Creating a therapeutic environment : a non-randomised controlled trial of a quiet time intervention for patients in acute care

Background: Noise is a significant barrier to sleep for acute care hospital patients, and sleep has been shown to be therapeutic for health, healing and recovery. Scheduled quiet time interventions to promote inpatient rest and sleep have been successfully trialled in critical care but not in acute care settings. Objectives: The study aim was to evaluate as cheduled quiet time intervention in an acute care setting. The study measured the effect of a scheduled quiet time on noise levels, inpatients’ rest and sleep behaviour, and wellbeing. The study also examined the impact of the intervention on patients’, visitors’ and health professionals’ satisfaction, and organisational functioning. Design: The study was a multi-centred non-randomised parallel group trial. Settings: The research was conducted in the acute orthopaedic wards of two major urban public hospitals in Brisbane, Australia. Participants: All patientsadmitted to the two wards in the5-month period of the study were invited to participate, withafinalsample of 299 participants recruited. This sample produced an effect size of 0.89 for an increase in the number of patients asleep during the quiet time. Methods: Demographic data were collected to enable comparison between groups. Data for noise level, sleep status, sleepiness and well being were collected using previously validated instruments: a Castle Model 824 digital sound level indicator; a three point sleep status scale; the Epworth Sleepiness Scale; and the SF12 V2 questionnaire. The staff, patient and visitor surveys on the experimental ward were adapted from published instruments. Results: Significant differences were found between the two groups in mean decibel level and numbers of patients awake and asleep. The difference in mean measured noise levels between the two environments corresponded to a ‘perceived’ difference of 2 to 1. There were significant correlations between average decibel level and number of patients awake and asleep in the experimental group, and between average decibel level and number of patients awake in the control group. Overall, patients, visitors and health professionals were satisfied with the quiet time intervention. Conclusions: The findings show that a quiet time intervention on an acute care hospital ward can affect noise level and patient sleep/wake patterns during the intervention period. The overall strongly positive response from surveys suggests that scheduled quiet time would be a positively perceived intervention with therapeutic benefit.

Marketplace forces and the history of retailing : The cycle of control

This paper traces the history of store (retailer-controlled) and national (manufacture controlled)brands; identifies the key historical characteristics of the past 200 years of marketing history;describes the four main time periods of U.S. retail marketing (1800 - 2000); and comments on the most likely developments within the current phases of brand marketing. Will the future focus on technology and new forms of communications? The Internet exemplifies an unconventional retailing environment, with etailer numbers growing rapidly. The central proposition of this paper is that a "cycle of control" - a pattern of marketing developments within the history of retailing and national marketing communications - Can indicate the success of marketing strategies in the future.

Effect of height of bridge above water on salt deposition levels

Maintenance of bridge structures is a major issue for the Queensland Department of Main Roads. In the previous phase of this CRC project an initial approach was made towards the development of a program for lifetime prediction of metallic bridge components. This involved the analysis of five representative bridge structures with respect to salt deposition (a major contributor to metallic corrosion) to determine common elements to be used as “cases” - those defined for buildings are not applicable. The five bridges analysed included the Gladstone Port Access Road Overpass, Stewart Road Overpass, South Johnstone River Bridge, Johnson Creek Bridge and the Ward River Bridge.

Report : effect of natural cleaning on salt deposition on Queensland bridges

Maintenance of bridge structures is a major issue for the Queensland Department of Main Roads. In the previous phase of this CRC project an initial approach was made towards the development of a program for lifetime prediction of metallic bridge components. This involved the analysis of five representative bridge structures with respect to salt deposition (a major contributor to metallic corrosion) to determine common elements to be used as “cases” - those defined for buildings are not applicable. The five bridges analysed included the Gladstone Port Access Road Overpass, Stewart Road Overpass, South Johnstone River Bridge, Johnson Creek Bridge and the Ward River Bridge.

