Raising the voice of dissatisfaction : a qualitative study of the Queensland acute health care consumer and the experience of complaining

Research into complaints handling in the health care system has predominately focused on examining the processes that underpin the organisational systems. An understanding of the cognitive decisions made by patients that influence whether they are satisfied or dissatisfied with the care they are receiving has had limited attention thus far. This study explored the lived experiences of Queensland acute care patients who complained about some aspect of their inpatient stay. A purposive sample of sixteen participants was recruited and interviewed about their experience of making a complaint. The qualitative data gathered through the interview process was subjected to an Interpretative Phenomenological Analysis (IPA) approach, guided by the philosophical influences of Heidegger (1889-1976). As part of the interpretive endeavour of this study, Lazarus’ cognitive emotive model with situational challenge was drawn on to provide a contextual understanding of the emotions experienced by the study participants. Analysis of the research data, aided by Leximancer™ software, revealed a series of relational themes that supported the interpretative data analysis process undertaken. The superordinate thematic statements that emerged from the narratives via the hermeneutic process were ineffective communication, standards of care were not consistent, being treated with disrespect, information on how to complain was not clear, and perceptions of negligence. This study’s goal was to provide health services with information about complaints handling that can help them develop service improvements. The study patients articulated the need for health care system reform; they want to be listened to, to be acknowledged, to be believed, for people to take ownership if they had made a mistake, for mistakes not to occur again, and to receive an apology. For these initiatives to be fully realised, the paradigm shift must go beyond regurgitating complaints data metrics in percentages per patient contact, towards a concerted effort to evaluate what the qualitative complaints data is really saying. An opportunity to identify a more positive and proactive approach in encouraging our patients to complain when they are dissatisfied has the potential to influence improvements.

Drawing the line : the legal status and treatment of the 17-year-old accused in Queensland

Seventeen year olds who come into contact with the police in Queensland are classified as adults and are not afforded the protections available under the Youth Justice Act 1992 (Qld) (YJA). As with any other adult, their offences are dealt with under a raft of legislative provisions including the Criminal Code 1889 (Qld) (the Code), the Police Powers and Responsibilities Act 2000 (Qld) (PPRA) and the Penalties and Sentences Act 1992 (Qld) (PSA). This article argues that this situation is unfair and contravenes international human rights agreements which Australia has ratified, in particular the United Nations Convention on the Rights of the Child (CROC). Article 1 of that Convention defines a child as a person under the age of 18. The youth offences legislation in Queensland only applies to those who have not yet turned 17. This article examines the effects of this anomaly in Queensland, focusing in particular on the pre-adjudication treatment of ‘17 year old adults’.

Polymer self assembly on carbon nanotubes

This chapter analyses the poly(3-hexylthiophene) self-assembly on carbon nanotubes and the interaction between the two materials forming a new hybrid nanostructure. The chapter starts with a review of the several studies investigating polymers and biomolecules self-assembled on nanotubes. Then conducting polymers and polythiophenes are briefly introduced. Accordingly, carbon nanotube structure and properties are reported in Sect. 3. The experimental section starts with the bulk characterisation of polymer thin films with the inclusion of uniformly distributed carbon nanotubes. By using volume film analysis techniques (AFM, TEM, UV–Vis and Raman), we show how the polymer’s higher degree of order is a direct consequence of interaction with carbon nanotubes. Nevertheless, it is through the use of nanoscale analysis and molecular dynamic simulations that the self-assembly of the polymer on the nanotube surface can be clearly evidenced and characterised. In Sect. 6, the effect of the carbon templating structure on the P3HT organisation on the surface is investigated, showing the chirality-driven polymer assembly on the carbon nanotube surface. The interaction between P3HT and CNTs brings also to charge transfer, with the modification of physical properties for both species. In particular, the alteration of the polymer electronic properties and the modification of the nanotube mechanical structure are a direct consequence of the P3HT p-p stacking on the nanotube surface. Finally, some considerations based on molecular dynamics studies are reported in order to confirm and support the experimental results discussed.

