Development and pilot study of the Primary Care Practice Improvement Tool (PC-PIT) : an innovative approach

Objective To assess the usability and validity of the Primary Care Practice Improvement Tool (PC-PIT), a practice performance improvement tool based on 13 key elements identified by a systematic review. It was co-created with a range of partners and designed specifically for primary health care. Design This pilot study examined the PC-PIT using a formative assessment framework and mixed-methods research design. Setting and participants Six high-functioning general practices in Queensland, Australia, between February and July 2013. A total of 28 staff participated — 10 general practitioners, six practice or community nurses, 12 administrators (four practice managers; one business manager and eight reception or general administrative staff). Main outcome measures Readability, content validity and staff perceptions of the PC-PIT. Results The PC-PIT offers an appropriate and acceptable approach to internal quality improvement in general practice. Quantitative assessment scores and qualitative data from all staff identified two areas in which the PC-PIT required modification: a reduction in the indicative reading age, and simplification of governance-related terms and concepts. Conclusion The PC-PIT provides an innovative approach to address the complexity of organisational improvement in general practice and primary health care. This initial validation will be used to develop a suite of supporting, high-quality and free-to-access resources to enhance the use of the PC-PIT in general practice. Based on these findings, a national trial is now underway.

Specialist versus generic models of psychiatry training and service provision for people with intellectual disabilities

Background  Models of service provision and professional training differ between countries. This study aims to investigate a specialist intellectual disabilities model and a generic mental health model, specifically comparing psychiatrists’ knowledge and competencies, and service quality and accessibility in meeting the mental health needs of people with intellectual disabilities. Method  Data were collected from consultant and trainee psychiatrists within a specialist intellectual disabilities model (UK) and a generic mental health model (Australia). Results  The sample sizes were 294 (UK) and 205 (Australia). Statistically significant differences were found, with UK participants having positive views about the specialist intellectual disabilities service model they worked within, demonstrating flexible and accessible working practices and service provision, responsive to the range of mental health needs of the population with intellectual disabilities, and providing a wide range of treatments and supports. The UK participants were knowledgeable, well trained and confident in their work. They wanted to work with people with intellectual disabilities. In all of these areas, the converse was found from the Australian generic mental health service model. Conclusions  The specialist intellectual disabilities model of service provision and training has advantages over the generic mental health model.

Safe Design Project : Review of occupational health and safety legal requirements for designers, manufacturers, suppliers, importers and other relevant obligation bearers

In seeking to achieve Australian workplaces free from injury and disease NOHSC works to lead and coordinate national efforts to prevent workplace death, injury and disease. We seek to achieve our mission through the quality and relevance of information we provide and to influence the activities of all parties with roles in improving Australia’s OHS performance. NOHSC has five strategic objectives: • improving national data systems and analysis, • improving national access to OHS information, • improving national components of the OHS and related regulatory framework, • facilitating and coordinating national OHS research efforts, • monitoring progress against the National OHS Improvement Framework. This publication is a contribution to achieving those objectives

Assessment of robust autonomy for unmanned systems : progress and challenges

The growing number of potential applications of Unmanned Aircraft Systems (UAS) in civilian operations and national security is putting pressure of National Airworthiness Authorities to provide a path for certification and allow UAS integration into the national airspace. The success of this integration depends not only on developments in improved UAS reliability and safety, but also on regulations for certification, and methodologies for operational performance and safety assessment. This paper focuses on the latter and describes progress in relation to a previously proposed framework for evaluating robust autonomy of UAS. The paper draws parallels between the proposed evaluation framework and the evaluation of pilots during the licensing process. It discusses how the data from the proposed evaluation can be used as an aid for decision making in certification and UAS designs. Finally, it discusses challenges associated with the evaluation.

1950s made in Brisbane : Italian tailors and the continental suit

During the 1950s and 1960s, when the French couturiers Dior, Balenciaga, Givenchy and Chanel dominated the fashion industry, the Italian community in Brisbane, Australia, was very active in the local industry through retail, dress-making and tailoring. Australia is geographically at the margins of the developed countries and has been dependent on European trends and taste. In the 1950s, communication was based on magazines and especially newsreels and film; each ethnic group dressed as they liked and according to their custom. Moreover, ‘Made in Italy’ was not yet the prestigious concept that revolutionized ready-to-wear design from the 1970s. However, Italian tailors and demi-couturiers brought to Brisbane their trans-national sense of elegance (the Italian style) and the taste in fashion that influenced new generations in England and elsewhere in Europe from the 1950s. They brought quality and workmanship, offering excellence through the use of quality fabrics from prestigious English and Italian brands. These tailors and dress-makers also contributed towards the local industry through passing on the skills that they brought from Italy. This article is based on a project that seeks to understand the connection between fashion, history and place. The area under examination is the Valley, short for Fortitude Valley, an area adjacent to the Brisbane CBD. Fundamental to this connection between place and fashion was the presence of many Italian migrants in the area. Through archival research and oral history, the aim of this ethnographic project is to bring to the fore an untold story about the economic and aesthetic contribution of Italian migrants to Queensland. Central to the understanding of this aesthetic change is the Italian suit. This research is innovative in that it opens a new area of study in Australian fashion history, connected to the history of migrants and their identity.