Determinants of pre-hospital care non-usage for patients with emergency care needs [including commentary by Snooks H.]

Objective-To establish the demographic, health status and insurance determinants of pre-hospital ambulance non-usage for patients with emergency medical needs. Methods-Triage category, date of birth, sex, marital status, country of origin, method and time of arrival, ambulance insurance status, diagnosis, and disposal were collected for all patients who presented over a four month period (n=10 229) to the emergency department of a major provincial hospital. Data for patients with urgent (n=678) or critical care needs (n=332) who did not use pre-hospital care were analysed using Poisson regression. Results-Only a small percentage (6.6%) of the total sample were triaged as having urgent medical needs or critical care needs (3.2%). Predictors of usage for those with urgent care needs included age greater than 65 years (prevalence ratio (PR)=0.54; 95% confidence interval (CI)= 0.35 to 0.83), being admitted to intensive care or transferred to another hospital (PR=0.62; 95% CI=0.44 to 0.89) or ward (PR=0.72; 95% CI=0.56 to 0.93) and ambulance insurance status (PR=0.67; 95% CI=052 to 0.86). Sex, marital status, time of day and country of origin were not predictive of usage and non-usage. Predictors of usage for those with critical care needs included age 65 years or greater (PR=0.45; 95% CI=0.25 to 0.81) and a diagnosis of trauma (PR=0.49; 95% CI=0.26 to 0.92). A non-English speaking background was predictive of non-usage (PR=1.98; 95% CI=1.06 to 3.70). Sex, marital status, time of day, triage and ambulance insurance status were not predictive of non-usage. Conclusions-Socioeconomic and medical factors variously influence ambulance usage depending on the severity or urgency of the medical condition. Ambulance insurance status was less of an influence as severity of condition increased suggesting that, at a critical level of urgency, patients without insurance are willing to pay for a pre-hospital ambulance service.

The new world of work and employment: fitness workers and what they want from the employment relationship

This paper reports on an empirically based study of the Queensland (Australia) health and fitness industry over 15 years (1993 -2008). This study traces the development of the new occupation of fitness instructor in a service industry which has evolved si nce the 1980s and is embedded in values of consumption and individualism. It is the new world of work. The data from the 1993 study was historically significant, capturing the conditions o f employment in an unregulated setting prior to the introduction of the first industrial a ward in that industry in 1994. Fitness workers bargained directly with employers over all a spects of the employment relationship without the constraints of industrial regulation or the presence of trade unions. The substantive outcomes of the employment relationship were a direct reflection of m anagerial prerogative and worker orientation and preference, and did not reflect the rewards and outcomes traditionally found in Australian workplaces. While the focus of the 1993 research was on exploring the employment relationship in a deregulated environment, an unusual phenomenon was identified: fitness workers happily trading-off what would be considere d standard working conditions for the opportunity to work (‘take the stage’). Since then, several streams of literature have evolved providing a new context for understanding this phenomenon in the fitness industry, including: the sociology of the body (Shilling 1993; Turner 1996); emotional (Hochschild 1984) and aesthetic labour (Warhurst et al 2000); the so cial relations of production and space (Lefebvre 1991; Moss 1995); body history (Helps 2007); the sociology of consumption (Saunders 1988; Baudrillard 1998; Ritzer 2004); and work identity (Du Gay 1996; Strangleman 2004). The 2008 survey instrument replicated the 1993 study but was additionally informed b y the new literature. Surveys were sent to 310 commercial fitness centres and 4,800 fitness workers across Queensland. Worker orientation appears unchanged, and industry working conditions still seem atypical despite regulation si nce 1994. We argue that for many fitness workers the goal is to gain access to the fitness centre economy. For this they are willing to trade-off standard conditions of employment, and exchange traditional employm ent rewards for m ore intrinsic psycho-social rewards gained the through e xp o sure of their physical capital (Bourdieu 1984) o r bo dily prowess to the adoration o f their gazing clients. Building on the tradition of emotional labour and aesthetic labour, this study introduces the concept of ocularcentric labour: a state in which labour’s quest for the psychosocial rewards gained from their own body image shapes the employment relationship. With ocularcentric labour the p sycho-social rewards have greater value for the worker than ‘hard’, core conditions of employment, and are a significant factor in bargaining and outcomes, often substituting fo r direct earnings. The wo rkforce profile (young, female, casual) and their expectations (psycho-social rewards of ado ration and celebrity) challenge traditional trade unions in terms of what they can deliver, given the fitness workers’ willingness to trade-off minimum conditions, hard-won by unions.

