Clinical indicators of quality for Australian residential aged care facilities : establishing reliability, validity, and quality thresholds

Background: In response to the need for more comprehensive quality assessment within Australian residential aged care facilities, the Clinical Care Indicator (CCI) Tool was developed to collect outcome data as a means of making inferences about quality. A national trial of its effectiveness and a Brisbane-based trial of its use within the quality improvement context determined the CCI Tool represented a potentially valuable addition to the Australian aged care system. This document describes the next phase in the CCI Tool.s development; the aims of which were to establish validity and reliability of the CCI Tool, and to develop quality indicator thresholds (benchmarks) for use in Australia. The CCI Tool is now known as the ResCareQA (Residential Care Quality Assessment). Methods: The study aims were achieved through a combination of quantitative data analysis, and expert panel consultations using modified Delphi process. The expert panel consisted of experienced aged care clinicians, managers, and academics; they were initially consulted to determine face and content validity of the ResCareQA, and later to develop thresholds of quality. To analyse its psychometric properties, ResCareQA forms were completed for all residents (N=498) of nine aged care facilities throughout Queensland. Kappa statistics were used to assess inter-rater and test-retest reliability, and Cronbach.s alpha coefficient calculated to determine internal consistency. For concurrent validity, equivalent items on the ResCareQA and the Resident Classification Scales (RCS) were compared using Spearman.s rank order correlations, while discriminative validity was assessed using known-groups technique, comparing ResCareQA results between groups with differing care needs, as well as between male and female residents. Rank-ordered facility results for each clinical care indicator (CCI) were circulated to the panel; upper and lower thresholds for each CCI were nominated by panel members and refined through a Delphi process. These thresholds indicate excellent care at one extreme and questionable care at the other. Results: Minor modifications were made to the assessment, and it was renamed the ResCareQA. Agreement on its content was reached after two Delphi rounds; the final version contains 24 questions across four domains, enabling generation of 36 CCIs. Both test-retest and inter-rater reliability were sound with median kappa values of 0.74 (test-retest) and 0.91 (inter-rater); internal consistency was not as strong, with a Chronbach.s alpha of 0.46. Because the ResCareQA does not provide a single combined score, comparisons for concurrent validity were made with the RCS on an item by item basis, with most resultant correlations being quite low. Discriminative validity analyses, however, revealed highly significant differences in total number of CCIs between high care and low care groups (t199=10.77, p=0.000), while the differences between male and female residents were not significant (t414=0.56, p=0.58). Clinical outcomes varied both within and between facilities; agreed upper and lower thresholds were finalised after three Delphi rounds. Conclusions: The ResCareQA provides a comprehensive, easily administered means of monitoring quality in residential aged care facilities that can be reliably used on multiple occasions. The relatively modest internal consistency score was likely due to the multi-factorial nature of quality, and the absence of an aggregate result for the assessment. Measurement of concurrent validity proved difficult in the absence of a gold standard, but the sound discriminative validity results suggest that the ResCareQA has acceptable validity and could be confidently used as an indication of care quality within Australian residential aged care facilities. The thresholds, while preliminary due to small sample size, enable users to make judgements about quality within and between facilities. Thus it is recommended the ResCareQA be adopted for wider use.

Slum free India program. Report on the findings and recommendations of QUT BEE workshop to investigate strategies to deliver better outcomes