Good Practice Report : Postgraduate Research and Coursework Degrees

Over the past decade, enrolments in postgraduate courses in Australian universities have risen by 34% (or from 258,164 in 2004 to 347,363 in 2013) (uCube, 2014). This substantial growth can be attributed to increased demand for postgraduate coursework as continuing professional education, the expansion of Higher Degrees Research (HDR) intakes, and the development of postgraduate research and coursework degrees in new fields. At the same time, the establishment of the Australian Qualification Framework (AQF) and national Tertiary Education Quality and Standards Agency (TEQSA), as well as the internationalisation of postgraduate education, have brought challenges and opportunities to the sector. During the past five years, the Australian Government Office for Learning and Teaching (OLT) and its predecessor bodies have funded a number of projects and Fellowships on postgraduate coursework and research degrees. They span diverse topics–from entry pathways and research training to supporting international and Indigenous students, examination, scoping studies of new and emergent programs, and effective supervision. In 2014 the OLT commissioned this good practice report to review the grants and fellowships conducted between 2009 and 2014. Encompassing twenty-seven learning and teaching projects and fellowships, the aims of this report include providing universities and academics with an overview of the current state of postgraduate study in Australia and the major influences upon it; a coherent overview of funded projects’ findings and outcomes; and a central point to access good practices, resources and tools in summary form. The objectives of this good practice report are to provide: • A literature review, which contextualises the projects within the Australian and international Higher Education environment, emphasises factors that currently influence postgraduate programs, and highlights challenges and opportunities for the sector. It also explains variations in postgraduate course types and definitions within the Australian Qualification Framework (AQF), and identifies key learning and teaching issues as well as good practices identified in scholarly research and position papers. • A collated overview of the twenty-seven national learning and teaching projects and fellowships on postgraduate coursework and research, including a summary of each project’s aims and objectives, methodologies, outcomes and resources. • A summative index of project characteristics (topics, themes and approaches) and inventory of scholarly research outcomes of the completed projects (publications, reports) as well as resources produced (tools, methods, good practice case studies), and their location (URL Links, references, etc.). • A summary of good practices that have been identified from the literature and the findings of completed projects. • A set of recommendations to address remaining gaps in the field and areas in which further work or development are appropriate. Bringing this work together will help enable university course teams to improve the delivery and development of existing postgraduate courses and to develop new ones, and it will provide academics with an overview of good practices and resources for teaching, supervising and supporting postgraduate students.

Informal interactions between audit committees and internal audit functions : exploratory evidence and directions for future research

Purpose – This paper aims to recognise the importance of informal processes within corporate governance and complement existing research in this area by investigating factors associated with the existence of informal interactions between audit committees and internal audit functions and in providing directions for future research. Design/methodology/approach – To examine the existence and drivers of informal interactions between audit committees and internal audit functions, this paper relies on a questionnaire survey of chief audit executives (CAEs) in the UK from listed and non-listed, as well as financial and non-financial, companies. While prior qualitative research suggests that informal interactions do take place, most of the evidence is based on particular organisational setting or on a very small range of interviews. The use of a questionnaire enabled the examination of the existence of internal interactions across a relatively larger number of entities. Findings – The paper finds evidence of audit committees and internal audit functions engaging in informal interactions in addition to formal pre-scheduled regular meetings. Informal interactions complement formal meetings with the audit committee and as such represent additional opportunities for the audit committees to monitor internal audit functions. Audit committees’ informal interactions are significantly and positively associated with audit committee independence, audit chair’s knowledge and experience, and internal audit quality. Originality/value – The results demonstrate the importance of the background of the audit committee chair for the effectiveness of the governance process. This is possibly the first paper to examine the relationship between audit committee quality and internal audit, on the existence and driver of informal interactions. Policy makers should recognize that in addition to formal mechanisms, informal processes, such as communication outside of formal pre-scheduled meetings, play a significant role in corporate governance.