Staff perspectives of a cardiology short stay unit

Objective To evaluate staff perceptions about working environment, efficiency and the clinical safety of a cardiovascular intervention short stay unit (SSU) during the first year of operation. Design Postal questionnaire. Setting Cardiac catheterisation laboratory (CCL), coronary care unit (CCU), general cardiology ward (GCW) and the short stay unit (SSU) of a tertiary referral hospital situated in the mid coastal region of NSW. Subjects Cardiologists (including visiting medical officers [VMO]), cardiology fellows, cardiology advanced trainees and nurses. Results Responses on the working environment of the SSU and the discharge process were statistically significant. A substantial proportion of both nurses and doctors had concerns about patient safety, even though no adverse events were formally recorded in the database. Conclusions Though the participants of the survey agree on the efficiency of the SSU in providing beds to the hospital, they disagree on aspects that are important in the functioning of the SSU, including the working environment, patient selection and clinical safety. The results highlight potential issues that could be improved or addressed and are relevant to the rollout of SSUs across NSW.

Biomechanical force displacement analysis of strength of fixation of tracker holding devices to bone in computer aided joint replacement

Computer aided joint replacement surgery has become very popular during recent years and is being done in increasing numbers all over the world. The accuracy of the system depends to a major extent, on accurate registration and immobility of the tracker attachment devices to the bone. This study was designed to asses the forces needed to displace the tracker attachment devices in the bone simulators. Bone simulators were used to maintain the uniformity of the bone structure during the study. The fixation devices tested were 3mm diameter self drilling, self tapping threaded pin, 4mm diameter self tapping cortical threaded pin, 5mm diameter self tapping cancellous threaded pin and a triplanar fixation device ‘ortholock’ used with three 3mm pins. All the devices were tested for pull out, translational and rotational forces in unicortical and bicortical fixation modes. Also tested was the normal bang strength and forces generated by leaning on the devices. The forces required to produce translation increased with the increasing diameter of the pins. These were 105N, 185N, and 225N for the unicortical fixations and 130N, 200N, 225N for the bicortical fixations for 3mm, 4mm and 5mm diameter pins respectively. The forces required to pull out the pins were 1475N, 1650N, 2050N for the unicortical, 1020N, 3044N and 3042N for the bicortical fixated 3mm, 4mm and 5mm diameter pins. The ortholock translational and pull out strength was tested to 900N and 920N respectively and still it did not fail. Rotatory forces required to displace the tracker on pins was to the magnitude of 30N before failure. The ortholock device had rotational forces applied up to 135N and still did not fail. The manual leaning forces and the sudden bang forces generated were of the magnitude of 210N and 150N respectively. The strength of the fixation pins increases with increasing diameter from three to five mm for the translational forces. There is no significant difference in pull out forces of four mm and five mm diameter pins though it is more that the three mm diameter pins. This is because of the failure of material at that stage rather than the fixation device. The rotatory forces required to displace the tracker are very small and much less that that can be produced by the surgeon or assistants in single pins. Although the ortholock device was tested to 135N in rotation without failing, one has to be very careful not to put any forces during the operation on the tracker devices to ensure the accuracy of the procedure.