As a result of a broad invitation extended by Professor Martin Betts, Executive Dean of the Faculty of Built Environment and Engineering, to the community of interest at QUT, a cross-disciplinary collaborative workshop was conducted to contribute ideas about responding to the Government of India’s urgent requirement to implement a program to re-house slum dwellers. This is a complex problem facing the Indian Ministry of Housing. Not only does the government aspire to eradicate existing slum conditions and to achieve tangible results within five years, but it must also ensure that slums do not form in the future. The workshop focused on technological innovation in construction to deliver transformation from the current unsanitary and overcrowded informal urban settlements to places that provide the economically weaker sections of Indian society with healthy, environmentally sustainable, economically viable mass housing that supports successful urban living. The workshop was conducted in two part process as follows: Initially, QUT academics from diverse fields shared current research and provided technical background to contextualise the challenge at a pre-workshop briefing session. This was followed by a one-day workshop during which participants worked intensively in multi-disciplinary groups through a series of exercises to develop innovative approaches to the complex problem of slum redevelopment. Dynamic, compressed work sessions, interspersed with cross-functional review and feedback by the whole group took place throughout the day. Reviews emphasised testing the concepts for their level of complexity, and likelihood of success. The two-stage workshop process achieved several objectives:  Inspired a sense of shared purpose amongst a diverse group of academics  Built participants’ knowledge of each other’s capacity  Engaged multi disciplinary team in an innovative design research process  Built participants’ confidence in the collaborative process  Demonstrated that collaborative problem solving can create solutions that represent transformative change.  Developed a framework of how workable solutions might be developed for the program through follow up workshops and charrettes of a similar nature involving stakeholders drawn from the context of the slum housing program management.

Asset health prediction using condition indicators and operating environment indicators : a case study

Prognostics and asset life prediction is one of research potentials in engineering asset health management. We previously developed the Explicit Hazard Model (EHM) to effectively and explicitly predict asset life using three types of information: population characteristics; condition indicators; and operating environment indicators. We have formerly studied the application of both the semi-parametric EHM and non-parametric EHM to the survival probability estimation in the reliability field. The survival time in these models is dependent not only upon the age of the asset monitored, but also upon the condition and operating environment information obtained. This paper is a further study of the semi-parametric and non-parametric EHMs to the hazard and residual life prediction of a set of resistance elements. The resistance elements were used as corrosion sensors for measuring the atmospheric corrosion rate in a laboratory experiment. In this paper, the estimated hazard of the resistance element using the semi-parametric EHM and the non-parametric EHM is compared to the traditional Weibull model and the Aalen Linear Regression Model (ALRM), respectively. Due to assuming a Weibull distribution in the baseline hazard of the semi-parametric EHM, the estimated hazard using this model is compared to the traditional Weibull model. The estimated hazard using the non-parametric EHM is compared to ALRM which is a well-known non-parametric covariate-based hazard model. At last, the predicted residual life of the resistance element using both EHMs is compared to the actual life data.

Mental health of newly arrived Burmese refugees in Australia : contributions of pre-migration and post-migration experience

Objective: This study documents the mental health status of people from Burmese refugee backgrounds, recently arrived in Australia; then examines the contributions of gender, premigration and postmigration factors in predicting mental health. Method: Structured interviews, including a demographic questionnaire, the Harvard Trauma Questionnaire, Postmigration Living Difficulties Checklist and Hopkins Symptom Checklist assessed premigration trauma, postmigration living difficulties, depression, anxiety, somatisation and traumatisation symptoms in a sample of 70 adults across five Burmese ethnic groups. Results: Substantial proportions of participants reported psychological distress in symptomatic ranges including: posttraumatic stress disorder (9%); anxiety (20%), and; depression (36%), as well as significant symptoms of somatisation (37%). Participants reported multiple and severe premigration traumas. Postmigration living difficulties of greatest concern included communication problems and worry about family not in Australia. Gender did not predict mental health. Level of exposure to traumatic events and postmigration living difficulties each made unique and relatively equal contributions to traumatisation symptoms. Postmigration living difficulties made unique contributions to depression, anxiety and somatisation symptoms. Conclusions: While exposure to traumatic events impacted on participants’ mental wellbeing, postmigration living difficulties had greater salience in predicting mental health outcomes of people from Burmese refugee backgrounds. Reported rates of posttraumatic stress disorder symptoms were consistent with a large review of adults across seven western countries. High levels of somatisation pointed to a nuanced expression of distress. Findings have implications for service provision in terms of implementing appropriate interventions to effectively meet the needs of this newly arrived group in Australia.