Public space for street-scape theatrics : guerrilla spatial tactics and methods of urban hacking in Brisbane, Australia

It could be argued that architecture has an inherent social responsibility to enrich the urban and spatial environments for the city’s occupants. However how we define quality, and how ‘places’ can be designed to be fair and equitable, catering for individuals on a humanistic and psychological level, is often not clearly addressed. Lefebvre discusses the idea of the ‘right to the city’; the belief that public space design should facilitate freedom of expression and incite a sense of spatial ownership for its occupants in public/commercial precincts. Lefebvre also points out the importance of sensory experience in the urban environment. “Street-scape theatrics” are performative activities that summarise these two concepts, advocating the ‘right to the city’ by way of art as well as providing sensual engagement for city users. Literature discusses the importance of Street-scape Theatrics however few sources attempt to discuss this topic in terms of how to design these spaces/places to enhance the city on both a sensory and political level. This research, grounded in political theory, investigates the case of street music, in particular busking, in the city of Brisbane, Australia. Street culture is a notion that already exists in Brisbane, but it is heavily controlled especially in central locations. The study discusses how sensory experience of the urban environment in Brisbane can be enriched through the design for busking; multiple case studies, interviews, observations and thematic mappings provide data to gather an understanding of how street performers see and understand the built form. Results are sometime surprisingly incongruous with general assumptions in regards to street artist as well as the established political and ideological framework, supporting the idea that the best and most effective way of urban hacking is working within the system. Ultimately, it was found that the Central Business District in Brisbane, Australia, could adopt certain political and design tactics which attempt to reconcile systematic quality control with freedom of expression into the public/commercial sphere, realism upheld. This can bridge the gap between the micro scale of the body and the macro of the political economy through freedom of expression, thus celebrating the idiosyncratic nature of the city.

“Do I really need a nap?”: The role of sleep science in informing sleep practices in early childhood education and care settings

A compelling body of studies identifies the importance of sleep for children’s learning, behavioral regulation, and health. These studies have primarily focused on nighttime sleep or on total sleep duration. The independent contribution of daytime sleep, or napping, in childhood is an emerging research focus. Daytime sleep is particularly pertinent to the context of early childhood education and care (ECEC) where, internationally, allocation of time for naps is commonplace through to the time of school entry. The biological value of napping varies with neurological maturity and with individual circumstance. Beyond the age of 3 years, when monophasic sleep patterns become typical, there is an increasing disjuncture between children’s normative sleep requirements and ECEC practice. At this time, research evidence consistently identifies an association between napping and decreased quality and duration of night sleep. We assess the implications of this evidence for educational practice and health policy. We identify the need to distinguish the functions of napping from those of rest, and assert the need for evidence-based guidelines on sleep–rest practices in ECEC settings to accommodate individual variation in sleep needs. Given both the evidence on the impact of children’s nighttime sleep on long-term trajectories of health and well-being and the high rates of child attendance in ECEC programs, we conclude that policy and practice regarding naptime have significant implications for child welfare and ongoing public health.

Parent feeding interactions and practices during childhood cancer treatment: A qualitative investigation

In the general population it is evident that parent feeding practices can directly shape a child’s life long dietary intake. Young children undergoing childhood cancer treatment may experience feeding difficulties and limited food intake, due to the inherent side effects of their anti-cancer treatment. What is not clear is how these treatment side effects are influencing the parent–child feeding relationship during anti-cancer treatment. This retrospective qualitative study collected telephone based interview data from 38 parents of childhood cancer patients who had recently completed cancer treatment (child’s mean age: 6.98 years). Parents described a range of treatment side effects that impacted on their child’s ability to eat, often resulting in weight loss. Sixty-one percent of parents (n = 23) reported high levels of stress in regard to their child’s eating and weight loss during treatment. Parents reported stress, feelings of helplessness, and conflict and/or tension between parent and the child during feeding/eating interactions. Parents described using both positive and negative feeding practices, such as: pressuring their child to eat, threatening the insertion of a nasogastric feeding tube, encouraging the child to eat and providing home cooked meals in hospital. Results indicated that parent stress may lead to the use of coping strategies such as positive or negative feeding practices to entice their child to eat during cancer treatment. Future research is recommended to determine the implication of parent feeding practice on the long term diet quality and food preferences of childhood cancer survivors.

