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

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

A Transformational Role : Donor and charity perspectives on major giving in Australia

Tapping into the thoughts of nearly 50 Australians involved with major giving, this study seeks to know more about why and how people give in what might be called ‘momentous’ ways. It tracks both their triumphs and trials. Perhaps most importantly, it gives a public voice to the perceptions, attitudes, concerns and stories of Australians who have chosen to act philanthropically in a sizeable and ongoing way. In counterpoint, the views, experiences and frustrations of seasoned fundraising professionals who work to generate major giving across a range of causes form the other voices in this study. Thus, donors talk about giving, and occasionally raising support from their peers, and fundraisers talk about developing major gifts. This research has been supported by the Perpetual Foundation, the EF and SL Gluyas Trust and the Edward Corbould Charitable Trust under the management of Perpetual Trustee Company Ltd.

The politics of media policy [Review]

"The Politics of Media Policy opens with a highly insightful analysis of how to do media policy studies in original and significant ways. Unfortunately, by anchoring its empirical analysis closely to a desire to expose the hidden machinations of neo-liberal ideology, it loses focus the more that it moves out of the dominant terrain of political economy in the study of media ownership. Des Freedman has pointed to important new directions in media policy studies, but has unfortunately only got half way to developing a new synthesis for understanding the relationship between policy institutions and broader ideas." -- from author's personal website

Communication and control : case studies in Australian telecommuting

This paper discusses the results of in-depth semi-structured interviews with 39 telecommuters from 12 Australian organisations. The paper serves two broad aims: firstly, it identifies current trends in telecommuting and offers a perspective on Australian developments. Secondly, it provides a focus on significant communication aspects of the Australian telecommuting experience. Findings are that the majority of interviewees reported overall satisfaction with telecommuting as an important contributor to their improved work and lifestyle outcomes. Overall, telecommuters appear to cope with communication aspects of their work environments. They also were not overreliant on advanced communications media when telecommuting. Difficulties as reported by telecommuter interviewees included: perceived discomfort over lack of management support for their telecommuting; reduced levels of interpersonal communication suggesting the likely need to adopt a ‘media mix’ approach to servicing their communication needs; problems of information access; and telecommuters’ reported levels of difficulty with their uses of some computer and communication technologies. Problems relating to telecommuters’ perceived professional and social isolation, were also identified. Finally, the paper underscores where organisational communication theorists and practitioners need to more energetically embrace the concepts of virtual work and telecommuting

Household food expenditure and its contribution to socioeconomic inequalities in purchasing foods consistent with Australian dietary guideline recommendations

Aim: To examine the amount of money spent on food by household income, and to ascertain whether food expenditure mediates the relationship between household income and the purchase of staple foods consistent with Australian dietary guideline recommendations. ----- ----- Methods: In face-to-face interviews (n = 1003, 66.4% response rate), households in Brisbane, Australia were asked about their purchasing choices for a range of staple foods, including grocery items, fruits and vegetables. For each participant, information was obtained about their total weekly household food expenditure, along with their sociodemographic and household characteristics. ----- ----- Results: Household income was significantly associated with food expenditure; participants residing in higher-income households spent more money on food per household member than those from lower-income households. Lower income households were less likely to make food purchasing choices of dietary staples that were consistent with recommendations. However, food expenditure did not attenuate the relationship between household income and the purchase of staple foods consistent with dietary guideline recommendations. ----- ----- Conclusions: The findings suggest that food expenditure may not contribute to income inequalities in purchasing staple foods consistent with dietary guideline recommendations: instead, other material or psychosocial factors not considered in the current study may be more important determinants of these inequalities. Further research should examine whether expenditure on non-staple items and takeaway foods is a larger contributor to socioeconomic inequalities in dietary behavior.

Reconnecting the interrupted landscape : a cultural landscape approach to Australian open-cut coal mining landscapes

In the late 20th century, a value-shift began to influence political thinking, recognising the need for environmentally, socially and culturally sustainable resource development. This shift entailed moves away from thinking of nature and culture as separate entities - The former existing merely to serve the latter. Cultural landscape theory recognises 'nature' as at once both 'natural', and as a 'cultural' construct. As such it may offer a framework through which to progress in the quest for 'sustainable development'. This 2005 Masters thesis makes a contribution to that quest by asking whether contemporary developments in cultural landscape theory can contribute to rehabilitation strategies for Australian open-cut coal mining landscapes, an examplar resource development landscape. A thematic historial overview of landscape values and resource development in Australis post-1788, and a review of cultural landscape theory literature contribute to the formation of the theoretical framework: "reconnecting the interrupted landscape". The author then explores a possible application of this framework within the Australian open-cut coal mining landscape.