Behaviour and design of cold-formed steel compression members at elevated temperatures

Cold-formed steel members have been widely used in residential, industrial and commercial buildings as primary load bearing structural elements and non-load bearing structural elements (partitions) due to their advantages such as higher strength to weight ratio over the other structural materials such as hot-rolled steel, timber and concrete. Cold-formed steel members are often made from thin steel sheets and hence they are more susceptible to various buckling modes. Generally short columns are susceptible to local or distortional buckling while long columns to flexural or flexural-torsional buckling. Fire safety design of building structures is an essential requirement as fire events can cause loss of property and lives. Therefore it is essential to understand the fire performance of light gauge cold-formed steel structures under fire conditions. The buckling behaviour of cold-formed steel compression members under fire conditions is not well investigated yet and hence there is a lack of knowledge on the fire performance of cold-formed steel compression members. Current cold-formed steel design standards do not provide adequate design guidelines for the fire design of cold-formed steel compression members. Therefore a research project based on extensive experimental and numerical studies was undertaken at the Queensland University of Technology to investigate the buckling behaviour of light gauge cold-formed steel compression members under simulated fire conditions. As the first phase of this research, a detailed review was undertaken on the mechanical properties of light gauge cold-formed steels at elevated temperatures and the most reliable predictive models for mechanical properties and stress-strain models based on detailed experimental investigations were identified. Their accuracy was verified experimentally by carrying out a series of tensile coupon tests at ambient and elevated temperatures. As the second phase of this research, local buckling behaviour was investigated based on the experimental and numerical investigations at ambient and elevated temperatures. First a series of 91 local buckling tests was carried out at ambient and elevated temperatures on lipped and unlipped channels made of G250-0.95, G550-0.95, G250-1.95 and G450-1.90 cold-formed steels. Suitable finite element models were then developed to simulate the experimental conditions. These models were converted to ideal finite element models to undertake detailed parametric study. Finally all the ultimate load capacity results for local buckling were compared with the available design methods based on AS/NZS 4600, BS 5950 Part 5, Eurocode 3 Part 1.2 and the direct strength method (DSM), and suitable recommendations were made for the fire design of cold-formed steel compression members subject to local buckling. As the third phase of this research, flexural-torsional buckling behaviour was investigated experimentally and numerically. Two series of 39 flexural-torsional buckling tests were undertaken at ambient and elevated temperatures. The first series consisted 2800 mm long columns of G550-0.95, G250-1.95 and G450-1.90 cold-formed steel lipped channel columns while the second series contained 1800 mm long lipped channel columns of the same steel thickness and strength grades. All the experimental tests were simulated using a suitable finite element model, and the same model was used in a detailed parametric study following validation. Based on the comparison of results from the experimental and parametric studies with the available design methods, suitable design recommendations were made. This thesis presents a detailed description of the experimental and numerical studies undertaken on the mechanical properties and the local and flexural-torsional bucking behaviour of cold-formed steel compression member at ambient and elevated temperatures. It also describes the currently available ambient temperature design methods and their accuracy when used for fire design with appropriately reduced mechanical properties at elevated temperatures. Available fire design methods are also included and their accuracy in predicting the ultimate load capacity at elevated temperatures was investigated. This research has shown that the current ambient temperature design methods are capable of predicting the local and flexural-torsional buckling capacities of cold-formed steel compression members at elevated temperatures with the use of reduced mechanical properties. However, the elevated temperature design method in Eurocode 3 Part 1.2 is overly conservative and hence unsuitable, particularly in the case of flexural-torsional buckling at elevated temperatures.

How does ambulance service utilisation impact demand for Emergency Departments in Queensland, Australia?

