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Presentation given to postgraduates at the School of Social and Policy Research, The Northern Institute, Charles Darwin University, Darwin, Northern Territory, 28 August 2010.

Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments.

Executive summary Objective: The aims of this study were to identify the impact of Pandemic (H1N1) 2009 Influenza on Australian Emergency Departments (EDs) and their staff, and to inform planning, preparedness, and response management arrangements for future pandemics, as well as managing infectious patients presenting to EDs in everyday practice. Methods This study involved three elements: 1. The first element of the study was an examination of published material including published statistics. Standard literature research methods were used to identify relevant published articles. In addition, data about ED demand was obtained from Australian Government Department of Health and Ageing (DoHA) publications, with several state health departments providing more detailed data. 2. The second element of the study was a survey of Directors of Emergency Medicine identified with the assistance of the Australasian College for Emergency Medicine (ACEM). This survey retrieved data about demand for ED services and elicited qualitative comments on the impact of the pandemic on ED management. 3. The third element of the study was a survey of ED staff. A questionnaire was emailed to members of three professional colleges—the ACEM; the Australian College of Emergency Nursing (ACEN); and the College of Emergency Nursing Australasia (CENA). The overall response rate for the survey was 18.4%, with 618 usable responses from 3355 distributed questionnaires. Topics covered by the survey included ED conditions during the (H1N1) 2009 influenza pandemic; information received about Pandemic (H1N1) 2009 Influenza; pandemic plans; the impact of the pandemic on ED staff with respect to stress; illness prevention measures; support received from others in work role; staff and others’ illness during the pandemic; other factors causing ED staff to miss work during the pandemic; and vaccination against Pandemic (H1N1) 2009 Influenza. Both qualitative and quantitative data were collected and analysed. Results: The results obtained from Directors of Emergency Medicine quantifying the impact of the pandemic were too limited for interpretation. Data sourced from health departments and published sources demonstrated an increase in influenza-like illness (ILI) presentations of between one and a half and three times the normal level of presentations of ILIs. Directors of Emergency Medicine reported a reasonable level of preparation for the pandemic, with most reporting the use of pandemic plans that translated into relatively effective operational infection control responses. Directors reported a highly significant impact on EDs and their staff from the pandemic. Growth in demand and related ED congestion were highly significant factors causing distress within the departments. Most (64%) respondents established a ‘flu clinic’ either as part of Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments. the ED operations or external to it. They did not note a significantly higher rate of sick leave than usual. Responses relating to the impact on staff were proportional to the size of the colleges. Most respondents felt strongly that Pandemic (H1N1) 2009 Influenza had a significant impact on demand in their ED, with most patients having low levels of clinical urgency. Most respondents felt that the pandemic had a negative impact on the care of other patients, and 94% revealed some increase in stress due to lack of space for patients, increased demand, and filling staff deficits. Levels of concern about themselves or their family members contracting the illness were less significant than expected. Nurses displayed significantly higher levels of stress overall, particularly in relation to skill-mix requirements, lack of supplies and equipment, and patient and patients’ family aggression. More than one-third of respondents became ill with an ILI. Whilst respondents themselves reported taking low levels of sick leave, respondents cited difficulties with replacing absent staff. Ranked from highest to lowest, respondents gained useful support from ED colleagues, ED administration, their hospital occupational health department, hospital administration, professional colleges, state health department, and their unions. Respondents were generally positive about the information they received overall; however, the volume of information was considered excessive and sometimes inconsistent. The media was criticised as scaremongering and sensationalist and as being the cause of many unnecessary presentations to EDs. Of concern to the investigators was that a large proportion (43%) of respondents did not know whether a pandemic plan existed for their department or hospital. A small number of staff reported being redeployed from their usual workplace for personal risk factors or operational reasons. As at the time of survey (29 October –18 December 2009), 26% of ED staff reported being vaccinated against Pandemic (H1N1) 2009 Influenza. Of those not vaccinated, half indicated they would ‘definitely’ or ‘probably’ not get vaccinated, with the main reasons being the vaccine was ‘rushed into production’, ‘not properly tested’, ‘came out too late’, or not needed due to prior infection or exposure, or due to the mildness of the disease. Conclusion: Pandemic (H1N1) 2009 Influenza had a significant impact on Australian Emergency Departments. The pandemic exposed problems in existing plans, particularly a lack of guidelines, general information overload, and confusion due to the lack of a single authoritative information source. Of concern was the high proportion of respondents who did not know if their hospital or department had a pandemic plan. Nationally, the pandemic communication strategy needs a detailed review, with more engagement with media networks to encourage responsible and consistent reporting. Also of concern was the low level of immunisation, and the low level of intention to accept vaccination. This is a problem seen in many previous studies relating to seasonal influenza and health care workers. The design of EDs needs to be addressed to better manage infectious patients. Significant workforce issues were confronted in this pandemic, including maintaining appropriate staffing levels; staff exposure to illness; access to, and appropriate use of, personal protective equipment (PPE); and the difficulties associated with working in PPE for prolonged periods. An administrative issue of note was the reporting requirement, which created considerable additional stress for staff within EDs. Peer and local support strategies helped ensure staff felt their needs were provided for, creating resilience, dependability, and stability in the ED workforce. Policies regarding the establishment of flu clinics need to be reviewed. The ability to create surge capacity within EDs by considering staffing, equipment, physical space, and stores is of primary importance for future pandemics.

