881 resultados para Poor responder


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Explanations for poor educational experiences and results for Australian Indigenous school students have, to a great extent, focused on intended or conscious acts or omissions. This paper adopts an analysis based on the legislation prohibiting indirect racial discrimination. Using the elements of the legislation and case law it argues that apparently benign and race-neutral policies and practices may unwittingly be having an adverse impact on Indigenous students' education. These practices or policies include the building blocks of learning, a Eurocentric school culture. Standard English as the language of assessment, legislation to limit schools' legal liability, and teachers' promotions.

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Introduction: Nursing clinicians are primarily responsible for the monitoring and treatment of increased body temperature. The body temperature of patients during their acute care hospital stay is measured at regular repeated intervals. In the event a patient is assessed with an elevated temperature, a multitude of decisions are required. The action of instigating temperature reducing strategies is based upon the assumption that elevated temperature is harmful and that the strategy employed will have some beneficial effect. Background and Significance: The potential harmful effects of increased body temperature (fever, hyperthermia) following neurological insult are well recognised. Although few studies have investigated this phenomenon in the diagnostic population of non-traumatic subarachnoid haemorrhage, it has been demonstrated that increased body temperature occurs in 41 to 72% of patients with poor clinical outcome. However, in the Australian context the frequency, or other characteristics of increased body temperature, as well as the association between increased body temperature with poor clinical outcome has not been established. Design: This study used a correlational study design to: describe the frequency, duration and timing of increased body temperature; determine the association between increased body temperature and clinical outcome; and describe the clinical interventions used to manage increased body temperature in patients with non-traumatic subarachnoid haemorrhage. A retrospective clinical chart audit was conducted on 43 patients who met the inclusion criteria. Findings: The major findings of this study were: increased body temperature occurred frequently; persisted for a long time; and onset did not occur until 20 hours after primary insult; increased body temperature was associated with death or dependent outcome; and no intervention was recorded in many instances. Conclusion: This study has quantified in a non-traumatic subarachnoid haemorrhage patient population the characteristics of increased body temperature, established an association between increased body temperature with death or dependent outcome and described the current management of elevated temperatures in the Australian context to improve nursing practice, education and research.

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This study explores full-time workers' understanding of and assumptions about part-time work against six job quality components identified in recent literature. Forty interviews were conducted with employees in a public sector agency in Australia, a study context where part-time work is ostensibly 'good quality' and is typically long term, voluntary, involving secure contracts (i.e. permanent rather than casual) and having predictable hours distributed evenly over the week and year. Despite strong collective bargaining arrangements as well as substantial legal and industrial obligations, the findings revealed some serious concerns for part-time job quality. These concerns included reduced responsibilities and lesser access to high status roles and projects, a lack of access to promotion opportunities, increased work intensity and poor workplace support. The highly gendered, part-time labour market also means that it is women who disproportionately experience this disadvantage. To foster equity, greater attention needs to focus on monitoring and enhancing job quality, regardless of hours worked.

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Chronic wounds are a significant socioeconomic problem for governments worldwide. Approximately 15% of people who suffer from diabetes will experience a lower-limb ulcer at some stage of their lives, and 24% of these wounds will ultimately result in amputation of the lower limb. Hyperbaric Oxygen Therapy (HBOT) has been shown to aid the healing of chronic wounds; however, the causal reasons for the improved healing remain unclear and hence current HBOT protocols remain empirical. Here we develop a three-species mathematical model of wound healing that is used to simulate the application of hyperbaric oxygen therapy in the treatment of wounds. Based on our modelling, we predict that intermittent HBOT will assist chronic wound healing while normobaric oxygen is ineffective in treating such wounds. Furthermore, treatment should continue until healing is complete, and HBOT will not stimulate healing under all circumstances, leading us to conclude that finding the right protocol for an individual patient is crucial if HBOT is to be effective. We provide constraints that depend on the model parameters for the range of HBOT protocols that will stimulate healing. More specifically, we predict that patients with a poor arterial supply of oxygen, high consumption of oxygen by the wound tissue, chronically hypoxic wounds, and/or a dysfunctional endothelial cell response to oxygen are at risk of nonresponsiveness to HBOT. The work of this paper can, in some way, highlight which patients are most likely to respond well to HBOT (for example, those with a good arterial supply), and thus has the potential to assist in improving both the success rate and hence the costeffectiveness of this therapy.