Children of substance-using mothers : child health engagement and child protection outcomes

Aim: Maternal substance use has been associated with a range of child risk factors. The study investigated the relationship between engagement with child health services and child protection outcomes for children of substance using mothers. ----- ----- Methods: A sample of 119 children of mothers who disclosed opiate, amphetamine or methadone use during a maternity admission between 2000 and 2003, as included in a previous matched co-hort study1, were included in the current study. Statutory child protection agency and child health engagement information for the first two years of life, was obtained. The relationship between type of maternal substance use, child health engagement and child protection outcomes was examined. ----- ----- Results: Seventy two percent of study group infants were engaged with child health services during the first two years of life. Chi square analysis showed no significant relationship between child health engagement and child protection reports. Child health engagement was associated with decreased substantiated child protection notifications for children of methadone using mothers, but not for children of illicit substance users. ----- ----- Conclusions: Almost a quarter of identified children of substance using mothers are not accessing standard child health services in their first two years of life. This study provides support for increased attention to the provision of child health services for children of methadone using mothers. Further research into effective intervention strategies for children of illicit substance using mothers is indicated.

Use of acoustic emission technique for structural health monitoring of bridges

Bridges are valuable assets of every nation. They deteriorate with age and often are subjected to additional loads or different load patterns than originally designed for. These changes in loads can cause localized distress and may result in bridge failure if not corrected in time. Early detection of damage and appropriate retrofitting will aid in preventing bridge failures. Large amounts of money are spent in bridge maintenance all around the world. A need exists for a reliable technology capable of monitoring the structural health of bridges, thereby ensuring they operate safely and efficiently during the whole intended lives. Monitoring of bridges has been traditionally done by means of visual inspection. Visual inspection alone is not capable of locating and identifying all signs of damage, hence a variety of structural health monitoring (SHM) techniques is used regularly nowadays to monitor performance and to assess condition of bridges for early damage detection. Acoustic emission (AE) is one technique that is finding an increasing use in SHM applications of bridges all around the world. The chapter starts with a brief introduction to structural health monitoring and techniques commonly used for monitoring purposes. Acoustic emission technique, wave nature of AE phenomenon, previous applications and limitations and challenges in the use as a SHM technique are also discussed. Scope of the project and work carried out will be explained, followed by some recommendations of work planned in future.

Exploiting system fluctuations. Differential training in physical prevention and rehabilitation programs for health and exercise

Background: Traditional causal modeling of health interventions tends to be linear in nature and lacks multidisciplinarity. Consequently, strategies for exercise prescription in health maintenance are typically group based and focused on the role of a common optimal health status template toward which all individuals should aspire. ----- ----- Materials and methods: In this paper, we discuss inherent weaknesses of traditional methods and introduce an approach exercise training based on neurobiological system variability. The significance of neurobiological system variability in differential learning and training was highlighted.----- ----- Results: Our theoretical analysis revealed differential training as a method by which neurobiological system variability could be harnessed to facilitate health benefits of exercise training. It was observed that this approach emphasizes the importance of using individualized programs in rehabilitation and exercise, rather than group-based strategies to exercise prescription.----- ----- Conclusion: Research is needed on potential benefits of differential training as an approach to physical rehabilitation and exercise prescription that could counteract psychological and physical effects of disease and illness in subelite populations. For example, enhancing the complexity and variability of movement patterns in exercise prescription programs might alleviate effects of depression in nonathletic populations and physical effects of repetitive strain injuries experienced by athletes in elite and developing sport programs.

Wellness in higher education : a transformative framework for health related disciplines

The perceived benefits of Wellness Education in University environments are substantiated by a number of studies in relation to the place, impact and purpose of Wellness curricula. Many authors recommend that Wellness curriculum design must include personal experiences, reflective practice and active self-managed learning approaches in order to legitimise the adoption of Wellness as a personal lifestyle approach. Wellness Education provides opportunities to engage in learning self-regulation skills both within and beyond the context of the Wellness construct. Learner success is optimised by creating authentic opportunities to develop and practice self regulation strategies that facilitate making meaning of life's experiences. Such opportunities include provision of options for self determined outcomes and are scaffolded according to learner needs; thus, configuring a learner-centred curriculum in Wellness Education would potentially benefit by overlaying principles from the domains of Self Determination Theory, Self Regulated Learning and Transformative Education Theory to highlight authentic, transformative learning as a lifelong approach to Wellness.