Optical and microscopic study of a polymer-nanotube mixture for organic photovoltaic applications

Organic solar cells based on bulk heterojunction between a conductive polymer and a carbon nanostructure offer potential advantages compared to conventional inorganic cells. Low cost, light weight, flexibility and high peak power per unit weight are all features that can be considered a reality for organic photovoltaics. Although polymer/carbon nanotubes solar cells have been proposed, only low power conversion efficiencies have been reached without addressing the mechanisms responsible for this poor performance. The purpose of this work is therefore to investigate the basic interaction between carbon nanotubes and poly(3-hexylthiophene) in order to demonstrate how this interaction affects the performance of photovoltaic devices. The outcomes of this study are the contributions made to the knowledge of the phenomena explaining the behaviour of electronic devices based on carbon nanotubes and poly(3-hexylthiophene). In this PhD, polymer thin films with the inclusion of uniformly distributed carbon nanotubes were deposited from solution and characterised. The bulk properties of the composites were studied with microscopy and spectroscopy techniques to provide evidence of higher degrees of polymer order when interacting with carbon nanotubes. Although bulk investigation techniques provided useful information about the interaction between the polymer and the nanotubes, clear evidence of the phenomena affecting the heterojunction formed between the two species was investigated at nanoscale. Identifying chirality-driven polymer assisted assembly on the carbon nanotube surface was one of the major achievements of this study. Moreover, the analysis of the electrical behaviour of the heterojunction between the polymer and the nanotube highlighted the charge transfer responsible for the low performance of photovoltaic devices. Polymer and carbon nanotube composite-based devices were fabricated and characterised in order to study their electronic properties. The carbon nanotube introduction in the polymer matrix evidenced a strong electrical conductivity enhancement but also a lower photoconductivity response. Moreover, the extension of pristine polymer device characterisation models to composites based devices evidenced the conduction mechanisms related to nanotubes. Finally, the introduction of carbon nanotubes in the polymer matrix was demonstrated to improve the pristine polymer solar cell performance and the spectral response even though the power conversion efficiency is still too low.

The association between objectively measured neighborhood features and walking in middle-aged adults

Purpose: To explore the role of the neighborhood environment in supporting walking Design: Cross sectional study of 10,286 residents of 200 neighborhoods. Participants were selected using a stratified two-stage cluster design. Data were collected by mail survey (68.5% response rate). Setting: The Brisbane City Local Government Area, Australia, 2007. Subjects: Brisbane residents aged 40 to 65 years. Measures Environmental: street connectivity, residential density, hilliness, tree coverage, bikeways, and street lights within a one kilometer circular buffer from each resident’s home; and network distance to nearest river or coast, public transport, shop, and park. Walking: minutes in the previous week categorized as < 30 minutes, ≥ 30 < 90 minutes, ≥ 90 < 150 minutes, ≥ 150 < 300 minutes, and ≥ 300 minutes. Analysis: The association between each neighborhood characteristic and walking was examined using multilevel multinomial logistic regression and the model parameters were estimated using Markov chain Monte Carlo simulation. Results: After adjustment for individual factors, the likelihood of walking for more than 300 minutes (relative to <30 minutes) was highest in areas with the most connectivity (OR=1.93, 99% CI 1.32-2.80), the greatest residential density (OR=1.47, 99% CI 1.02-2.12), the least tree coverage (OR=1.69, 99% CI 1.13-2.51), the most bikeways (OR=1.60, 99% CI 1.16-2.21), and the most street lights (OR=1.50, 99% CI 1.07-2.11). The likelihood of walking for more than 300 minutes was also higher among those who lived closest to a river or the coast (OR=2.06, 99% CI 1.41-3.02). Conclusion: The likelihood of meeting (and exceeding) physical activity recommendations on the basis of walking was higher in neighborhoods with greater street connectivity and residential density, more street lights and bikeways, closer proximity to waterways, and less tree coverage. Interventions targeting these neighborhood characteristics may lead to improved environmental quality as well as lower rates of overweight and obesity and associated chromic disease.

An audio wiki supporting mobile collaboration

Wikis have proved to be very effective collaboration and knowledge management tools in large variety of fields thanks to their simplicity and flexible nature. Another important development for the internet is the emergence of powerful mobile devices supported by fast and reliable wireless networks. The combination of these developments begs the question of how to extend wikis on mobile devices and how to leverage mobile devices' rich modalities to supplement current wikis. Realizing that composing and consuming through auditory channel is the most natural and efficient way for mobile device user, this paper explores the use of audio as the medium of wiki. Our work, as the first step towards this direction, creates a framework called Mobile Audio Wiki which facilitates asynchronous audio-mediated collaboration on the move. In this paper, we present the design of Mobile Audio Wiki. As a part of such design, we propose an innovative approach for a light-weight audio content annotation system for enabling group editing, versioning and cross-linking among audio clips. To elucidate the novel collaboration model introduced by Mobile Audio Wiki, its four usage modes are identified and presented in storyboard format. Finally, we describe the initial design for presentation and navigation of Mobile Audio Wiki.