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Videotelephony (real-time audio-visual communication) has been used successfully in adult palliative home care. This paper describes two attempts to complete an RCT (both of which were abandoned following difficulties with family recruitment), designed to investigate the use of videotelephony with families receiving palliative care from a tertiary paediatric oncology service in Brisbane, Australia. To investigate whether providing videotelephone-based support was acceptable to these families, a 12-month non-randomised acceptability trial was completed. Seventeen palliative care families were offered access to a videotelephone support service in addition to the 24 hours ‘on-call’ service already offered. A 92% participation rate in this study provided some reassurance that the use of videotelephones themselves was not a factor in poor RCT participation rates. The next phase of research is to investigate the integration of videotelephone-based support from the time of diagnosis, through outpatient care and support, and for palliative care rather than for palliative care in isolation

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Background The problem of silent multiple comparisons is one of the most difficult statistical problems faced by scientists. It is a particular problem for investigating a one-off cancer cluster reported to a health department because any one of hundreds, or possibly thousands, of neighbourhoods, schools, or workplaces could have reported a cluster, which could have been for any one of several types of cancer or any one of several time periods. Methods This paper contrasts the frequentist approach with a Bayesian approach for dealing with silent multiple comparisons in the context of a one-off cluster reported to a health department. Two published cluster investigations were re-analysed using the Dunn-Sidak method to adjust frequentist p-values and confidence intervals for silent multiple comparisons. Bayesian methods were based on the Gamma distribution. Results Bayesian analysis with non-informative priors produced results similar to the frequentist analysis, and suggested that both clusters represented a statistical excess. In the frequentist framework, the statistical significance of both clusters was extremely sensitive to the number of silent multiple comparisons, which can only ever be a subjective "guesstimate". The Bayesian approach is also subjective: whether there is an apparent statistical excess depends on the specified prior. Conclusion In cluster investigations, the frequentist approach is just as subjective as the Bayesian approach, but the Bayesian approach is less ambitious in that it treats the analysis as a synthesis of data and personal judgements (possibly poor ones), rather than objective reality. Bayesian analysis is (arguably) a useful tool to support complicated decision-making, because it makes the uncertainty associated with silent multiple comparisons explicit.

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Both in developed and developing economies, major public funding is invested in civil infrastructure assets. Efficiency and comfort level of expected and demanded living standards are largely dependant on the management strategies of these assets. Buildings are one of the major & vital assets, which need to be maintained primarily to ensure its functionality by effective & efficient delivery of services and to optimize economic benefits. Not withstanding, public building infrastructure is not considered in Infrastructure report card published by Australian Infrastructure Report Card Alliance Partners (2001). The reason appears to be not having enough data to rate public building infrastructure. American Infrastructure Report Card (2001) gave “School Buildings” ‘d-’ rating, which is below ‘poor’. For effective asset management of building infrastructure, a need emerged to optimise the budget for managing assets, to cope up with increased user expectations, to response effectively to possible asset failures, to deal with ageing of assets and aging populations and to treat other scenarios including technology advancement and non-asset solutions. John (Asset Management, 2001) suggests that in the area of asset management worldwide, UK, Australia and New Zealand are leading.