Background: There are indications that pre-hospital emergency care and management of patients can help reduce the demand for hospital emergency departments (EDs). Ambulance services play a significant role at this stage of care. In 2003, the Queensland Government introduced a Community Ambulance Cover (CAC) levy in return for a free ambulance service at the point of access to all Queenslanders. This may have led to the impression in consumers of an entitlement to free ambulance services under any circumstances regardless of the urgency of the matter which may have in turn contributed to the crowding of EDs in Queensland. Objectives: This paper aims to answer the following questions: - How many patients arrive at hospital EDs by ambulance in Queensland, compared to other modes of arrival? - How has this changed over time, particularly after the CAC introduction in 2003? What percentage of ambulance arrivals are urgent ED patients? - Has the perceived free ambulance services created extra demand for EDs in Queensland, compared with other Australian jurisdictions that charge patients for ambulance services? Methods: We will secondary analyse the data from sources such as Queensland Ambulance Services, Department of Health and Australian Bureau of Statistics to answer the research questions. Findings and Conclusions Queensland has the highest utilization rate of ambulance services (about 18% in 2007-08) and the highest annual growth rate in demand for these services (7.7% on average since 2000-01), well above the population growth. On the other hand, the proportion of ED patients arriving by ambulance in Queensland has increased by about 4% annually. However, when compared with other states and territories with charge at the point of access, it seems that the growth in demand for EDs cannot be explained solely or mainly by CAC or ambulance utilisation in Queensland.

The Autistic Behavioural Indicators Instrument (ABII) : development and instrument utility in discriminating autistic disorder from speech and language impairment and typical development

The Autistic Behavioural Indicators Instrument (ABII) is an 18-item instrument developed to identify children with Autistic Disorder (AD) based on the presence of unique autistic behavioural indicators. The ABII was administered to 20 children with AD, 20 children with speech and language impairment (SLI) and 20 typically developing (TD) children aged 2-6 years. Results indicated that the ABII discriminated children diagnosed with AD from those diagnosed with SLI and those who were TD, based on the presence of specific social attention, sensory, and behavioural symptoms. A combination of symptomology across these domains correctly classified 100% of children with and without AD. The paper concludes that the ABII shows considerable promise as an instrument for the early identification of AD.

An ecological assessment of secondary poisoning risk in the Australian sugarcane industry

Rodenticide use in agriculture can lead to the secondary poisoning of avian predators. Currently the Australian sugarcane industry has two rodenticides, Racumin® and Rattoff®, available for in-crop use but, like many agricultural industries, it lacks an ecologically-based method of determining the potential secondary poisoning risk the use of these rodenticides poses to avian predators. The material presented in this thesis addresses this by: a. determining where predator/prey interactions take place in sugar producing districts; b. quantifying the amount of rodenticide available to avian predators and the probability of encounter; and c. developing a stochastic model that allows secondary poisoning risk under various rodenticide application scenarios to be investigated. Results demonstrate that predator/prey interactions are highly constrained by environmental structure. Rodents used crops that provided high levels of canopy cover and therefore predator protection and poorly utilised open canopy areas. In contrast, raptors over-utilised areas with low canopy cover and low rodent densities, but which provided high accessibility to prey. Given this pattern of habitat use, and that industry baiting protocols preclude rodenticide application in open canopy crops, these results indicate that secondary poisoning can only occur if poisoned rodents leave closed canopy crops and become available for predation in open canopy areas. Results further demonstrate that after in-crop rodenticide application, only a small proportion of rodents available in open areas are poisoned and that these rodents carry low levels of toxicant. Coupled with the low level of rodenticide use in the sugar industry, the high toxic threshold raptors have to these toxicants and the low probability of encountering poisoned rodents, results indicate that the risk of secondary poisoning events occurring is minimal. A stochastic model was developed to investigate the effect of manipulating factors that might influence secondary poisoning hazard in a sugarcane agro-ecosystem. These simulations further suggest that in all but extreme scenarios, the risk of secondary poisoning is also minimal. Collectively, these studies demonstrate that secondary poisoning of avian predators associated with the use of the currently available rodenticides in Australian sugar producing districts is minimal. Further, the ecologically-based method of assessing secondary poisoning risk developed in this thesis has broader applications in other agricultural systems where rodenticide use may pose risks to avian predators.