Low frequency of CHEK2 1100delC allele in Australian multiple-case breast cancer families : functional analysis in heterozygous individuals

A protein-truncating variant of CHEK2, 1100delC, is associated with a moderate increase in breast cancer risk. We have determined the prevalence of this allele in index cases from 300 Australian multiple-case breast cancer families, 95% of which had been found to be negative for mutations in BRCA1 and BRCA2. Only two (0.6%) index cases heterozygous for the CHEK2 mutation were identified. All available relatives in these two families were genotyped, but there was no evidence of co-segregation between the CHEK2 variant and breast cancer. Lymphoblastoid cell lines established from a heterozygous carrier contained approximately 20% of the CHEK2 1100delC mRNA relative to wild-type CHEK2 transcript. However, no truncated CHK2 protein was detectable. Analyses of expression and phosphorylation of wild-type CHK2 suggest that the variant is likely to act by haploinsufficiency. Analysis of CDC25A degradation, a downstream target of CHK2, suggests that some compensation occurs to allow normal degradation of CDC25A. Such compensation of the 1100delC defect in CHEK2 might explain the rather low breast cancer risk associated with the CHEK2 variant, compared to that associated with truncating mutations in BRCA1 or BRCA2.

Engaging students in clinical bacteriology: A fresh look

Frequently there is a disconnectedness, either perceived or actual, between theoretical principles and laboratory practice in science education and this holds true for clinical microbiology where traditionally knowledge is delivered in ‘chunks’ in a lecture format with the misguided belief that students have to know ‘everything about everything’. This preoccupation with content delivery often leaves no time for active class discussion or reflection. Moreover, laboratory classes are treated as add-ons to the process, rather than an integrated part of the whole learning experience. In redesigning our units (subjects) we have bridged the gap between the theory and practice of clinical bacteriology. In doing so, we have seen a transformation in the learning experiences of our students and in the way we teach.

Cultivating Innovation through Social Relationships: A Qualitative Study of Outstanding Australian Innovators in Science, Technology and the Creative Industries

In this chapter, we describe and explore social relationship patterns associated with outstanding innovation. In doing so, we draw upon the findings of 16 in-depth interviews with award-winning Australian innovators from science & technology and the creative industries. The interviews covered topics relating to various influences on individual innovation capacity and career development. We found that for all of the participants, innovation was a highly social process. Although each had been recognised individually for their innovative success, none worked in isolation. The ability to generate innovative outcomes was grounded in certain types of interaction and collaboration. We outline the distinctive features of the social relationships which seem to be important to innovation, and ask which ‘social network capabilities’ might underlie the ability to create an optimal pattern of interpersonal relationships. We discuss the implications of these findings for universities, which we argue play a key role in the development of nascent innovators.

Louis Nowra, 'Radiance' (Sydney: Currency Press, 1993)

Louis Nowra wrote 'Radiance' especially for the three actors who performed it in the play’s premier season at Belvoir Street Theatre in September 1993. And the Currency Press playscript / programme produced for that season foregrounds these three performers – Rachael Maza, Lydia Miller and Rhoda Roberts – in such a way that the usual distinction between dramatis personae and the actors who play them is considerably diminished. Both the blurb on the back cover and Nowra’s introduction emphasise this special relationship between text and actors, but it is the front cover shot which particularly reflects the conjunction between the two. Rather than depicting a scene from performance, or a ‘graphic’ suggesting something of the play’s thematic content, the front cover of Radiance features the three actors in a posed promotional shot. Arms joined warmly, lovingly, about each other’s waist, bodies turned away from but faces towards the camera, it is the actors we see, not their characters. It’s a very joyful image; they’re positively beaming. Radiant. They look as if they could really be the three half-sisters they portray, except that such moments of blithe sorority are just about non-existent in the play.

The democratic deficit and school-based management in Australia

Purpose: The paper seeks to apply the theory of the democratic deficit to school-based management with an emphasis on Australia. This theory was developed to examine managerial restructuring of the Australian Public Service in the 1990s. Given similarities between the use of managerial practices in the public service and government schools, the authors draw on recent literature about school-based management in Australia and apply the democratic deficit theory to it. ----- ----- Design/methodology/approach: This paper is conceptual in focus. The authors analyse literature in terms of the three components of the democratic deficit – i.e. the weakening of accountability, the denial of the roles and values of public employees, and the emergence of a “hollow state” – and in relation to the application of this theory to the Australian Public Service.----- ----- Findings: A trend towards the three components of the democratic deficit is evident in Australia although, to date, its emergence has not been as extensive as in the UK. The authors argue that the democratic principles on which public schooling in Australia was founded are being eroded by managerial and market practices.----- ----- Practical implications: These findings provide policy makers and practitioners with another way of examining managerial and market understandings of school-based management and its impact on teachers and on students. It offers suggestions to reorient practices away from those that are exclusively managerial-based towards those that are public-sector based.----- ----- Originality/value: The value of this paper is that it applies the theory of the democratic deficit to current understandings of school-based management.