Bridging the gap: Exploring the barriers to using economic evidence in healthcare decision making and strategies for improving uptake

Evidence from economic evaluations is often not used to inform healthcare policy despite being well regarded by policy makers and physicians. This article employs the accessibility and acceptability framework to review the barriers to using evidence from economic evaluation in healthcare policy and the strategies used to overcome these barriers. Economic evaluations are often inaccessible to policymakers due to the absence of relevant economic evaluations, the time and cost required to conduct and interpret economic evaluations, and lack of expertise to evaluate quality and interpret results. Consistently reported factors that limit the translation of findings from economic evaluations into healthcare policy include poor quality of research informing economic evaluations, assumptions used in economic modelling, conflicts of interest, difficulties in transferring resources between sectors, negative attitudes to healthcare rationing, and the absence of equity considerations. Strategies to overcome these barriers have been suggested in the literature, including training, structured abstract databases, rapid evaluation, reporting checklists for journals, and considering factors other than cost effectiveness in economic evaluations, such as equity or budget impact. The factors that prevent or encourage decision makers to use evidence from economic evaluations have been identified, but the relative importance of these factors to decision makers is uncertain.

The impact of frailty and polypharmacy on adverse outcomes in older inpatients

Background Older people are at significant risk of adverse outcomes as a result of changes in physiology, frailty, co-morbidity and polypharmacy.1 Timely identification of high-risk patients may facilitate the optimization of medication and reduce the incidence of adverse outcomes. The aims of this study were to evaluate in older inpatients the relationships between risk factors, including frailty and polypharmacy, and adverse health outcomes. Methods This is a prospective study of 1418 patients, aged 70 and older, admitted to general medical units in 11 acute care hospitals across Australia. The interRAI Acute Care (interRAI AC) assessment tool was used for data collection. Frailty status was measured using a Frailty Index (FI), adding each individual’s deficits and dividing by the total number of deficits considered. Adverse health outcomes included falls in hospital, delirium, in-hospital functional and cognitive decline, discharge to a higher level of care and inpatient mortality. Results Patients had a mean age 81 ± 6.8 years with a median length of hospital stay of 6 days (interquartile range 4 to 11 days); 701 (50%) experienced at least one adverse outcome. Polypharmacy (5-9 drugs per day) was observed in almost half of the study population (n=695, 49%) and hyper-polypharmacy (≥10 drugs) observed in about one-third of patients (n=490, 34.6%). Cognitive impairment was shown to be associated with the lower rate of prescribing. FI had a significant association with all adverse outcomes studied (p = <0.05). In contrast, no association was observed between polypharmacy categories and adverse outcomes except for those on 10 or more drugs where they were more likely to be discharged to a higher level of care (p= 0.014). Conclusions Among older inpatients, frailty status was a significant predictor of adverse outcomes. Lower rates of prescribing to patients with cognitive impairment may underpin the lack of an association between polypharmacy and adverse outcomes in this cohort. References: 1. Olsson IN, Runnamo R, Engfeldt P. Medication quality and quality of life in the elderly, a cohort study.Health Qual Life Outcomes.2011;9:95

Physical, chemical, biological and ecotoxicological properties of wastewater discharged from Davis Station, Antarctica

The properties and toxicity of untreatedwastewater at Davis Station, East Antarctica,were investigated to inform decisions regarding the appropriate level of treatment for local discharge purposes and more generally, to better understand the risk associated with dispersal and impact of wastewaters in Antarctica. Suspended solids, nutrients (nitrogen, phosphorus), biological oxygen demand (BOD), metals, organic contaminants, surfactants and microbiological load were measured at various locations throughout the wastewater discharge system. Wastewater quality and properties varied greatly between buildings on station, each ofwhich has separate holding tanks. Nutrients, BOD and settleable solid levelswere higher than standard municipal wastewaters. Microbiological loads were typical of untreated wastewater. Contaminants detected in the wastewater included metals and persistent organic compounds, mainly polybrominated diphenyl ethers (PBDEs). The toxicity of wastewater was also investigated in laboratory bioassays using two local Antarctic marine invertebrates, the amphipod Paramoera walkeri and the microgastropod Skenella paludionoides. Animals were exposed to a range of wastewater concentrations from3% to 68% (test 1) or 63% (test 2) over 21 days with survival monitored daily. Significant mortality occurred in all concentrations of wastewater after 14 to 21 days, and at higher concentrations (50–68% wastewater) mortality occurred after only one day. Results indicate that the local receiving marine environment at Davis Station is at risk from existing wastewater discharges, and that advanced treatment is required both to remove contaminants shown to cause toxicity to biota, as well as to reduce the environmental risks associated with non-native micro-organisms in wastewater.