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For the last two decades heart disease has been the highest single cause of death for the human population. With an alarming number of patients requiring heart transplant, and donations not able to satisfy the demand, treatment looks to mechanical alternatives. Rotary Ventricular Assist Devices, VADs, are miniature pumps which can be implanted alongside the heart to assist its pumping function. These constant flow devices are smaller, more efficient and promise a longer operational life than more traditional pulsatile VADs. The development of rotary VADs has focused on single pumps assisting the left ventricle only to supply blood for the body. In many patients however, failure of both ventricles demands that an additional pulsatile device be used to support the failing right ventricle. This condition renders them hospital bound while they wait for an unlikely heart donation. Reported attempts to use two rotary pumps to support both ventricles concurrently have warned of inherent haemodynamic instability. Poor balancing of the pumps’ flow rates quickly leads to vascular congestion increasing the risk of oedema and ventricular ‘suckdown’ occluding the inlet to the pump. This thesis introduces a novel Bi-Ventricular Assist Device (BiVAD) configuration where the pump outputs are passively balanced by vascular pressure. The BiVAD consists of two rotary pumps straddling the mechanical passive controller. Fluctuations in vascular pressure induce small deflections within both pumps adjusting their outputs allowing them to maintain arterial pressure. To optimise the passive controller’s interaction with the circulation, the controller’s dynamic response is optimised with a spring, mass, damper arrangement. This two part study presents a comprehensive assessment of the prototype’s ‘viability’ as a support device. Its ‘viability’ was considered based on its sensitivity to pathogenic haemodynamics and the ability of the passive response to maintain healthy circulation. The first part of the study is an experimental investigation where a prototype device was designed and built, and then tested in a pulsatile mock circulation loop. The BiVAD was subjected to a range of haemodynamic imbalances as well as a dynamic analysis to assess the functionality of the mechanical damper. The second part introduces the development of a numerical program to simulate human circulation supported by the passively controlled BiVAD. Both investigations showed that the prototype was able to mimic the native baroreceptor response. Simulating hypertension, poor flow balancing and subsequent ventricular failure during BiVAD support allowed the passive controller’s response to be assessed. Triggered by the resulting pressure imbalance, the controller responded by passively adjusting the VAD outputs in order to maintain healthy arterial pressures. This baroreceptor-like response demonstrated the inherent stability of the auto regulating BiVAD prototype. Simulating pulmonary hypertension in the more observable numerical model, however, revealed a serious issue with the passive response. The subsequent decrease in venous return into the left heart went unnoticed by the passive controller. Meanwhile the coupled nature of the passive response not only decreased RVAD output to reduce pulmonary arterial pressure, but it also increased LVAD output. Consequently, the LVAD increased fluid evacuation from the left ventricle, LV, and so actually accelerated the onset of LV collapse. It was concluded that despite the inherently stable baroreceptor-like response of the passive controller, its lack of sensitivity to venous return made it unviable in its present configuration. The study revealed a number of other important findings. Perhaps the most significant was that the reduced pulse experienced during constant flow support unbalanced the ratio of effective resistances of both vascular circuits. Even during steady rotary support therefore, the resulting ventricle volume imbalance increased the likelihood of suckdown. Additionally, mechanical damping of the passive controller’s response successfully filtered out pressure fluctuations from residual ventricular function. Finally, the importance of recognising inertial contributions to blood flow in the atria and ventricles in a numerical simulation were highlighted. This thesis documents the first attempt to create a fully auto regulated rotary cardiac assist device. Initial results encourage development of an inlet configuration sensitive to low flow such as collapsible inlet cannulae. Combining this with the existing baroreceptor-like response of the passive controller will render a highly stable passively controlled BiVAD configuration. The prototype controller’s passive interaction with the vasculature is a significant step towards a highly stable new generation of artificial heart.

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Policy instruments of education, regulation, fines and inspection have all been utilised by Australian jurisdictions as they attempt to improve the poor performance of occupational health and safety (OH&S) in the construction industry. However, such policy frameworks have been largely uncoordinated across Australia, resulting in differing policy systems, with differing requirements and compliance systems. Such complexity, particularly for construction firms operating across jurisdictional borders, led to various attempts to improve the consistency of OH&S regulation across Australia, four of which will be reviewed in this report. 1. The first is the Occupational Health and Safety Act 1991 (Commonwealth) which enabled certain organisations to opt out of state based regulatory regimes. 2. The second is the development of national standards, codes of practice and guidance documents by the National Occupational Health and Safety Council (NOHSC). The intent was that the OHS requirements, principles and practices contained in these documents would be adopted by state and territory governments into their legislation and policy, thereby promoting regulatory consistency across Australia. 3. The third is the attachment of conditions to special purpose payments from the Commonwealth to the States, in the form of OH&S accreditation with the Office of the Federal Safety Commissioner. 4. The fourth is the development of national voluntary codes of OHS practice for the construction industry. It is interesting to note that the tempo of change has increased significantly since 2003, with the release of the findings of the Cole Royal Commission. This paper examines and evaluates each of these attempts to promote consistency across Australia. It concludes that while there is a high level of information sharing between jurisdictions, particularly from the NOSHC standards, a fragmented OH&S policy framework still remains in place across Australia. The utility of emergent industry initiatives such as voluntary codes and guidelines for safer construction practices to enhance consistency are discussed.

