Framework for implementing design build project delivery system in road infrastructure in Indonesia

The thesis provides a framework for potential implementation of the design-build (DB) project delivery system in road infrastructure projects in Indonesia. This framework proposed a structure of the hierarchy of factors promoting the potential implementation of the DB project delivery system and introduced ways to implement the DB project delivery system through level of hierarchical factors. These findings not only give benefit to the academic knowledge but also to the public officials in guiding them with regard to the priority of promoting factors in the process to implement the DB system.

Composites for delivery of therapeutics : combining melt electrospun scaffolds with loaded electrosprayed microparticles

A novel strategy is reported to produce biodegradable microfiber-scaffolds layered with high densities of microparticles encapsulating a model protein. Direct electrospraying on highly porous melt electrospun scaffolds provides a reproducible scaffold coating throughout the entire architecture. The burst release of protein is significantly reduced due to the immobilization of microparticles on the surface of the scaffold and release mechanisms are dependent on protein-polymer interactions. The composite scaffolds have a positive biological effect in contact with precursor osteoblast cells up to 18 days in culture. The scaffold design achieved with the techniques presented here endorses these new composite scaffolds as promising templates for growth factor delivery.

Shifting from asset dominant to service centric delivery systems: engaging users and communities

Research and practice has observed a shift toward service-oriented approaches that depend on input from users and community as co-producers of services. Yet, in delivering public infrastructure the focus is still on assets rather than services. The contribution of external stakeholders in the co-production of public services is still limited. Using the Policy Delphi with a panel of experts, we found that although practitioners understand the need for asset management to follow the service approach, guidelines and policies still lack that service-centric perspective. Findings revealed a range of obstacles to effective service delivery, related to the sub-optimal involvement of stakeholders’, asymmetric levels of power, the lack of accountability, transparency and availability of government, and the lack of genuine consultations between government and stakeholder groups. The paper concludes by offering directions and strategies for asset managers and policymakers to support and reconnect disengaged government-citizen relations for optimal service delivery outcomes in asset management.

Emergency Health Services (EHS) : demand and service delivery models. monograph 3 : patients’ reasons and perceptions

Executive Summary Emergency health is a critical component of Australia’s health system and emergency departments (EDs) are increasingly congested from growing demand and blocked access to inpatient beds. The Emergency Health Services Queensland (EHSQ) study aims to identify the factors driving increased demand for emergency health and to evaluate strategies which may safely reduce the future demand growth. This monograph addresses the perspectives of users of both ambulance services and EDs. The research reported here aimed to identify the perspectives of users of emergency health services, both ambulance services and public hospital Emergency Departments and to identify the factors that they took into consideration when exercising their choice of location for acute health care. A cross-sectional survey design was used involving a survey of patients or their carers presenting to the EDs of a stratified sample of eight hospitals. A specific purpose questionnaire was developed based on a novel theoretical model which had been derived from analysis of the literature (Monograph 1). Two survey versions were developed: one for adult patients (self-complete); and one for children (to be completed by parents/guardians). The questionnaires measured perceptions of social support, health status, illness severity, self-efficacy; beliefs and attitudes towards ED and ambulance services; reasons for using these services, and actions taken prior to the service request. The survey was conducted at a stratified sample of eight hospitals representing major cities (four), inner regional (two) and outer regional and remote (two). Due to practical limitations, data were collected for ambulance and ED users within hospital EDs, while patients were waiting for or under treatment. A sample size quota was determined for each ED based on their 2009/10 presentation volumes. The data collection was conducted by four members of the research team and a group of eight interviewers between March and May 2011 (corresponding to autumn season). Of the total of 1608 patients in all eight emergency departments the interviewers were able to approach 1361 (85%) patients and seek their consent to participate in the study. In total, 911 valid surveys were available for analysis (response rate= 67%). These studies demonstrate that patients elected to attend hospital EDs in a considered fashion after weighing up alternatives and there is no evidence of deliberate or ill-informed misuse. • Patients attending ED have high levels of social support and self-efficacy that speak to the considered and purposeful nature of the exercise of choice. • About one third of patients have new conditions while two thirds have chronic illnesses • More than half the attendees (53.1%) had consulted a healthcare professional prior to making the decision. • The decision to seek urgent care at an ED was mostly constructed around the patient’s perception of the urgency and severity of their illness, reinforced by a strong perception that the hospital ED was the correct location for them (better specialised staff, better care for my condition, other options not as suitable). • 33% of the respondent held private hospital insurance but nevertheless attended a public hospital ED. Similarly patients exercised considered and rational judgements in their choice to seek help from the ambulance service. • The decision to call for ambulance assistance was based on a strong perception about the severity of the illness (too severe to use other means of transport) and that other options were not considered appropriate. • The decision also appeared influenced by a perception that the ambulance provided appropriate access to the ED which was considered most appropriate for their particular condition (too severe to go elsewhere, all facilities in one spot, better specialised and better care). • In 43.8% of cases a health care professional advised use of the ambulance. • Only a small number of people perceived that ambulance should be freely available regardless of severity or appropriateness. These findings confirm a growing understanding that the choice of professional emergency health care services is not made lightly but rather made by reasonable people exercising a judgement which is influenced by public awareness of the risks of acute health and which is most often informed by health professionals. It is also made on the basis of a rational weighing up of alternatives and a deliberate and considered choice to seek assistance from a service which the patient perceived was most appropriate to their needs at that time. These findings add weight to dispensing with public perceptions that ED and ambulance congestion is a result of inappropriate choice by patients. The challenge for health services is to better understand the patient’s needs and to design and validate services that meet those needs. The failure of our health system to do so should not be grounds for blaming the patient, claiming inappropriate patient choices.

