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.

Distinguishing forced versus discretionary replacements in new product diffusion models

In many product categories of durable goods such as TV, PC, and DVD player, the largest component of sales is generated by consumers replacing existing units. Aggregate sales models proposed by diffusion of innovation researchers for the replacement component of sales have incorporated several different replacement distributions such as Rayleigh, Weibull, Truncated Normal and Gamma. Although these alternative replacement distributions have been tested using both time series sales data and individual-level actuarial “life-tables” of replacement ages, there is no census on which distributions are more appropriate to model replacement behaviour. In the current study we are motivated to develop a new “modified gamma” distribution by two reasons. First we recognise that replacements have two fundamentally different drivers – those forced by failure and early, discretionary replacements. The replacement distribution for each of these drivers is expected to be quite different. Second, we observed a poor fit of other distributions to out empirical data. We conducted a survey of 8,077 households to empirically examine models of replacement sales for six electronic consumer durables – TVs, VCRs, DVD players, digital cameras, personal and notebook computers. This data allows us to construct individual-level “life-tables” for replacement ages. We demonstrate the new modified gamma model fits the empirical data better than existing models for all six products using both a primary and a hold-out sample.

Constructability implementation among Malaysian building contractors

The basic researches about constructability issue done in different countries demonstrate the potential power of this concept to affect the total goals of the construction projects which can lead to significant cost saving, time saving and better quality via considering the contractors’ construction experience in earlier construction project phases. The present research assesses the familiarity of Malaysian building contractors with constructability concept and activities; then it tests their general opinions on its implementation in different construction phases and projects. As the result, some descriptive studies are done on amount of contractors’ familiarity with this term among various kinds of contractors, projects and contracts which can illustrate constructability implementation level among Malaysian contractors. The results of this study show that Malaysian contractors are not all familiar enough with this term and there are still some barriers that prevent them from taking part in its activities completely. The differences in amount of familiarity with constructability matter and its terms of implementation are quite obvious among various types of participants.

Computed success rates of various carrier phase integer estimation solutions and their comparison with statistical success rates

The success rate of carrier phase ambiguity resolution (AR) is the probability that the ambiguities are successfully fixed to their correct integer values. In existing works, an exact success rate formula for integer bootstrapping estimator has been used as a sharp lower bound for the integer least squares (ILS) success rate. Rigorous computation of success rate for the more general ILS solutions has been considered difficult, because of complexity of the ILS ambiguity pull-in region and computational load of the integration of the multivariate probability density function. Contributions of this work are twofold. First, the pull-in region mathematically expressed as the vertices of a polyhedron is represented by a multi-dimensional grid, at which the cumulative probability can be integrated with the multivariate normal cumulative density function (mvncdf) available in Matlab. The bivariate case is studied where the pull-region is usually defined as a hexagon and the probability is easily obtained using mvncdf at all the grid points within the convex polygon. Second, the paper compares the computed integer rounding and integer bootstrapping success rates, lower and upper bounds of the ILS success rates to the actual ILS AR success rates obtained from a 24 h GPS data set for a 21 km baseline. The results demonstrate that the upper bound probability of the ILS AR probability given in the existing literatures agrees with the actual ILS success rate well, although the success rate computed with integer bootstrapping method is a quite sharp approximation to the actual ILS success rate. The results also show that variations or uncertainty of the unit–weight variance estimates from epoch to epoch will affect the computed success rates from different methods significantly, thus deserving more attentions in order to obtain useful success probability predictions.

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.

Luxury fashion: The role of innovation as a key contributing factor in the development of luxury fashion goods and sustainable fashion design

Luxury is a quality that is difficult to define as the historical concept of luxury appears to be both dynamic and culturally specific. The everyday definition explains a ‘luxury’ in relation to a necessity: a luxury (product or service) is defined as something that consumers want rather than need. However, the growth of global markets has seen a boom in what are now referred to as ‘luxury brands’. This branding of products as luxury has resulted in a change in the way consumers understand luxury goods and services. In their attempts to characterize a luxury brand, Fionda & Moore in their article “The anatomy of a Luxury Brand” summarize a range of critical conditions that are in addition to product branding “... including product and design attributes of quality, craftsmanship and innovative, creative and unique products” (Fionda & Moore, 2009). For the purposes of discussing fashion design however, quality and craftsmanship are inseparable while creativity and innovation exist under different conditions. The terms ‘creative’ and ‘innovative’ are often used inter-changeably and are connected with most descriptions of the design process, defining ‘design’ and ‘fashion’ in many cases. Christian Marxt and Fredrik Hacklin identify this condition in their paper “Design, product development, innovation: all the same in the end?”(Marxt & Hacklin, 2005) and suggest that design communities should be aware that the distinction between these terms, whilst once quite definitive, is becoming narrow to a point where they will mean the same thing. In relation to theory building in the discipline this could pose significant problems. Brett Richards (2003) identifies innovation as different from creativity in that innovation aims to transform and implement rather than simply explore and invent. Considering this distinction, in particular relation to luxury branding, may affect the way in which design can contribute to a change in the way luxury fashion goods might be perceived in a polarised fashion market, namely suggesting that ‘luxury’ is what consumers need rather than the ‘pile it high, sell it cheap’ fashion that the current market dynamic would indicate they want. This paper attempts to explore the role of innovation as a key contributing factor in luxury concepts, in particular the relationship between innovation and creativity, the conditions which enable innovation, the role of craftsmanship in innovation and design innovation in relation to luxury fashion products. An argument is presented that technological innovation can be demonstrated as a common factor in the development of luxury fashion product and that the connection between designer and maker will play an important role in the development of luxury fashion goods for a sustainable fashion industry.