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Principal Topic Small and micro-enterprises are believed to play a significant part in economic growth and poverty allevition in developing countries. However, there are a range of issues that arise when looking at the support required for local enterprise development, the role of micro finance and sustainability. This paper explores the issues associated with the establishment and resourcing of micro-enterprise develoment and proposes a model of sustainable support of enterprise development in very poor developing economies, particularly in Africa. The purpose of this paper is to identify and address the range of issues raised by the literature and empirical research in Africa, regarding micro-finance and small business support, and to develop a model for sustainable support for enterprise development within a particular cultural and economic context. Micro-finance has become big business with a range of models - from those that operate on a strictly business basis to those that come from a philanthropic base. The models used grow from a range of philosophical and cultural perspectives. Entrepreneurship training is provided around the world. Success is often measured by the number involved and the repayment rates - which are very high, largely because of the lending models used. This paper will explore the range of options available and propose a model that can be implemented and evaluated in rapidly changing developing economies. Methodology/Key Propositions The research draws on entrepreneurial and micro-finance literature and empirical research undertaken in Mozambique, which lies along the Indian ocean sea border of Southern Africa. As a result of war and natural disasters over a prolonged period, there is little industry, primary industries are primitive and there is virtually no infrastructure. Mozambique is ranked as one of the poorest countries in the world. The conditions in Mozambique, though not identical, reflect conditions in many other parts of Africa. A numebr of key elements in the development of enterprises in poor countries are explored including: Impact of micro-finance Sustainable models of micro-finance Education and training Capacity building Support mechanisms Impact on poverty, families and the local economy Survival entrepreneurship versus growth entrepreneurship Transitions to the formal sector. Results and Implications The result of this study is the development of a model for providing intellectual and financial resources to micro-entrepreneurs in poor developing countries in a sustainable way. The model provides a base for ongoing research into the process of entrepreneurial growth in African developing economies. The research raises a numeber of issues regarding sustainability including the nature of the donor/recipient relationship, access to affordable resources, the impact of individual entrepreneurial activity on the local economny and the need for ongoing research to understand the whole process and its impact, intended and unintended.

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In today's highly challenging business environment, an innovative and systemic approach is imperative to survival and growth. Organisational integration and technological integration, are often seen as a catalyst of change that could lead to significant improvements in organisations. The levels of improvement in inter and intra firm integration should arise from a detailed understanding and development of competences within and between organisations. Preliminary findings suggest that lack of trust across organisational cultures within the firms has a negative influence on the development of the capabilities to integrate and align technological innovations and hinders implementation and the effectiveness of the operations. Additionally, poor communication and conflict effects customer satisfaction. Firms need to transfer the competences that support cooperative integration, developed through interaction with supply chain partners, to their relationship arrangements with other supply chain partners, as these are key to ensuring low operational costs.