Commentary on Nutrition and older Indigenous Australians : service delivery implications in remote communities. A narrative review

Indigenous Australians are the most socially and economically disadvantaged population group in Australia and have the poorest health status. The statistics describe and highlight the degree of sicknesses and disadvantage along with lower life expectancy, elevated mortality rate and increased risk of cardiovascular disease, cancer, diabetes, respiratory disease and kidney disease. While these statistics reflect poor health status and a high level of illness within Indigenous communities, it is known that individual, family and community behaviours play a key role in Indigenous health and wellbeing outcomes. These behavioural issues include use of tobacco, alcohol and other substances along with lack of physical activity and poor nutrition. The paper Nutrition and older Indigenous Australians: Service delivery implications in remote communities. A narrative view explores some of the issues specific to nutrition. Bronwyn Fredericks was invited to provide this commentary by the Editor of the Australasian Journal on Aging.

A novel method using intranasal delivery of EdU demonstrates that accessory olfactory ensheathing cells respond to injury by proliferation

Olfactory ensheathing cells (OECs) play an important role in the continuous regeneration of the primary olfactory nervous system throughout life and for regeneration of olfactory neurons after injury. While it is known that several individual OEC subpopulations with distinct properties exist in different anatomical locations, it remains unclear how these different subpopulations respond to a major injury. We have examined the proliferation of OECs from one distinct location, the peripheral accessory olfactory nervous system, following large-scale injury (bulbectomy) in mice. We used crosses of two transgenic reporter mouse lines, S100ß-DsRed and OMP-ZsGreen, to visualise OECs, and main/accessory olfactory neurons, respectively. We surgically removed one olfactory bulb including the accessory olfactory bulb to induce degeneration, and found that accessory OECs in the nerve bundles that terminate in the accessory olfactory bulb responded by increased proliferation with a peak occurring 2 days after the injury. To label proliferating cells we used the thymidine analogue ethynyl deoxyuridine (EdU) using intranasal delivery instead of intraperitoneal injection. We compared and quantified the number of proliferating cells at different regions at one and four days after EdU labelling by the two different methods and found that intranasal delivery method was as effective as intrapeitoneal injection. We demonstrated that accessory OECs actively respond to widespread degeneration of accessory olfactory axons by proliferating. These results have important implications for selecting the source of OECs for neural regeneration therapies and show that intranasal delivery of EdU is an efficient and reliable method for assessing proliferation of olfactory glia.

Satisfaction survey for a medication management program : satisfaction guaranteed?