Design and implementation of the Exercise for Health trial – a pragmatic exercise intervention for women with breast cancer

Background Exercise for Health was a pragmatic, randomised, controlled trial comparing the effect of an eight-month exercise intervention on function, treatment-related side effects and quality of life following breast cancer, compared with usual care. The intervention commenced six weeks post-surgery, and two modes of delivering the same intervention was compared with usual care. The purpose of this paper is to describe the study design, along with outcomes related to recruitment, retention and representativeness, and intervention participation. Methods: Women newly diagnosed with breast cancer and residing in a major metropolitan city of Queensland, Australia, were eligible to participate. Consenting women were randomised to a face-to-face-delivered exercise group (FtF, n=67), telephone-delivered exercise group (Tel, n=67) or usual care group (UC, n=60) and were assessed pre-intervention (5-weeks post-surgery), mid-intervention (6 months post-surgery) and 10 weeks post-intervention (12 months post-surgery). Each intervention arm entailed 16 sessions with an Exercise Physiologist. Results: Of 318 potentially eligible women, 63% (n=200) agreed to participate, with a 12-month retention rate of 93%. Participants were similar to the Queensland breast cancer population with respect to disease characteristics, and the randomisation procedure was mostly successful at attaining group balance, with the few minor imbalances observed unlikely to influence intervention effects given balance in other related characteristics. Median participation was 14 (min, max: 0, 16) and 13 (min, max: 3, 16) intervention sessions for the FtF and Tel, respectively, with 68% of those in Tel and 82% in FtF participating in at least 75% of sessions. Discussion: Participation in both intervention arms during and following treatment for breast cancer was feasible and acceptable to women. Future work, designed to inform translation into practice, will evaluate the quality of life, clinical, psychosocial and behavioural outcomes associated with each mode of delivery.

Sustaining the next generation of teacher-researchers to work for social justice

This chapter explores a research project involving teachers working with some of the most disadvantaged young people in South Australia, children growing up in poverty, in families struggling with homelessness and ill-health, in the outer southern suburbs. Additionally, there were particular children were struggling with intellectual, emotional and social difficulties which were extreme enough for them not be included in a mainstream class. The research project made two crucial interrelated moves to support teachers to tackle this tough work. First, the project had an explicit social justice agenda. We were not simply researching literacy outcomes, but literacy pedagogies for the students teachers were most worried about. And we wanted to understand how the material conditions of students’ everyday lifeworlds impacted on the working conditions of teachers’ schoolworlds. We sought to open up a discursive space where teachers could talk about poverty, violence, racism and classism in ways that would take them beyond despair and into new imaginings and positive action. Second, the project was designed to start from the urgent questions of early career teachers and to draw on the accumulated practice wisdom of their chosen mentors. Hence we designed not only a teacher-researcher community, but cross-generational networks. Our aim was to build the capacities of both generations to address long-standing educational problems in new ways that drew overtly on their different and complementary resources.

Establishing Aboriginal health research priorities in Victoria

Short overview of the VACCHO Social Determinants Research Forum (2010).