Occupational therapy students’ contribution to occasions of service during practice placements in health settings

Currently in the Australian higher education sector, the productivity benefits of occupational therapy clinical education placements are a contested issue. This article will report results of a study that developed a methodology for documenting time use during placements and investigated the productivity changes associated with occupational therapy clinical education placements in Queensland, Australia. Supervisors’ and students’ time use during placements and how this changed for supervisors compared to pre- and post-placement is also presented. Methods: Using a cohort survey design, participants were students from two Queensland universities, and their supervisors employed by Queensland Health. Time use was recorded in 30 minute blocks according to particular categories. Results: There was a significant increase in supervisors’ time spent in patient care activities (F = 94.0112,12.37 df, P < 0.001) between pre- and during placement (P < 0.001) and decrease between during and post-placement (P < 0.001). Supervisors’ time spent in all non-patient care activities was also significant (F = 4.5802,16 df, P = 0.027) increasing between pre- and during placement (P = 0.028). There was a significant decrease in supervisors’ time spent in placement activities (F = 5.1332,19.18 df, P = 0.016) from during to post-placement. Students spent more time than supervisors in patient care activities while on placement. Discussion: A novel method for reporting productivity and time-use changes during clinical education programs for occupational therapy has been applied. Supervisors spent considerable time in assessing and managing students and their clinical education role should be seen as core business in standard occupational therapy practice. This paper will contribute to future assessments of the economic.

Quantum key distribution in the classical authenticated key exchange framework

Key establishment is a crucial primitive for building secure channels in a multi-party setting. Without quantum mechanics, key establishment can only be done under the assumption that some computational problem is hard. Since digital communication can be easily eavesdropped and recorded, it is important to consider the secrecy of information anticipating future algorithmic and computational discoveries which could break the secrecy of past keys, violating the secrecy of the confidential channel. Quantum key distribution (QKD) can be used generate secret keys that are secure against any future algorithmic or computational improvements. QKD protocols still require authentication of classical communication, although existing security proofs of QKD typically assume idealized authentication. It is generally considered folklore that QKD when used with computationally secure authentication is still secure against an unbounded adversary, provided the adversary did not break the authentication during the run of the protocol. We describe a security model for quantum key distribution extending classical authenticated key exchange (AKE) security models. Using our model, we characterize the long-term security of the BB84 QKD protocol with computationally secure authentication against an eventually unbounded adversary. By basing our model on traditional AKE models, we can more readily compare the relative merits of various forms of QKD and existing classical AKE protocols. This comparison illustrates in which types of adversarial environments different quantum and classical key agreement protocols can be secure.

Is language a barrier for quality care in hospitals? A case series from an Emergency Department of a teaching hospital in Brisbane

Aim: The aim of this pilot study is to describe the use of an Emergency Department (ED) at a large metropolitan teaching hospital by patients who speak English or other languages at home. Methods: All data were retrieved from the Emergency Department Information System (EDIS) of this tertiary teaching hospital in Brisbane. Patients were divided into two groups based on the language spoken at home: patients who speak English only at home (SEO) and patients who do not speak English only or speak other language at home (NSEO). Modes of arrival, length of ED stay and the proportion of hospital admission were compared among the two groups of patients by using SPSS V18 software. Results: A total of 69,494 patients visited this hospital ED in 2009 with 67,727 (97.5%) being in the SEO group and 1,281 (1.80%) in the NSEO group. The proportion of ambulance utilisation in arrival mode was significantly higher among SEO 23,172 (34.2%) than NSEO 397 (31.0%), p <0.05. The NSEO patients had longer length of stay in the ED (M = 337.21, SD = 285.9) compared to SEO patients (M= 290.9, SD = 266.8), with 46.3 minutes (95%CI 62.1, 30.5, p <0.001) difference. The admission to the hospital among NSEO was 402 (31.9%) higher than SEO 17,652 (26.6%), p <0.001. Conclusion: The lower utilisation rates of ambulance services, longer length of ED stay and higher hospital admission rates in NSEO patients compared to SEO patients are consistent with other international studies and may be due to the language barriers.