Correlates of sitting time in working age Australian women : who should be targeted with interventions to decrease sitting time?

Background: While there is emerging evidence that sedentary behavior is negatively associated with health risk, research on the correlates of sitting time in adults is scarce. Methods: Self-report data from 7,724 women born between 1973-1978 and 8,198 women born between 1946-1951 were collected as part of the Australian Longitudinal Study on Women’s Health. Linear regression models were computed to examine whether demographic, family and caring duties, time use, health and health behavior variables were associated with weekday sitting time. Results: Mean sitting time (SD) was 6.60 (3.32) hours/day for the 1973-1978 cohort and 5.70 (3.04) hours/day for the 1946-1951 cohort. Indicators of socio-economic advantage, such as full11 time work and skilled occupations in both cohorts and university education in the mid-age cohort, were associated with high sitting time. A cluster of ‘healthy behaviours’ was associated with lower sitting time in the mid-aged women (moderate/high physical activity levels, non-smoking, non-drinking). For both cohorts, sitting time was highest in women in full-time work, in skilled occupations and in those who spent the most time in passive leisure. Conclusions: The results suggest that, in young and mid-aged women, interventions for reducing sitting time should focus on both occupational and leisure-time sitting.

Working time arrangements and recreation : making time for weekends when working long hours

Work time spread across the entire week, rather than the conventional five day working week, has meant that workers are now less able to utilise longer stretches of recreation time especially in gaining access to a full two-day break over a weekend. This paper explores the issues contributing to workers' acquisition of longer recreation time. It seeks to determine the effects of this acquisition on the quality of working and non-working time for the employee through a study of work-life balance in the construction industry. It finds that weekends are more important to achieving work-life balance than shorter days over a six-day week when working long hours. Further, 'personal time' is a key element in achieving satisfactory work-life balance for employees, and this type of 'time' is often forgone in trying to integrate the necessary and desired non-work activities in the shorter time available to workers.

Ambivalence and the experience of China-educated nurses working in Australia

The last decade has seen an increase in research on the experience of immigrant nurses. There are two prevailing approaches in this body of work. One is a focus on the positive or negative aspects of the experience, and the other, a depiction of the experience as a linear movement from struggle to a comfortable state. Based on our study findings on the experience of China educated nurses working in Australia, this study proposes that the concept of ambivalence is more appropriate in portraying the experience of immigrant nurses. Several sources of ambivalence experienced by the participants are represented: a disparity between expectation and reality, conflicting social and cultural norms, the dual reference points of comparison, divergent interests within families, and a sense that although it is unsatisfactory, it is hard to go back. We argue that immigration generates various forms of ambivalence and immigrant nurses must live with more or less ambivalence. The notion of ambivalence can explain a range of behaviours and situations beyond the scope of rational-choice explanations. To date, ambivalence as a theoretical concept in understanding the experience of immigrant nurses has been either ignored or insufficiently addressed in the literature.