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Introduction: Paramedics and other emergency health workers are exposed to infectious disease particularly when undertaking exposure-prone procedures as a component of their everyday practice. This study examined paramedic knowledge of infectious disease aetiology and transmission in the pre-hospital care environment.--------- Methods: A mail survey of paramedics from an Australian ambulance service (n=2274) was conducted.--------- Results: With a response rate of 55.3% (1258/2274), the study demonstrated that paramedic knowledge of infectious disease aetiology and modes of transmission was poor. Of the 25 infectious diseases included in the survey, only three aetiological agents were correctly identified by at least 80% of respondents. The most accurate responses for aetiology of individual infectious diseases were for HIV/AIDS (91.4%), influenza (87.4%), and hepatitis B (85.7%). Poorest results were observed for pertussis, infectious mononucleosis, leprosy, dengue fever, Japanese B encephalitis and vancomycin resistant enterococcus (VRE), all with less than half the sample providing a correct response. Modes of transmission of significant infectious diseases were also assessed. Most accurate responses were found for HIV/AIDS (85.8%), salmonella (81.9%) and influenza (80.1%). Poorest results were observed for infectious mononucleosis, diphtheria, shigella, Japanese B encephalitis, vancomycin resistant enterococcus, meningococcal meningitis, rubella and infectious mononucleosis, with less than a third of the sample providing a correct response.--------- Conclusions: Results suggest that knowledge of aetiology and transmission of infectious disease is generally poor amongst paramedics. A comprehensive in-service education infection control programs for paramedics with emphasis on infectious disease aetiology and transmission is recommended.

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The quality of office indoor environments is considered to consist of those factors that impact the occupants according to their health and well-being and (by consequence) their productivity. Indoor Environment Quality (IEQ) can be characterized by four indicators: • Indoor air quality indicators • Thermal comfort indicators • Lighting indicators • Noise indicators. Within each indicator, there are specific metrics that can be utilized in determining an acceptable quality of an indoor environment based on existing knowledge and best practice. Examples of these metrics are: indoor air levels of pollutants or odorants; operative temperature and its control; radiant asymmetry; task lighting; glare; ambient noise. The way in which these metrics impact occupants is not fully understood, especially when multiple metrics may interact in their impacts. It can be estimated that the potential cost of lost productivity from poor IEQ may be much in excess of other operating costs of a building. However, the relative productivity impacts of each of the four indicators is largely unknown. The CRC Project ‘Regenerating Construction to Enhance Sustainability’ has a focus on IEQ impacts before and after building refurbishment. This paper provides an overview of IEQ impacts and criteria and the implementation of a CRC project that is currently researching these factors during the refurbishment of a Melbourne office building. IEQ measurements and their impacts will be reported in a future paper

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The quality of office indoor environments is considered to consist of those factors that impact occupants according to their health and well-being and (by consequence) their productivity. Indoor Environment Quality (IEQ) can be characterized by four indicators: • Indoor air quality indicators • Thermal comfort indicators • Lighting indicators • Noise indicators. Within each indicator, there are specific metrics that can be utilized in determining an acceptable quality of an indoor environment based on existing knowledge and best practice. Examples of these metrics are: indoor air levels of pollutants or odorants; operative temperature and its control; radiant asymmetry; task lighting; glare; ambient noise. The way in which these metrics impact occupants is not fully understood, especially when multiple metrics may interact in their impacts. While the potential cost of lost productivity from poor IEQ has been estimated to exceed building operation costs, the level of impact and the relative significance of the above four indicators are largely unknown. However, they are key factors in the sustainable operation or refurbishment of office buildings. This paper presents a methodology for assessing indoor environment quality (IEQ) in office buildings, and indicators with related metrics for high performance and occupant comfort. These are intended for integration into the specification of sustainable office buildings as key factors to ensure a high degree of occupant habitability, without this being impaired by other sustainability factors. The assessment methodology was applied in a case study on IEQ in Australia’s first ‘six star’ sustainable office building, Council House 2 (CH2), located in the centre of Melbourne. The CH2 building was designed and built with specific focus on sustainability and the provision of a high quality indoor environment for occupants. Actual IEQ performance was assessed in this study by field assessment after construction and occupancy. For comparison, the methodology was applied to a 30 year old conventional building adjacent to CH2 which housed the same or similar occupants and activities. The impact of IEQ on occupant productivity will be reported in a separate future paper

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The recognition of excessive fears and worries in children is important for early intervention. Despite current knowledge about the important contribution fathers make to their children’s emotional, social and cognitive development, more emphasis is often given to the views of mothers in both research and practice. This paper reports on a community study of 220 families. Fathers, mothers and children reported on children’s fears and worries using three different methods. While father and mother ratings were moderately correlated on two of the measures, there was relatively poor parent-child agreement. Implications for the role of fathers in the assessment of childhood fears and worries are discussed.