Technical report : acoustic analysis of the natural environment

This technical report is concerned with one aspect of environmental monitoring—the detection and analysis of acoustic events in sound recordings of the environment. Sound recordings offer ecologists the advantage of cheaper and increased sampling but make available so much data that automated analysis becomes essential. The report describes a number of tools for automated analysis of recordings, including noise removal from spectrograms, acoustic event detection, event pattern recognition, spectral peak tracking, syntactic pattern recognition applied to call syllables, and oscillation detection. These algorithms are applied to a number of animal call recognition tasks, chosen because they illustrate quite different modes of analysis: (1) the detection of diffuse events caused by wind and rain, which are frequent contaminants of recordings of the terrestrial environment; (2) the detection of bird and calls; and (3) the preparation of acoustic maps for whole ecosystem analysis. This last task utilises the temporal distribution of events over a daily, monthly or yearly cycle.

New media pathways : navigating the links between home, school and the workplace

The terms ‘literacy’ and ‘technology’ remain highly contentious within the field of education. What is meant by ‘literacy’ and the methods used to measure it vary quite markedly in educational and historical contexts across the world. Similarly, while there is a shared concern to research the potential impact of new information and communication technologies (ICTs) on patterns of teaching and learning, there are major discrepancies about which aspects and uses of these technologies should be incorporated into formal learning environments and how this can be accomplished. While government policy makers tend to regard ICTs in relation to ideas of ‘smartness’, efficiency, and the ‘knowledge’ (or ‘new’) economy, educators and educational researchers promote them as offering new tools for learning and critical thinking and the development of new literacies and socio-cultural identities. This clearly has ramifications for the ways literacy is taught and conceptualised throughout the years of schooling, K-12. Outside school, meanwhile, students engage with ICTs on another level entirely, as tools for the maintenance of social networks, for leisure, and for learning and participating in the cultures of their peers. Whatever the differences in perspective, it remains the case that a society’s dominant understandings about literacy and technology will have significant implications for the development of school curriculum.

Trans digital storytelling : everyday activism, mutable identity and the problem of visibility

Mainstream representations of trans people typically run the gamut from victim to mentally ill and are almost always articulated by non-trans voices. The era of user-generated digital content and participatory culture has heralded unprecedented opportunities for trans people who wish to speak their own stories in public spaces. Digital Storytelling, as an easy accessible autobiographic audio-visual form, offers scope to play with multi-dimensional and ambiguous representations of identity that contest mainstream assumptions of what it is to be ‘male’ or ‘female’. Also, unlike mainstream media forms, online and viral distribution of Digital Stories offer potential to reach a wide range of audiences, which is appealing to activist oriented storytellers who wish to confront social prejudices. However, with these newfound possibilities come concerns regarding visibility and privacy, especially for storytellers who are all too aware of the risks of being ‘out’ as trans. This paper explores these issues from the perspective of three trans storytellers, with reference to the Digital Stories they have created and shared online and on DVD. These examplars are contextualised with some popular and scholarly perspectives on trans representation, in particular embodied and performed identity. It is contended that trans Digital Stories, while appearing in some ways to be quite conventional, actually challenge common notions of gender identity in ways that are both radical and transformative.

Working time alterations within the Australian construction industry

Purpose: The purpose of this paper is to provide a labour process theory interpretation of four case studies within the Australian construction industry. In each case study a working time intervention (a shift to a five-day working week from the industry standard six days) was implemented as an attempt to improve the work-life balance of employees. ----- ----- Design/methodology/approach: This paper was based on four case studies with mixed methods. Each case study has a variety of data collection methods which include questionnaires, short and long interviews, and focus groups. ----- ----- Findings: It was found that the complex mix of wage- and salary-earning staff within the construction industry, along with labour market pressures, means that changing to a five-day working week is quite a radical notion within the industry. However, there are some organisations willing to explore opportunities for change with mixed experiences. ----- ----- Practical implications: The practical implications of this research include understanding the complexity within the Australian construction industry, based around hours of work and pay systems. Decision-makers within the construction industry must recognize a range of competing pressures that mean that “preferred” managerial styles might not be appropriate. ----- ----- Originality/value:– This paper shows that construction firms must take an active approach to reducing the culture of long working hours. This can only be achieved by addressing issues of project timelines and budgets and assuring that take-home pay is not reliant on long hours of overtime.