Working together for Toby : early childhood student teachers engaging in collaborative problem-based learning around child abuse and neglect

Early childhood teacher education programs have a responsibility, amongst many, to prepare teachers for decision-making on real world issues, such as child abuse and neglect. Their repertoire of skills can be enhanced by engaging with others, either face-to-face or online, in authentic problem-based learning. This paper draws on a study of early childhood student teachers who engaged in an authentic learning experience, which was to consider and to suggest how they would act upon a real-life case of child abuse encountered in an early childhood classroom in Queensland. This was the case of Toby (a pseudonym), who was suspected of being physically abused at home. Students drew upon relevant legislation, policy and resource materials to tackle Toby’s case. The paper provides evidence of students grappling with the complexity of a child abuse case and establishing, through collaboration with others, a proactive course of action. The paper has a dual focus. First, it discusses the pedagogical context in which early childhood student teachers deal with issues of child abuse and neglect in the course of their teacher education program. Second, it examines evidence of students engaging in collaborative problem-solving around issues of child abuse and neglect and teachers’ responsibilities, both legal and professional, to the children and families they work with. Early childhood policy-makers, practitioners and teacher educators are challenged to consider how early childhood teachers are best equipped to deal with child protection and early intervention.

Elements of an environmental offsets policy : a working paper towards a policy for an environmental banking scheme appropriate for Queensland

In the past eight years, Australia has adopted the use of environmental offsets as a means to compensate for environmental degradation from development. Queensland has more environmental offsetting policies than any other Australian State or Territory. The methodology has profound effects on development companies, landowners (both private and public), regional land planning, organizations, government agencies, monetary banking institutions and environmental conservation bodies.

Modular transactional memory

Software transactional memory has the potential to greatly simplify development of concurrent software, by supporting safe composition of concurrent shared-state abstractions. However, STM semantics are defined in terms of low-level reads and writes on individual memory locations, so implementations are unable to take advantage of the properties of user-defined abstractions. Consequently, the performance of transactions over some structures can be disappointing. ----- ----- We present Modular Transactional Memory, our framework which allows programmers to extend STM with concurrency control algorithms tailored to the data structures they use in concurrent programs. We describe our implementation in Concurrent Haskell, and two example structures: a finite map which allows concurrent transactions to operate on disjoint sets of keys, and a non-deterministic channel which supports concurrent sources and sinks. ----- ----- Our approach is based on previous work by others on boosted and open-nested transactions, with one significant development: transactions are given types which denote the concurrency control algorithms they employ. Typed transactions offer a higher level of assurance for programmers reusing transactional code, and allow more flexible abstract concurrency control.

Negative mood, implicit alcohol-related memory, and alcohol use in young adults: The moderating effect of alcohol expectancy

Objective Alcohol-related implicit (preconscious) cognitive processes are established and unique predictors of alcohol use, but most research in this area has focused on alcohol-related implicit cognition and anxiety. This study extends this work into the area of depressed mood by testing a cognitive model that combines traditional explicit (conscious and considered) beliefs, implicit alcohol-related memory associations (AMAs), and self-reported drinking behavior. Method Using a sample of 106 university students, depressed mood was manipulated using a musical mood induction procedure immediately prior to completion of implicit then explicit alcohol-related cognition measures. A bootstrapped two-group (weak/strong expectancies of negative affect and tension reduction) structural equation model was used to examine how mood changes and alcohol-related memory associations varied across groups. Results Expectancies of negative affect moderated the association of depressed mood and AMAs, but there was no such association for tension reduction expectancy. Conclusion Subtle mood changes may unconsciously trigger alcohol-related memories in vulnerable individuals. Results have implications for addressing subtle fluctuations in depressed mood among young adults at risk of alcohol problems.