Machine prognostics based on health state probability estimation

The ability to accurately predict the remaining useful life of machine components is critical for machine continuous operation and can also improve productivity and enhance system’s safety. In condition-based maintenance (CBM), maintenance is performed based on information collected through condition monitoring and assessment of the machine health. Effective diagnostics and prognostics are important aspects of CBM for maintenance engineers to schedule a repair and to acquire replacement components before the components actually fail. Although a variety of prognostic methodologies have been reported recently, their application in industry is still relatively new and mostly focused on the prediction of specific component degradations. Furthermore, they required significant and sufficient number of fault indicators to accurately prognose the component faults. Hence, sufficient usage of health indicators in prognostics for the effective interpretation of machine degradation process is still required. Major challenges for accurate longterm prediction of remaining useful life (RUL) still remain to be addressed. Therefore, continuous development and improvement of a machine health management system and accurate long-term prediction of machine remnant life is required in real industry application. This thesis presents an integrated diagnostics and prognostics framework based on health state probability estimation for accurate and long-term prediction of machine remnant life. In the proposed model, prior empirical (historical) knowledge is embedded in the integrated diagnostics and prognostics system for classification of impending faults in machine system and accurate probability estimation of discrete degradation stages (health states). The methodology assumes that machine degradation consists of a series of degraded states (health states) which effectively represent the dynamic and stochastic process of machine failure. The estimation of discrete health state probability for the prediction of machine remnant life is performed using the ability of classification algorithms. To employ the appropriate classifier for health state probability estimation in the proposed model, comparative intelligent diagnostic tests were conducted using five different classifiers applied to the progressive fault data of three different faults in a high pressure liquefied natural gas (HP-LNG) pump. As a result of this comparison study, SVMs were employed in heath state probability estimation for the prediction of machine failure in this research. The proposed prognostic methodology has been successfully tested and validated using a number of case studies from simulation tests to real industry applications. The results from two actual failure case studies using simulations and experiments indicate that accurate estimation of health states is achievable and the proposed method provides accurate long-term prediction of machine remnant life. In addition, the results of experimental tests show that the proposed model has the capability of providing early warning of abnormal machine operating conditions by identifying the transitional states of machine fault conditions. Finally, the proposed prognostic model is validated through two industrial case studies. The optimal number of health states which can minimise the model training error without significant decrease of prediction accuracy was also examined through several health states of bearing failure. The results were very encouraging and show that the proposed prognostic model based on health state probability estimation has the potential to be used as a generic and scalable asset health estimation tool in industrial machinery.

Road safety issues for older road users : CARRS-Q Monograph 1

[Selection of papers from the Older Road User Safety Symposium, 26 November 2000, Brisbane, Australia.]----- This publication is a selection of papers on older road user safety which were presented at the Older Road User Safety Symposium on Sunday 26 November 2000 at the Sheraton Brisbane Hotel, Queensland, Australia. The Symposium was held on the day before Australia’s annual Road Safety Research, Policing and Education Conference, which provided an opportunity to garner both presenters and participants from the wider road safety community in Australia. Road safety is a large and diverse area of scholarship and practice, and many disciplines are drawn on in the processes of understanding and addressing road safety problems. The safety of older road users is no different. As this selection shows, work on older road user safety can be informed by demography, research on the mental and physical effects of ageing, social research on older people as road users, evaluation of educational and behavioural interventions, road crash analysis, engineering research and practice, and reviews of policy approaches within Australia and elsewhere. It is possible to summarise these into four constellations, which are reflected in the papers selected for this publication: social impacts and responses; physical and cognitive capability; specific road use performance; and environment/ecology. Though three years have passed since the Symposium, the issues raised in these papers remain current.

The expanding roles of the ghrelin-gene derived peptide obestatin in health and disease

Obestatin is a 23 amino acid, ghrelin gene-derived peptide hormone produced in the stomach and a range of other tissues throughout the body. While it was initially reported that obestatin opposed the actions of ghrelin with regards to appetite and food intake, it is now clear that obestatin is not an endogenous ghrelin antagonist of ghrelin, but it is a multi-functional peptide hormone in its own right. In this review we will discuss the controversies associated with the discovery of obestatin and explore emerging central and peripheral roles of obestatin, roles in adipogenesis, pancreatic homeostasis and cancer.

Revitalizing health for all : international Indigenous representative group. Learning from the experience of comprehensive primary health care in Aboriginal Australia — A commentary on three projects

This paper presents a regional commentary (hereafter ‘the commentary’) on the three Australian projects of the Teasdale-Corti Global Health Research Partnership Program. The three Australian projects are: Victorian Aboriginal Health Service Ltd (VAHS), Melbourne, Victoria—Forty Years of Comprehensive Primary Health Care; Central Australian Aboriginal Congress Inc. (Congress), Alice Springs, Northern Territory—Ingkintja, Male Health Program; and Urapuntja Health Service (UHS), Utopia, Northern Territory—Outstation Health Care. It highlights common themes and lessons in respect to the Revitalising Health for All project in the context of Aboriginal and Torres Strait Islander health in Australia.