Developing the Practice of Early Intervention into Youth Homelessness

The Australian government has found that early intervention services related to youth homelessness expanded through the Reconnect program have been found to be quite effective and successful. The main things that a good early intervention practice requires are highlighted.

Online urban information systems

Countless factors affect the inner workings of a city, so in an attempt to gain an understanding of place and making sound decisions, planners need to utilize decision support systems (DSS) or planning support systems (PSS). PSS were originally developed as DSS in academia for experimental purposes, but like many other technologies, they became one of the most innovative technologies in parallel to rapid developments in software engineering as well as developments and advances in networks and hardware. Particularly, in the last decade, the awareness of PSS have been dramatically heightened with the increasing demand for a better, more reliable and furthermore a transparent decision-making process (Klosterman, Siebert, Hoque, Kim, & Parveen, 2003). Urban planning as an act has quite different perspective from the PSS point of view. The unique nature of planning requires that spatial dimension must be considered within the context of PSS. Additionally, the rapid changes in socio-economic structure cannot be easily monitored or controlled without an effective PSS.

The voices of the exegesis

In a recent journal article, Luke Jaaniste and I identified an emergent model of exegesis. From a content analysis of submitted exegeses within a local archive, we identified an approach that is quite different from the traditional thesis, but is also distinct from previously identified forms of exegesis, which Milech and Schilo have described as a ‘context model’ (which assumes the voice of academic objectivity and provides an historical or theoretical context for the creative practice) and a ‘commentary’ model’ (which takes the form of a first person reflection on the challenges, insights and achievements of the practice). The model we identified combines these dichotomous forms and assumes a dual orientation–looking outwards to the established field of research, exemplars and theories, and inwards to the methodologies, processes and outcomes of the practice. We went on to argue that this ‘connective’ exegesis offers clear benefits to the researcher in connecting the practice to an established field while allowing the researcher to demonstrate how the methods have led to outcomes that advance the field in some way. And, while it helps the candidate to articulate objective claims for research innovation, it enables them to retain a voiced, personal relationship with their practice. However, it also poses considerable complexities and challenges in the writing. It requires a reconciliation of multi-perspectival subject positions: the disinterested perspective and academic objectivity of an observer/ethnographer/analyst/theorist at times and the invested perspective of the practitioner/ producer at others. The author must also contend with a range of writing styles, speech genres and voices: from the formal, polemical voice of the theorist to the personal, questioning and sometimes emotive voice of reflexivity. Moreover, the connective exegesis requires the researcher to synthesize various perspectives, subject positions, writing styles, and voices into a unified and coherent text. In this paper I consider strategies for writing a hybrid, connective exegesis. I first ground the discussion on polyvocality and alternate textual structures through reference to recent discussions in philosophy and critical theory, and point to examples of emergent approaches to texts and practices in related fields. I then return to the collection of archived exegeses to investigate the strategies that postgraduate candidates have adopted to resolve the problems that arise from a polyvocal, connective exegesis.

Everything is child abuse

In 2008, the Australian federal Senate held an Inquiry into the Sexualisation of Children in the Contemporary Media Environment. I made a submission to this Inquiry, noting that in public debate about this topic a number of quite distinct issues, with distinct aetiologies, were collapsed together. These included: child pornography; children being targeted by any form of marketing; young people becoming sexually active; sexual abuse of children; raunch culture; protecting children from any sexualised material in the media; and body image disorders. I suggested that commentators had collapsed these issues together because the image of the helpless child is a powerful one for critics to challenge undesirable aspects of contemporary culture. The result of many different ideological viewpoints all using the same argument - that the forms of culture they didn't like were damaging children - gives the impression that there is no element of culture today that isn't (somebody claims) causing harm to children: everything is child abuse. The danger of such discourses is that they draw attention away from the real harm that is being caused to children by sexual and other forms of maltreatment - which overwhelmingly occur within families, and for reasons ignored in these debates.

How to tell the difference between a positive image and a stereotype: reading Priscilla, Queen of the Desert

This paper intervenes in critical discussions about the representation of homosexuality. Rejecting the ‘manifest content’ of films, it turns to cultural history to map those public discourses which close down the ways in which films can be discussed. With relation to The Adventures of Priscilla, Queen of the Desert, it examines discussions of the film in Australian newspapers (both queer and mainstream) and finds that while there is disagreement about the interpretation to be made of the film, the terms within which those interpretations can be made are quite rigid. A matrix based on similarity, difference and value provides a series of positions and a vocabulary (transgression, assimilation, positive images and stereotypes) through which to make sense of this film. The article suggests that this matrix, and the idea that similarity and difference provide a suitable axis for making sense of homosexual identity, are problematic in discussing homosexual representation.