 0.3 D). Adaptive optics correction of astigmatism and higher order monochromatic aberration did not affect magnitude significantly. Colour changes occurred despite a range of participant L/M cone ratios. Direction of change in colour appearance was reversed for short compared to long wavelengths. We conclude that longitudinal chromatic aberrations, but not monochromatic aberrations, are involved in changing appearance of small lights with defocus. Additional neuronal mechanisms that may contribute to the colour changes are considered.