BACKGROUND Providing clinical pharmacy services to patients in their homes after discharge from hospital has been reported to reduce health care costs and improve outcomes. The Medication Management Program of the Fraser Health Authority involves pharmacists making home visits to provide clinical pharmacy services to elderly patients who have recently been discharged from hospital and others considered to be at high risk for adverse drug events. Although clinical and economic outcomes of this program have been evaluated, humanistic outcomes such as satisfaction have not been assessed. Moreover, very little evaluation of patient satisfaction with home pharmacy services has been reported in the literature. OBJECTIVE To evaluate patient satisfaction with the Medication Management Program. METHODS A telephone survey instrument, consisting of 7 Likert-scale items and 2 open-ended questions, was developed and administered to patients who received a home pharmacist visit between September 1 and November 23, 2011. In addition to the survey responses, demographic and clinical data for both respondents and nonrespondents were collected. RESULTS Of the 175 patients invited to participate in the survey, 103 (58.9%) agreed to participate. The majority of respondents agreed or strongly agreed with all of the survey items, indicating satisfaction with the program. For example, 97 (94%) agreed or strongly agreed that they would recommend the pharmacist home visit program continue to be available, and all 103 (100%) agreed or strongly agreed that they were satisfied with the pharmacist home visit. Respondents provided some suggestions for program improvement. CONCLUSIONS The survey findings demonstrate that patients were satisfied with the home clinical pharmacy services offered through the Fraser Health Medication Management Program.

Primary schools and the delivery of relationships and sexuality education : the experience of Queensland teachers

Primary school provides an appropriate opportunity for children to commence comprehensive relationships and sexuality education (RSE), yet many primary school teachers avoid teaching this subject area. In the absence of teacher confidence and competence, schools have often relied on health promotion professionals, external agencies and/or one-off issue related presentations rather than cohesive, systematic and meaningful health education. This study examines the implementation of a ten-lesson pilot RSE unit of work and accompanying assessment task in two primary schools in South-East Queensland, Australia. Drawing predominantly from qualitative data, this research explores the experiences of primary school teachers as they engage with RSE curriculum resources and content delivery. The results show that the provision of a high quality RSE curriculum resource grounded in contemporary educational principles and practices enables teachers to feel more confident to deliver RSE and minimises potential barriers such as parental objections and fear of mishandling sensitive content.

Research roadmap summary - Integrated Design and Delivery Solutions (IDDS)

Changes in the construction sector are creating opportunities in research to maximise the benefits of those changes and to continue the exciting developments in improved people skills, new processes and developing technologies. Many research centres around the world are investigating aspects of the current changes to drive their particular expertise forward. However, the CIB Integrated Design and Delivery Solutions (IDDS) priority research theme takes a higher-level view of the changes and then focuses down on a prioritised set of research targets. These targets have been investigated, re-focussed and validated over a period of four years through many workshops, conferences and meetings by a wide ranging group of representatives from approximately 90 industry and research organisations. The outcomes of such research, once put into practice should be significantly shortened timespans from conception of need to occupation of new or revised structures. As time is money, the owners will get their investments into productive use sooner, which means a shorter payback time. In addition, there will inevitably be a reduction in construction costs as productivity increases. The improvements in reliable delivery and improved quality currently being seen in relatively simplistic use of Building information Modelling (BIM) (compared to full IDDS) will inevitably continue its on-going trajectory of improvement. We should also consider the wider economic contribution to society that will stem from such improvements and, finally, and by no means unimportantly, the reliable modelling and delivery of sustainability at both the building and estate/ area scale will significantly improve carbon footprints and other sustainable outcomes. Whilst there are huge opportunities for early adopters, the primary risk will be the expansion of the gap between those working in this way and those who are not so advanced or who even refuse to progress . The opportunities to address the significant and widely varying wastes within the structure of the construction sector and within and across projects are huge and timely and industry is encouraged to become involved.

Integrated design and delivery solutions

Integrated design and delivery solutions (IDDS) is a priority theme of the International Council for Research and Innovation in Building and Construction (CIB), which will be used to drive the global research agenda forward. IDDS will use collaborative work processes and enhanced skills together with integrated data, information and knowledge management to minimize structural and process inefficiencies and to enhance the value delivered during design, build, operation, and across projects. IDDS build on building information modelling (BIM), incorporating advances in the training and employment of people, together with supporting new technologies. The successful use of IDDS involves changes in each of the project phases from conceptual planning and business case formulation to all stages of the supply chain: design, construction, commissioning, operation, retrofit and decommissioning. For each of these phases, key changes in the structure and culture of the project team across the different collaborating firms create a favourable context for IDDS. Special for IDDS thinking is the idea of adding project and whole-life value in all phases, for all stakeholders...