WaterFieldWork : a working lexicon for critical refugia in arid landscapes

Algebuckina Waterhole exists as a permanent waterhole near a north-south dirt road and an old trainline on the Oodnadatta Track - lines that once opened up the arid lands of central South Australia but are now bypassed. It also exists as the final and largest freshwater waterhole at the end of the Neales River system. It is a critical biodiversity site, a cultural place and a working environment. It is seen to need a resilient management plan that encompasses diverse interests and impacts. Its managers sense that the theories and practices emerging out of landscape disciplinary systems may be of help. Work-in-progress research towards a management methodology are presented through posing scenarios on how landscape thinking and design, informed by an emergent textual and visual lexicon for water landscapes, can intersect with scientific fieldwork to produce useful and transferable outcomes for Algebuckina.

Technology, memory and experience : virtual reality, motion capture and early modern theatre

This paper investigates virtual reality representations of performance in London’s late sixteenth-century Rose Theatre, a venue that, by means of current technology, can once again challenge perceptions of space, performance, and memory. The VR model of The Rose becomes a Camillo device in that it represents a virtual recreation of this venue in as much detail as possible and attempts to recover graphic demonstrations of the trace memories of the performance modes of the day. The VR model is based on accurate archeological and theatre historical records and is easy to navigate. The introduction of human figures onto The Rose’s stage via motion capture allows us to explore the relationships between space, actor and environment. The combination of venue and actors facilitates a new way of thinking about how the work of early modern playwrights can be stored and recalled. This virtual theatre is thus activated to intersect productively with contemporary studies in performance; as such, our paper provides a perspective on and embodiment of the relation between technology, memory and experience. It is, at its simplest, a useful archiving project for theatrical history, but it is directly relevant to contemporary performance practice as well. Further, it reflects upon how technology and ‘re-enactments’ of sorts mediate the way in which knowledge and experience are transferred, and even what may be considered ‘knowledge.’ Our work provides opportunities to begin addressing what such intermedial confrontations might produce for ‘remembering, experiencing, thinking and imagining.’ We contend that these confrontations will enhance live theatre performance rather than impeding or disrupting contemporary performance practice. This paper intersects with the CFP’s ‘Performing Memory’ and ‘Memory Lab’ themes. Our presentation (which includes a demonstration of the VR model and the motion capture it requires) takes the form of two closely linked papers that share a single abstract. The two papers will be given by two people, one of whom will be physically present in Utrecht, the other participating via Skype.

Attitudes to living and working in pandemic conditions among emergency prehospital medical care personnel

Introduction: Little is known about the risk perceptions and attitudes of healthcare personnel, especially of emergency prehospital medical care personnel, regarding the possibility of an outbreak or epidemic event. Problem: This study was designed to investigate pre-event knowledge and attitudes of a national sample of the emergency prehospital medical care providers in relation to a potential human influenza pandemic, and to determine predictors of these attitudes. Methods: Surveys were distributed to a random, cross-sectional sample of 20% of the Australian emergency prehospital medical care workforce (n = 2,929), stratified by the nine services operating in Australia, as well as by gender and location. The surveys included: (1) demographic information; (2) knowledge of influenza; and (3) attitudes and perceptions related to working during influenza pandemic conditions. Multiple logistic regression models were constructed to identify predictors of pandemic-related risk perceptions. Results: Among the 725 Australian emergency prehospital medical care personnel who responded, 89% were very anxious about working during pandemic conditions, and 85% perceived a high personal risk associated with working in such conditions. In general, respondents demonstrated poor knowledge in relation to avian influenza, influenza generally, and infection transmission methods. Less than 5% of respondents perceived that they had adequate education/training about avian influenza. Logistic regression analyses indicate that, in managing the attitudes and risk perceptions of emergency prehospital medical care staff, particular attention should be directed toward the paid, male workforce (as opposed to volunteers), and on personnel whose relationship partners do not work in the health industry. Conclusions: These results highlight the potentially crucial role of education and training in pandemic preparedness. Organizations that provide emergency prehospital medical care must address this apparent lack of knowledge regarding infection transmission, and procedures for protection and decontamination. Careful management of the perceptions of emergency prehospital medical care personnel during a pandemic is likely to be critical in achieving an effective response to a widespread outbreak of infectious disease.