Queers doing theory : Australian queer student activist print media’s representations of capitalism

Queer university student print media often represents capitalism in a framework which could be classified as Marxism. However, at the same time, queer student media extensively publishes ideas which could be classified as academic queer theory. This chapter features analysis of these representations from the 2003, 2004 and 2006 editions of national queer student publication, Querelle, and from a sample of queer student media from four Australian universities. The perspectives of Marxism and academic queer theory are often argued to be contradictory (See for example, Hennessy 1994; Morton 1996b; Kirsch 2007), and thus the students’ application of these theories in tandem could be considered problematic. McKee asks ‘Who gets to be an intellectual?’ (2004) and suggests that the intellectualising undertaken by mainstream and alternative cultural creators is just as valid as that undertaken by university academics. He also raises concerns that the concept of theory is seen to be kept separate from everyday culture (McKee 2002). This chapter argues that in the construction and representation of their politics in this manner the queer student activists are creating their own version of queer theory. This analysis of queer student media contributes to research on queer communities and queer theory, demonstrating how one specific cultural subset theorises queerness and queer politics, thereby contributing to the genealogy of queer.

AITPM national newsletter president's report April 2010

Well, it has been Clem 7 month here in Brisbane and my impression is “so far, so good!” For those of you who know Brisbane, the four lane twin Clem Jones Tunnel (M7) is approximately 4.5km long, and connects Ipswich Road (A7) at the Princess Alexandra Hospital on the south side with Bowen Bridge Road (A3) at the Royal Brisbane Hospital on the north side. There are also south access ramps to the Pacific Motorway and east access ramps to Shafston Avenue (headed to/from Wynnum). Brisbanites have been enjoying a three week no-toll taste test, and I paced through it one evening with minimal fuss. The tunnel seems to have eased the congestion at the Stanley Street on-ramp to the Pacific Motorway quite a bit, and Ipswich Road – Main Street through the ‘Gabba. One must watch the signage carefully, but once we get used to the infrastructure, this will not likely be problematic. It will be interesting to see how traffic behaves when the system settles after tolling, which has likely commenced by the time you’re reading. I believe a passenger car toll is about $4.20 one way but saves about 24 signalised intersection pass-throughs.

AITPM national newsletter President's report May 2010

We’ve had a bit of sticker shock in these parts. Well, apparently. Since my last missive, Brisbane’s Clem Jones Tunnel which was initially free now has a toll, at least partially, at the introductory rate of $2.95 for a one-way car ride between 5a.m. and midnight – free overnight. From 9 May 2010 the toll will be $4.28. Since the introductory toll was introduced, use of the tunnel appears to have declined somewhat – no surprise to transport professionals I suppose. An additional factor may have been that the “novelty value” of driving through the tunnel for free had worn off. This demonstrates to me that much of the community may still see the use of road infrastructure as a rite of passage, with only some actually weighing up the true value of their travel time and vehicle wear and tear against their out of pocket (or onto credit card) cost. Thus, we’re in pioneering times and the role of transport economics in the overall transport infrastructure planning realm is of considerable importance – especially as much of the new big ticket infrastructure is likely to be tolled into the future. The Queensland Premier, Anna Bligh, made poignant commentary about Brisbane City Council’s tunnel use in that such infrastructure is built for future times and not just as a quick fix for current traffic problems. My expectation is that once Airport Link, which is really the northern half of the corridor, opens in 2012, there will be a significant spike in Clem7 usage.

The development of fast bowling experts in Australian cricket

In this paper, we highlight key concepts from dynamical systems theory and complexity sciences to exemplify constraints on talent development in a sample of elite cricketers. Eleven international fast bowlers who cumulatively had taken more than 2,400 test wickets in over 600 international test matches were interviewed using an in-depth, open-ended, and semi-structured approach. Qualitative data were analysed to identify key components in fast bowling expertise development. Results revealed that, contrary to traditional perspectives, the athletes progressed through unique, nonlinear trajectories of development, which appears to be a commonality in the experts' developmental pathways. During development, individual experts encountered unique constraints on the acquisition of expertise in cricket fast bowling, resulting in unique performance adaptations. Specifically, data illustrated experts' ability to continually adapt behaviours under multifaceted ecological constraints.