Challenges for integrated design and delivery solutions

A new approach of integrated design and delivery solutions (IDDS) aims to radically improve the performance of the construction industries. IDDS builds upon recent trends in the construction industries that have seen the widespread adoption of technologies such as building information modelling (BIM) and innovative processes such as integrated project delivery. However, these innovations are seen to develop in isolation, with little consideration of the overarching interactions between people, process and technology. The IDDS approach is holistic in that it recognizes that it is only through a combination of initiatives such as skill development, process re-engineering, responsive information technology, enhanced interoperability and integrating knowledge management, among others, that radical change can be achieved. To implement IDDS requires step changes in many project aspects, and this gap between current performance and that required for IDDS is highlighted. The research required to bridge the gaps is identified in four major aspects of collaborative processes, workforce skills, integrated information and knowledge management.

CIB White Paper on IDDS Integrated Design & Delivery Solutions

CIB is developing a priority theme, now termed Improving Construction and Use through Integrated Design & Delivery Solutions (IDDS). The IDDS working group for this theme adopted the following definition: Integrated Design and Delivery Solutions use collaborative work processes and enhanced skills, with integrated data, information, and knowledge management to minimize structural and process inefficiencies and to enhance the value delivered during design, build, and operation, and across projects. The design, construction, and commissioning sectors have been repeatedly analysed as inefficient and may or may not be quite as bad as portrayed; however, there is unquestionably significant scope for IDDS to improve the delivery of value to clients, stakeholders (including occupants), and society in general, simultaneously driving down cost and time to deliver operational constructed facilities. Although various initiatives developed from computer‐aided design and manufacturing technologies, lean construction, modularization, prefabrication and integrated project delivery are currently being adopted by some sectors and specialisations in construction; IDDS provides the vision for a more holistic future transformation. Successful use of IDDS requires improvements in work processes, technology, and people’s capabilities to span the entire construction lifecycle from conception through design, construction, commissioning, operation, refurbishment/ retrofit and recycling, and considering the building’s interaction with its environment. This vision extends beyond new buildings to encompass modifications and upgrades, particularly those aimed at improved local and area sustainability goals. IDDS will facilitate greater flexibility of design options, work packaging strategies and collaboration with suppliers and trades, which will be essential to meet evolving sustainability targets. As knowledge capture and reuse become prevalent, IDDS best practice should become the norm, rather than the exception.

Research roadmap report : Integrated Design and Delivery Solutions (IDDS)

Changes in the construction sector are creating opportunities in research to maximise the benefits of those changes and to continue the exciting developments in improved people skills, new processes and developing technologies. There are many research centres around the world investigating aspects of the current changes to drive their particular expertise forward. However, the CIB Integrated Design and Delivery Solutions (IDDS) priority research theme takes a higher-level view of the changes and then focuses down on a prioritised set of research targets. These targets have been investigated, re-focussed and validated over a period of four years through many workshops, conferences and meetings by a wide ranging group of representatives from approximately 90 industry and research organisations. This roadmap prioritises and details the research to be performed, why and by whom. In particular, some 25 CIB Working Commissions and Task Groups are explained as having potential roles in the delivery of this research theme. We are extremely privileged to have been urged on by such distinguished construction professionals in their forewords and the case for research. The outcomes of such research, once put into practice should be significantly shortened timespans from conception of need to occupation of new or revised structures. As time is money, the owners will get their investments into productive use sooner, which means a shorter payback time. In addition, there will inevitably be a reduction in construction costs as productivity increases. The improvements in reliable delivery and improved quality currently being seen in relatively simplistic use of Building information Modelling (BIM) (compared to full IDDS) will inevitably continue its on-going trajectory of improvement. We should also consider the wider economic contribution to society that will stem from such improvements and, finally, and by no means unimportantly, the reliable modelling and delivery of sustainability at both the building and estate/ area scale will significantly improve carbon footprints and other sustainable outcomes. Whilst there are huge opportunities for early adopters, the primary risk will be the expansion of the gap between those working in this way and those who are not so advanced or who even refuse to progress1. However, a similar issue arises between industry, clients, educators and trainers; the latter have particular challenges, having existed for many years in a sector that has had relatively few technological changes. However, the opportunities to address the significant and widely varying wastes within the structure of the construction sector and within and across projects are huge and timely. Whilst this Roadmap is specifically targeted at the Standing Commissions and Task Groups of the CIB, it is hoped that there are elements for research and applied research across academia and industry.